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
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
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
“[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)