About ten years ago, when I was still a little boy, my aunt Tina was diagnosed with panic disorder. I heard that word very often during my family gatherings, when my family members were talking about my aunt's condition and everyone was worried about her. At that time, I was still too young to understand what was really wrong, or what all those big words meant. But, I often heard the word therapy and medication in reference to my aunt. Everybody looked very worried when her condition was discussed. Now that I am ten years older and taking a psychology course, I often think back and wonder what experience means in the professional world. In the frame of this current writing assignment I want to take the time out to find out what actually happened to my aunt and what she really experienced at this time. In order to fulfil this assignment, I will present findings from literature on panic disorder, and some of the experiences that my aunt shared with me in a recent conversation, in order to make make comparisons between literature and the actual experience that my aunt had. In Summery, it appears that panic disorder is characterized by an experience of unable terror that can impair peoples life on many levels and can also cause additional problems such as other anxiety problems and even depression.
During the conversations with my aunt, I asked her how she experienced her condition. She said "It started out as one panic attack and then it increased.". When I asked her how those attacks felt to her, she was not really able to describe them in detail. In fact, it was very hard for her to describe what had happened to her, altogether. However, she said " it's a totally experience of terror that I never felt before or after that. You have a lot of fear, and you have no idea from what, or where it's coming from". She remembered :"sometimes, it felt like something was suffocating me. My heart was racing and I was scared, because I did not know what was happening I thought I had a heart attack and I was afraid that I would die".
Actually, my aunt encountered many of the symptoms for panic disorder such as, "episodes of intense fear dyspnea (shortness in breath), losing control, shaking, and chills (Glass, 2003 pp. 283). These are some of a few of the 13 symptoms that describe a panic attack in DSM-IV-TR (2003, pp. 432). She also recalled that "... the worst part is that you have no idea when this will happen again, and it can happen at any time" This is similar to how literature describes the symptoms for panic disorder, which starts with an initial panic attack that is followed by more attacks. According to Sue, Sue and Sue (2003, pp131) "panic attacks can last between a few minutes and several hours, and create an anxiety that seems to be worse than in other anxiety disorders. I also looked through the DSM-IV-TR, where the diagnosis of panic disorder includes "recurrent unexpected attacks for at least one month of apprehension over having another attack or worrying about having a panic attack" (DSM IV-TR, pp 433).
My aunt actually validated that by telling me that "My panic attacks were irrational they showed up at any time: "One time I was, walking, ... it was a beautiful day and I could actually feel the panic attack coming up. But, I was completely helpless in that situation. From then on, I was always worried about having another attack especially in public and feeling so helpless among all of those strange people. I was afraid that they would think I was crazy ".
Eventually she stopped leaving her home, because of that. As a result, she dropped out of college, became unemployed, and had no social life. The fear of leaving the home and going into public was so intense that it became a disorder in itself: agoraphobia (the fear to go into public). The sadness she experienced by not being able to go into public and take care of her usual activities made her feel lonely, and she became depressed. According to Sue, Sue and Sue, agoraphobia (the fear to go into public spaces) and depression are typical comorbidities, in panic disorder. Comorbidity means that someone who has a disorder or disease develops another disorder as result of the initial illness (2003, pp.131). In the case of my aunt, the comorbid effect are quite clear. S She suffered from anxiety because she would often go through episodes of intense fear of having these attacks at anytime. Her panic attacks in public were very embarrassing for her. She tried to avoid such embarrassment, by staying at home, to make sure that she's safe from the looks of strangers if the next panic attack comes up. Because of that behavior (agoraphobia), she could not go to school or work anymore, and that made her drop out of everything. The resulting feeling of being a failure made her very sad, and not being able to be among people made her very lonely and depressed. This was another comorbid effect that she suffered.
It seems that my aunt is not alone with this problem. The lifetime prevalence rate (which means the amount of people who have the disease in a lifetime currently) for panic disorder is approximately 3.5 percent, and two times more common in woman (Kessler et a., 1994; National Institute of mental Health [NIHM] 1999). In a major survey on panic disorder that was done on the World Wide Web, more women (83.5 percent) than men (76.4 percent) reported spontaneous panic attacks (Stones and Perry, 1997, pp. 6). After proper treatment, woman are more likely than men to suffer a recurrence of the disorder (1997, pp. 6).
While interviewing my aunt Tina, I wondered if someone else in my ancestry could have had this disorder in the past. So, I did some research on the matter and I was surprised to find out the estimate for inheritabillity for agoraphobia and panic disorder due to genetic factors is 35% (Kendler, Neale, Kessler, Heath and Eaves, 1992, p.49). this means that in over a third of all people with this disorder, the illness runs in the family. This statistic showed me that there is a mediocre chance that I or my children will develop this disorder.
In the process of interviewing my aunt Tina, I wondered how did she recover from all of this pain and melancholy. So, I asked her what she did to treat her panic disorder? She replied saying "I used both of the approaches. One was biomedical which means through medicine and another which used psychotherapy (Psychotherapeutic)."
The Biomedical treatments have an efficacy rate of 75% in clinical trial (American Psychiatric Association, 1998). Benzodiapines, which is a Valium, reduces anxiety and muscle tensions (Gould, Otto, et al., 1997S; Taylor, 1995). The most recommenced drugs for panic disorders are the SSRI's (Selective Serotonin Reuptake Inhibitors) which are antidepressants, such as Paxil, Prozac and Zoloft. The side affects for these antidepressant include possible weight loss and sexual dysfunction (Gorman, 2001, pp. 3). While someone like my aunt is using these drugs it takes approximately four to eight weeks for these medications to work completely. It is noted that some patients may initially have more panic attacks during the first few weeks (American Psychiatric Association, 1998). Relapse rates after cessation appear to be quite high, at 76 percent after the treatment of imipramine or alprozalam (Katschnig & Amering, 1994, pp. 15 ), for example.
Since medication alone does not solve the problem (unless someone wants to stay on medication forever), my aunt also received cognitive behavioral therapy, from a psychiatrist (Barlow, Gorman, Shear & Woods 2000, pp, 285; Otto Polack and Sabatino, 1996,pp. 27), as well as group therapy with a psychiatrist, where she met may others with similar experiences (Peneva, Otto, Maki and Polack, 1998,pp. 36. Those treatments together were successful. The steps toward taking this type of "medicine" includes
1. Educating the client about panic disorder and symptoms
2. Training the client in muscle-relaxation techniques
3. Performing system-induction tasks (such as voluntary hyperventilation or breathing
Through a straw, to reduce alarm about bodily sensations.
4. Helping the client identify and change unrealistic thoughts- for example, the therapist might comment, "Maybe you are attributing danger to what is going on in your body," or " A panic attack will not stop your breathing.".
5. Encouraging the client to face the systems both within the session and in the outside world, using such statements as, "Allow your body to have it's reactions and let the reactions pass."
6. Providing coping statements: "This feeling is not pleasant, but I can handle it.
7. Teaching the client to identify the antecedents of the panic: "What stresses are you under?' 8. Helping the client to learn to use coping strategies, such as relaxation and cognitive restructuring (inter prating events more positively), to handle stress.
(American Psychiatric Association)
Finally, I have a better understanding of what my aunt went through, back then. Panic disorder was a very frightening illness, and can bring about many other disorders and problems. fortunately, my aunt was able to profit from the treatments that are out there to treat panic disorder.

Bibliography
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