Trauma, PTSD, and Panic Disorder

panicked, sweaty man
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PTSD and panic disorder commonly co-occur. This may not be surprising given that people who have experienced a traumatic event or have PTSD are at a heightened risk to develop a number of other psychiatic disorders, such as depression, substance use disorders, or other anxiety disorders. One anxiety disorder that is commonly found among people with a history of traumatic exposure or PTSD is panic disorder.

What is Panic Disorder?

To have a diagnosis of panic disorder, you need to meet the following criteria as described by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

First, you need to have experienced a panic attack. Most people know whether or not they have experienced a panic attack. It can be an incredibly frightening experience. The DSM-IV describes a panic attack as the experience of intense fear or discomfort where four or more of the following things are felt:

  • pounding heart or increased heart rate
  • sweating
  • trembling or shaking
  • feeling as though you are being smothered or having difficulties breathing
  • choking
  • chest pain or discomfort
  • nausea or adbominal pains and/or discomfort
  • feeling dizzy, lightheaded, or faint
  • feeling as though things around you are unreal or feeling detached from yourself
  • feeling as though you are going to lose control or go crazy
  • fear of dying
  • numbness or tingling in extremities
  • chills or hot flashes

In addition, to have a diagnosis of panic disorder, you must have experienced recurrent, unexpected panic attacks. These are panic attacks that just pop up "out of the blue." For example, a person may be in their car and all of a sudden they experience a sudden rush of fear and terror (a panic attack).

At least one of the attacks must also be followed by one month or more of one or more of the following experiences:

  • Concern about having additional panic attacks
  • Worry about the consequences or implications of a panic attack. For example, a person may think to themselves during a panic attack that they are having a heart attack and are going to die.
  • A change in behavior because of the attacks. For example, a person may avoid certain places where a panic attack has occurred.

Finally, it is important to mention that someone can experience panic attacks and not have panic disorder. Panic attacks are actually quite common. In fact, as many as 12% of people may experience a panic attack at some point in their lifetime.

Trauma, PTSD, and Panic Disorder

Approximately 5% of people will develop panic disorder at some point in their lifetime. However, these rates may be higher among people who have experienced a traumatic event. A large number of people who have experienced a traumatic event report that they had a panic attack following the event.

In addition, approximately 30% of people who have experienced a traumatic event also report experiencing unexpected panic attacks.

In particular, one study found high rates of childhood sexual abuse (41%) and physical abuse (59%) among women with panic disorder. Another study found high rates of sexual molestation (24% for women and 5% for men) and physical abuse as a child (around 14% for both men and women) among people with panic disorder. Women with panic disorder have also been found to report high rates of rape (23%).

Besides simply traumatic exposure, panic disorder also commonly co-occurs with PTSD. Specifically, around 7% of men and 13% of women with PTSD also have panic disorder.

Treatment

Fortunately, there are effective treatments available for both panic disorder and PTSD. The About.com guide for panic disorder provides a wealth of information on treatment options for people with panic disorder, as well as a number of helpful tips on how to cope with panic attacks.

In addition, there are a number of options available for people seeking treatment for PTSD. Some of the symptoms of PTSD may place a person at risk for panic attacks, especially the hyperarousal symptoms. In addition, the physical health problems and unhealthy behaviors (for example, smoking and substance use) that often associated with PTSD may increase the likelihood that panic attacks are experienced. By treating a person's PTSD, then, the risk for the experience of panic attacks may be lessened.

You can find a list of PTSD and panic disorder treatment providers in your area at the website for the Anxiety Disorder Association of America (ADAA).

Sources:
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Eaton, W.W., Kessler, R.C., Wittchen, H.U., & Magee, W.J. (1994). Panic and panic disorder in the United States. American Journal of Psychiatry, 151, 413-420.

Falsetti, S.A., & Resnick, H.S. (1997). Frequency and severity of panic attack symptoms in a treatment seeking sample of trauma victims. Journal of Traumatic Stress, 4, 683-689.

Kessler, R.C., Berglund, P., Demler, O., Jin, R., & Walters, E.E. (2005). Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

Leskin, G.A., & Sheikh, J.I. (2002). Lifetime trauma history and panic disorder: Findings from the National Comorbidity Survey. Journal of Anxiety Disorders, 16, 599-603.

Nixon, R.D.V., Resick, P.A., & Griffen, M.G. (2004). Panic following trauma: The etiology of acute posttraumatic arousal. Journal of Anxiety Disorders, 18, 193-210.

Sheikh, J.I., Swales, P.J., Kravitz, J., Bail, G., & Taylor, C.B. (1994). Childhood abuse history in older women with panic disorder. American Journal of Geriatric Psychiatry, 2, 75-77.

Telch, M. J., Lucas, J. A., & Nelson, P. (1989). Nonclinical panic in college students: An investigation of prevalence and symptomatology. Journal of Abnormal Psychology, 98, 300-306.

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