Anxiety Disorder and Panic Attacks may share common Biological and Psychological causes. There are many forms of anxiety. While some are related to stressful events others seem to occur for no apparent reason. However every effect has a cause. In anxiety and panic attacks, the cause may vary from person to person. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why antidepressants and anti-anxiety medications are useful in treating around 40% of cases.

However, recent research evidence implicates abnormal levels of commensal (usually occurring) gut bacteria that can cause the release of high levels of trace amines and toxins, both of which can trigger abnormal neurotransmitter activity in the brain. The underlying causes can be teased out and treated, leading to more effective long-term outcome.

Definition of Anxiety Disorders

Anxiety disorders are probably the most common form of mental disturbance in Australia. The Diagnostic and Statistical Manual of mental Disorders (DSM-IV) defines twelve types of anxiety disorders in the adult population which can be grouped under seven headings. The following is a description of the various anxiety disorders. It is presented here purely for its educational value and is not meant to diagnose or treat any condition. Differential diagnosis and treatment of anxiety disorders requires training, skill and experience. Please call the clinic or see a suitably qualified health professional for diagnosis and treatment.

A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present.

Agoraphobia is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms.

Panic Disorder Without Agoraphobia is characterised by recurrent unexpected Panic Attacks about which there is persistent concern. Panic Disorder With Agoraphobia is characterised by both recurrent unexpected Panic Attacks and Agoraphobia.

Agoraphobia Without History of Panic Disorder is characterised by the presence of Agoraphobia and panic-like symptoms without a history of unexpected Panic Attacks.

Specific Phobia is characterised by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.

Social Phobia is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour.

Obsessive-Compulsive Disorder is characterised by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralise anxiety).

Posttraumatic Stress Disorder is characterised by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma.

Acute Stress Disorder is characterized by symptoms similar to those of Posttraumatic Stress Disorder that occur immediately in the aftermath of an extremely traumatic event.

Generalised Anxiety Disorder is characterised by at least 6 months of persistent and excessive anxiety and worry.

Anxiety Disorder Due to a General Medical Condition is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition.

Substance-Induced Anxiety Disorder is characterised by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure.

Anxiety Disorder Not Otherwise Specified is included for coding disorders with prominent anxiety or phobic avoidance that do not meet criteria for any of the specific Anxiety Disorders defined in this section (or anxiety symptoms about which there is inadequate or contradictory information).

Anxiety disorders in children and adolescents

The DSM-IV defines Separation Anxiety disorder as specific to children. This disorder is defined as anxiety regarding separation from home or family that is excessive or inappropriate for the child's age. In some children, separation anxiety takes the form of school avoidance. Children and adolescents can also be diagnosed with panic disorder, phobias, generalised anxiety disorder, and the post-traumatic stress disorder.

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Overcoming Anxiety and Panic Attacks

What triggers anxiety and panic attacks?

Anxiety is a normal emotion in reaction to danger or to stressful situations perceived as threatening to a person's survival, even though we may not be consciously aware of the threat. Anxiety disorder and panic attacks occur when that normal reaction is exaggerated. Although a stressful event can trigger an anxiety or panic attack, sometimes they seem to occur for no obviously apparent reason. However, it is important to remember that for every effect there is always a cause.

Psychiatry suggests that abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role in anxiety and panic. This theory is supported by evidence that antidepressant and anti-anxiety medications are useful in the treatment of anxiety for some patients. However these "chemical imbalances" are themselves effects of more fundamental causes that are not usually investigated or treated in general psychiatric practice. Anti-depressant medications (SSRIs) work for around 40% of people, while around 30% of people respond just as well to a placebo (harmless sugar pill which they think is medication).

Effectively a panic attack is a warning that something is wrong either in the environment of in the body. The interpretations of the physiological sensations as catastrophic triggers a massive release of adrenaline which exaggerates the sensations and further reinforces the idea that something is very wrong, which of course makes matters even worse

Anyone can have anxiety and panic attacks, but they also tend to run in some families, probably due to shared genetic weaknesses, diet and poor nutrient uptake and abnormal overgrowth of some gut bacteria. Stressful life events can also trigger anxiety and in worse cases panic attacks. In some persons, there may be metabolic dysfunctions that predispose to these brain neurotransmitter imbalances. For example, lack of essential nutrients or intestinal dysbiosis (abnormal levels of gut bacteria). Recent evidence implicates abnormal levels of commensal (usually occurring) gut bacteria that can cause the release of high levels of trace amines and toxins into the blood stream. These Amines and Toxins can trigger neurotransmitter sites in the brain to malfunction causing feelings of excessive tiredness, depression, anxiety and/or panic attacks.

Scientists at the Psychiatric department of Mt Sinai Hospital in New York examined hundreds of studies in the scientific literature and found that up to 90% of people with Irritable Bowel Syndrome had a psychiatric disorder, anxiety and depression being the most common. These possible triggers should be investigated and treated.

The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms mainly occur because of an 'overdrive' of nervous impulses from the brain to various parts of the body during a panic attack. The real problem is actually a mistaken belief of imminent danger – not the panic itself – since panic is in fact an appropriate emotional reaction when you are convinced that you may be in danger. However, THE BELIEF THAT YOU ARE IN DANGER IS UNTRUE, and when you understand this on a deeper level, you will master your panic attacks.

What Are the sensations of a Panic Attack?

A panic attack is really nothing more than perfectly normal bodily sensations of anxiety coupled with an extreme misinterpretation of those sensations as dangerous or life threatening. Your belief that you are in danger results in increased anxiety, which then leads to more sensations and more catastrophic thoughts, creating a vicious cycle between bodily sensations, distorted thoughts, and anxiety, which can rather quickly result in a panic attack.

The bodily sensations are real enough, but it is their EXAGERATED INTERPRETATIONS that lead to an escalation of fearful anxiety and panic attack. Various symptoms occur during a panic attack:

Palpitations or a thumping heart. Sweating and trembling. Hot flushes or chills. Feeling short of breath, sometimes with choking sensations. Chest pains. Feeling sick (nauseous). Feeling dizzy, or faint. Fear of dying or going crazy. Numbness, or pins and needles. Feelings of unreality, or being detached from yourself.

During a panic attack you tend to over-breathe in a shallow manner and hyperventilate. If you over-breathe you 'blow out' too much carbon dioxide which changes the acidity in the blood. This can then cause more symptoms such as confusion and cramps, and make palpitations, dizziness, and pins and needles worse. This can make the attack seem even more frightening, and make you over-breathe even more, and so on. A panic attack usually lasts 5-10 minutes, but sometimes they come in 'waves' for up to 2 hours.

People who have panic attacks are remarkably similar in the specific catastrophic thoughts that they have. The following are some of the most common irrational beliefs that precipitate Panic Attacks:

You misinterpret rapid heartbeat as meaning that you might have a heart attack or heart failure. You misinterpret tightness in your chest or throat or rapid breathing as meaning that you might choke and be unable to breathe. You misinterpret lightheadedness as meaning that you are on the verge of fainting. You misinterpret harmless feelings of depersonalisation or unreality as meaning that you are about to go crazy and wind up in a mental hospital. You mistakenly believe that when you panic, you might lose control and do something rash or impulsive, such as losing control of your car, running from your car in traffic, or flagrantly embarrassing yourself. Even though your fears are never realised, you mistakenly tell yourself, "This time is different and I am worse".

Dealing with a panic attack

To ease a panic attack, or to prevent one from getting worse: What causes anxiety, panic attacks and panic disorder?

A recent meta-analysis of hundred of studies found that amongst the studies reviewed, up to 90% of people with Irritable Bowel Syndrome (IBS) have a chronic psychiatric disorder (mostly anxiety and depression). Other studies have highlighted the fact that abnormally distributed gut bacteria profile cause IBS. The medical condition whereby the gut bacteria species are abnormally distributed is a condition called Intestinal Dysbiosis.

The current thinking is that Intestinal Dysbiosis leads to IBS, which in turn leads to Anxiety and Depression. Some health professionals may not have caught up with this very recent medical literature and may still think that the Gut and Brain functions are unrelated.

It may help if you understand about panic attacks. This may reassure you that any physical symptoms you get during a panic attack are not due to a physical disease but may be due to a dysfunction. It may help to know how to deal with a panic attack.

If you have recurring attacks (panic disorder), then assessment and treatment at the Behavioural Neurotherapy Clinic can help. The main aim of treatment at the clinic is to find the underlying metabolic condition/s that underpin the panic attacks. Treating these usually eliminates or reduces the number and severity of panic attacks. A few sessions of Cognitive-Behaviour Therapy may be recommended as well.

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Cognitive-Behaviour Therapy (CBT) for Anxiety reduction

This is a type of specialist counselling treatment. It is probably the most effective add-on to treatment of the underlying causes. Studies show that on its own it works well for over half of people with panic disorder (and agoraphobia) by reducing the catastrophising and therefore the severity of attacks.

Cognitive therapy is based on the idea that certain ways of thinking can trigger, or 'fuel', certain mental health problems such as panic attacks and agoraphobia. The Psychologist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and 'false' ideas or thoughts which you might have. For example, the ideas that you may have at the beginning of a panic attack like wrong beliefs about the physical symptoms or how you react to the symptoms, etc. The aim is then to change your thoughts and replace them with more useful ones that do not lead to panic. Also to help your thought patterns to be more realistic and helpful. Therapy is usually done in weekly sessions of about 50 minutes each, for a few weeks.

Behaviour therapy aims to change behaviours that are harmful or not helpful. This may be particularly useful if you have agoraphobia with panic disorder where you 'avoid' various situations or places. The Psychologist also teaches you how to behaviourally control anxiety when you face up to the feared situations and places. For example, by using breathing techniques.

Cognitive-behaviour therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours.

Generally we recommend a multidisciplinary approach which consists of treating the underlying metabolic anomalies (nutrient uptake and intestinal dysbiosis) and correcting dysfunctional thought patterns. In our experience, this protocol works for most people and is very effective at eliminating anxiety and panic attacks permanently. Anti-anxlitic medication may be useful in the acute stage at easing symptoms until complementary treatments become effective.