Panic disorder has biological roots

By Lorna Collier

Anne Grubich was at her father’s funeral service, mourning, when suddenly she became lightheaded, dizzy, disoriented and began having heart palpitations.

The terrifying feelings passed and Grubich, then 37, chalked them up to grief and stress – until they started coming back, this time in everyday, mundane situations, such as grocery shopping or eating dinner at a restaurant.

“It was almost like an out-of-body experience,” says Grubich, 48, an office manager in Elk Grove Village. “I thought something was physically wrong with me. I felt like I was dying or having a heart attack.”

Grubich’s doctor gave her a clean bill of health, but the attacks kept coming, so she started avoiding places in which they had occurred.

“I began making excuses,” she says. “If my girlfriends asked me to go to dinner, I wouldn’t, because it would happen in restaurants. Walking through the mall was torture for me. I wouldn’t fly.”

Although Grubich did not know it at the time, she was suffering from panic disorder: a condition characterized by repeated panic attacks, severe enough to affect her daily life. It’s a disorder estimated to affect anywhere from 2.7 million to 8 million Americans (1 to 3 percent of the population), including such celebrities as Donny Osmond and Kim Basinger, and often begins in late adolescence or early adulthood. While the precise cause is still under investigation, doctors say it appears to have genetic underpinnings – the condition runs in families – and involves a dysfunction in the “fear pathways” in the brain.

“This is a biologic illness that is a disruption of normal mechanisms,” says Daniel Yohanna, M.D., medical director of the Stone Institute of Psychiatry at Northwestern Memorial Hospital in Chicago. “There is evidence both in [brain-imaging] scans that show changes in the brain with panic attacks and also studies inducing panic attacks in prone people, by having them inhale carbon dioxide.”

“It is a real condition,” agrees Philip Carbonell, a psychologist who directs the Schaumburg-based Anxiety Treatment Center Ltd. During panic attacks, says Carbonell, patients have higher heart rates, respiration, blood pressure and temperature. “There are physiological measures that indicate this is not something the person is imagining.”

Still, panic disorder is often viewed skeptically by family members and others, who do not understand what they cannot see. “You can’t tell by looking at someone that they are having a panic attack,” says Carbonell. “For a family member to see absolutely no evidence of this is frustrating,” especially when the panic sufferer has just cancelled dinner plans due to an attack.

“They’ll get annoyed as all get out, thinking, ‘another plan spoiled,’” says Carbonell. “It seems to them as if the person is being obstinate or disagreeable. They’ll say, ‘why can’t you be better? Why can’t you just take my word for it that you can be OK?’”

Shelly Evans is a former panic sufferer who now runs a self-help group in Tinley Park called HOPE (Helping Our Panic End).

“I find it really amazing that there’s still such a stigma with it, especially with all the celebrities coming out with this left and right,” says Evans, 47, who had her first panic attack at age 18.

Especially aggravating, says Evans, are people who confuse panic attacks with simple jitters, which they think ought to be easy to overcome.

“[Being nervous] is different from a panic attack,” says Evans. She describes panic attacks to those who haven’t had one in this way: “We’re going to put you in the middle of the Dan Ryan Expressway at 2:30 p.m. in the middle lane, in cement boots, so that you can’t move.”

But instead of facing real danger, panic sufferers see nothing to explain the paralyzing terror flooding their bodies, leading to the common conclusion that they are going crazy or dying. Panic victims also begin avoiding situations or places in which attacks happen. Some people become housebound; Evans, for example, did not leave her house for three years.

Evans eventually was successfully treated, as are most people who seek medical help. The most common treatments today are cognitive behavior therapy and medications. Cognitive behavior therapy helps patients learn techniques to short-circuit symptoms of an attack before they spiral into terror; Anne Grubich used this therapy to help resolve her panic problems. Antidepressant medications such as Paxil and Zoloft, which affect serotonin levels in the brain, have been found to be effective in blocking panic attacks. Tranquilizers also are used, though some doctors fear their addictive potential. Yohanna says a combination of cognitive therapy and medications is most effective, helping 80 to 90 percent of patients.

In addition, doctors sometimes use computerized virtual reality treatments to help patients overcome such fears as driving or flying. Patients can be gradually exposed to these situations, while never actually leaving the doctor’s office.

Other advances in cognitive therapy include more intensive treatment, with five- to eight-hour sessions daily for six to 10 days, says Carbonell. More typically, Carbonell – who prefers to treat with cognitive therapy instead of medication, when possible -- sees patients for 12-week sessions.

“The good news is this is a very treatable illness,” says Yohanna.

(Written for the Chicago Tribune, 2004)

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