Adults with Asperger’s (AS) and High-Functioning Autism (HFA) are often prone to anxiety, which in extreme situations can lead to panic attacks. A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, the sufferer might think she is losing control, having a heart attack or even dying.
Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if an individual has had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, she may have a condition called panic disorder. Panic attacks were once dismissed as nerves or stress, but they're now recognized as a real medical condition. Although panic attacks can significantly affect quality of life, treatment can be very effective.
Panic attacks typically begin suddenly, without warning. They can strike at almost any time —driving the car, at the mall, sound asleep, or in the middle of a business meeting. Panic attacks have many variations, but symptoms usually peak within 10 minutes. The sufferer may feel fatigued and worn out after a panic attack subsides. Panic attacks typically include a few or many of these symptoms:
- Abdominal cramping
- Chest pain
- Fear of loss of control or death
- Hot flashes
- Rapid heart rate
- Sense of impending doom or danger
- Shortness of breath
- Tightness in your throat
- Trouble swallowing
One of the worst things about panic attacks is the intense fear that another one will occur. The sufferer may fear having a panic attack so much that he avoids situations where they may occur. He may even feel unable to leave his home (called agoraphobia) because no place feels safe.
AS and HFA adults who have any panic attack symptoms should seek medical help as soon as possible. Panic attacks are hard to manage without assistance, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems (e.g., a heart attack), it's important to get evaluated by a health care provider if the individual is not sure what's causing her symptoms. It's not known what causes panic attacks or panic disorder, but these factors may play a role:
- Certain changes in the way parts of the brain function
- Major stress
- Temperament that is more susceptible to stress
Some research suggests that the body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared itself for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's not known why a panic attack occurs when there's no obvious danger present. Symptoms of panic disorder often start in the late teens or early adulthood and affect more females than males. Factors that may increase the risk of developing panic attacks or panic disorder include:
- Death or serious illness of a loved one
- Experiencing a traumatic event (e.g., an accident or sexual assault)
- Family history of panic attacks or panic disorder
- History of childhood physical or sexual abuse
- Major changes in one’s life (e.g., the addition of a baby)
- Significant stress
Left untreated, panic attacks and panic disorder can result in severe complications that affect almost every area of life. The sufferer may be so afraid of having more panic attacks that he lives in a constant state of fear, ruining all quality of life. Complications that panic attacks may cause or be linked to include:
- Alcohol or substance abuse
- Avoidance of social situations
- Development of specific phobias (e.g., fear of driving or leaving the house)
- Financial problems
- Increased risk of suicide or suicidal thoughts
- Problems at work or school
If you have had signs or symptoms of a panic attack, make an appointment with your physician. After an initial evaluation, the physician may refer you to a psychiatrist or psychologist for treatment. Here's some information to help you prepare for your appointment and what to expect from the physician:
- Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.
- Make a list of your symptoms, including when they first occurred and how often you've had them.
- Write down key personal information, including traumatic events in your past and any stressful, major events that occurred before your first panic attack.
- Write down medical information, including other physical or mental health conditions that you have and the names of any medications you're taking.
- Write down questions to ask your physician (e.g., Do I need any diagnostic tests? Is it possible that an underlying medical problem is causing my symptoms? Is there anything I can do now to help manage my symptoms? Should I see a mental health specialist? What do you believe is causing my symptoms?).
- Write down questions to ask your mental health provider (e.g., Are there any brochures or other printed material that I can take home with me? Are there any self-care steps I can take to help manage my condition? Do I have panic attacks or panic disorder? For how long will I need to take medication? How will you monitor whether my treatment is working? If you're recommending medications, are there any possible side effects? If you're recommending therapy, how often will I need it and for how long? What can I do now to reduce the risk of my panic attacks recurring? What treatment approach do you recommend? What websites do you recommend visiting? Would group therapy be helpful in my case?).
A physician or mental health provider who sees you for possible panic attacks or panic disorder may ask any of the following questions:
- Did you experience significant stress or a traumatic event shortly before your first panic attack?
- Do you avoid the locations or experiences that seem to trigger an attack?
- Do you exercise?
- Do you use caffeine, alcohol or recreational drugs? How often?
- Does anything in particular seem to trigger an attack?
- Have you been diagnosed with any medical conditions?
- Have you experienced significant trauma — such as physical or sexual abuse or military battle — in your lifetime?
- Have you or any of your close relatives been diagnosed with a mental health problem, including panic attacks or panic disorder?
- How do your symptoms affect your life, including school, work and personal relationships?
- How often do you experience fear of another attack?
- How often do your attacks occur, and how long do they last?
- How would you describe your childhood, including your relationship with your parents?
- What are your symptoms, and when did they first occur?
To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your physician or other health care provider must determine if you have panic attacks, panic disorder or another condition (e.g., heart or thyroid problems) that resembles panic symptoms. You may have any of the following:
- Psychological self-assessments and questionnaires
- Inquiries about alcohol or other substance abuse
- Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG), to help determine how well it's functioning
- An evaluation by your physician or mental health provider to talk about your symptoms, stressful situations, fears or concerns, relationship problems, and other issues affecting your life
- A complete physical exam
Not everyone who has panic attacks has a panic disorder. To be diagnosed with panic disorder, you must meet these criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association:
- At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; ongoing fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy" or significantly changing your behavior, such as avoiding situations that you think may trigger a panic attack.
- You have frequent, unexpected panic attacks.
- Your panic attacks aren't caused by substance abuse, a medical condition or another mental health condition, such as social phobia or obsessive compulsive disorder.
For some AS and HFA adults, panic disorder includes agoraphobia (i.e., avoiding places or situations that cause you anxiety because you fear not being able to escape or get help if you have a panic attack). If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.
The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are psychotherapy and medications. Both are effective. Your physician likely will recommend one or both types of treatment, depending on your preference, your history, the severity of your panic disorder and whether there are therapists with special training in panic disorders in your area.
Psychotherapy is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.
Cognitive behavioral therapy can help you learn through your own experience that panic symptoms are not dangerous. During therapy sessions, your therapist will help you gradually re-create the symptoms of a panic attack in a safe, supportive setting. Once the physical sensations of panic no longer seem threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've been avoiding because of panic attacks.
Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms decrease significantly or go away within several months. As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.
Medications can help reduce symptoms associated with panic attacks as well as depression if that is an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:
Benzodiazepines- These mild sedatives belong to a group of medicines called central nervous system depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Niravam, Xanax), clonazepam (Klonopin) and lorazepam (Ativan). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.
Selective serotonin reuptake inhibitors (SSRIs)- Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs)- These medications are another class of antidepressants. The SNRI drug called venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.
If one medication doesn't work well for you, your physician may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your physician about the possible side effects and risks.
Researchers have explored a number of natural remedies as possible treatments for anxiety disorders, including panic disorder. Small studies over 10 years old indicate that an oral nutritional supplement called inositol, which influences the action of serotonin, may reduce the frequency and severity of panic attacks. However, more research is needed. Talk with your physician before trying any natural therapies. These products can cause side effects and may interact with other medications. Your physician can help determine if they are safe for you.
While panic attacks and panic disorder benefit from professional treatment, you can also help manage symptoms on your own. Some of the lifestyle and self-care steps you can take include:
- Avoid caffeine, alcohol and illegal drugs. All of these can trigger or worsen panic attacks.
- Get physically active. Aerobic activity may have a calming effect on your mood.
- Get sufficient sleep. Get enough sleep so that you don't feel drowsy during the day.
- Join a support group. Joining a group for people with panic attacks or anxiety disorders can connect you with others facing the same problems.
- Practice stress management and relaxation techniques. For example, yoga, deep breathing and progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the tension until every muscle in the body is relaxed — also may be helpful.
- Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
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