[Health in the 100-Year Life Era] Panic Disorder, Anxiety and Fear That Cannot Be Controlled

Anxiety and Stress Not Required for Onset
Experience Intense Fear Such as Shortness of Breath
Treatment Possible if Exact Cause Identified

Professor Hye-Yeon Park, Department of Psychiatry, Bundang Seoul National University Hospital.

Mr. A is driving. Suddenly, on a congested road, he feels suffocated. Then his heart starts pounding, his hands tremble, and his vision goes dark. Feeling dizzy, Mr. A is gripped by intense fear, worrying whether he might lose consciousness and cause an accident, or if this is a heart attack or stroke.

Panic disorder is a condition characterized by repeated panic attacks involving sudden episodes of severe anxiety and fear accompanied by various symptoms such as shortness of breath, palpitations, dizziness, trembling, chest pain, or nausea. The prevalence in Korea is about 0.8%, so it is not rare, and recently it has become widely known as several celebrities have spoken about their experiences with panic disorder.

The frightening aspect of panic attacks is that they can occur without preceding anxiety or stress. They can happen while resting comfortably at home or suddenly awaken someone from sleep. Additionally, panic symptoms may be accompanied by agoraphobia, where panic occurs in specific situations such as in cars, subways, movie theaters, or supermarkets.

Panic disorder occurs when there is dysfunction in brain function and the autonomic nervous system. One of the brain’s functions is to regulate fear and anxiety, heightening sensory perception to respond effectively to dangerous situations. However, in patients with panic disorder, this brain and bodily alarm system is triggered even in everyday situations, leading to panic attacks.

Because physical symptoms such as shortness of breath appear all at once and intense fear is experienced within minutes, it is difficult to control oneself in the moment, and emergency room visits are common. Often, patients are told that no special treatment is needed as symptoms improve over time and no abnormalities are found. However, during the first attack, thorough evaluation of causes such as respiratory diseases, arrhythmias or other heart diseases, and endocrine disorders like thyroid problems is necessary.

Repeated panic attacks lead to anticipatory anxiety about sudden situations and gradually reduce the range of daily activities. Consequently, patients avoid going out and cancel trips, becoming isolated and depressed, so appropriate treatment is essential. Panic disorder is a condition that can be managed through treatment once the exact cause is identified, with the main treatments being medication and cognitive behavioral therapy.

Medication involves the use of antidepressants such as selective serotonin reuptake inhibitors and anxiolytics, which help reduce anxiety and panic attacks. Cognitive behavioral therapy reduces excessive fear and anxiety responses related to panic symptoms and teaches patients how to control their physical symptoms themselves. Since panic disorder can worsen or relapse due to factors like stress or lack of sleep, continuous management is necessary even after treatment ends.

Many patients, like Mr. A, say that once they experience panic disorder, they cannot forget the fear. Offering comforting phrases such as “stay calm and overcome it” is not helpful to patients who are confused and suffering. While the ultimate goal of treatment is for patients to overcome the fear of panic attacks and regulate their emotions and physical symptoms on their own, this process is by no means simple. It is important for family members to help patients consult with specialists to receive accurate diagnosis and treatment and to act as supporters throughout the treatment process.

Professor Park Hye-yeon, Department of Psychiatry, Bundang Seoul National University Hospital