Causes of panic attacks|disorder

Agoraphobia and panic disorder encompass a complex intertwined construct of symptoms and causes which often starts before birth.

The first aspect that lays the foundation for agoraphobia and panic disorder is genetic programming or family history. This essentially dictates whether you have anxiety-panic-fear circuits that are prone to become overactive and cause agoraphobia and panic. There is unfortunately nothing to be done other than be aware of this and realize medications can be the most effective tool to battle the inherent neurophysiological dysfunction.

With the foundation planted by genetics, the next determination of whether one will express panic symptoms is early-middle-late childhood experiences such as difficulties, trauma or neglect. Almost invariably people with childhood trauma or patterns of negative events such as loss of a family member, neglect by parents or any other negative event that happened, is swept under the rug because children do not have the ability to deal and process emotions of this severity. Those emotions build up as they are not processed and at some point they “break-through” and are expressed as panic attacks and agoraphobia. While this is often the key to curing panic disorder, it is almost never addressed in therapy. Addressing this period of time in life via psychodynamic therapy is necessary to ensure a relapse free cure for panic disorder and severe agoraphobia.

The last component which often pushes one over the edge if they are on the border of developing panic disorder, is alcohol, sedative or other drug usage. Often times the alcohol and drugs come after the panic has begun which is used as a coping mechanism, albeit the most poor tool and one that only worsens the panic cycle.  Alcohol use specifically (or sedatives like benzodiazepines) actually sensitize your brain circuits to be extremely sensitive to having severe panic and this worsens the cycle as panic comes on easier and more intense, which then increases your fear of the panic.

Many people however experiment with alcohol and drugs before any signs of panic disorder.  Abuse of substances like alcohol can bring out panic attacks by initially sensitizing fear circuits in the brain and this leads to the first panic symptoms which then get conditioned into regular behavior by fearing these panic symptoms. The panic typically reveals itself during periods of withdrawal, both subtle withdrawal (such as the day after heavy drinking and otherwise no withdrawal is noticed) or becoming completely sober after regular drinking for years. Once the circuits are activated and the cycle begins, its very difficult to shut it down by yourself.

One other common precipitate is random panic circumstances that are completely normal such as near car accidents or any fight-or-flight response. These are physiologically and psychologically protective and helpful to activate maximum ability to recognize and avoid harm.  However in those prone or genetically programmed to develop panic, all it takes is one close-call and one normal panic experience to initiate the cycle.

Treatment is equally complex and even more so with severe panic and agoraphobia. CBT, exposure, psychodynamic, relaxation and medication are the necessary components to cure panic disorder and ensure it will never come back.

Michael Yasinski MD