Panic Disorders in Children and Adolescents

What is Panic?

The most important feature of these disorders is the presence of unexpected panic attacks, which are recurrent.  These are followed by at least a month of steady concern about having another attack, worry about what to do if one happens again, or significant changes in behavior related to the attacks.  The attacks are not due to  the effects of some substance, such as caffeine, or to a general medical condition.

There are two types of this disorder, with and without Agoraphobia.

Some panic attacks occur due to a trigger, but attacks resulting in a diagnosis of this disorder are spontaneous or un-cued.  At least two of these unexpected attacks of panic are required, but most people have many more.  People with this disorder also frequently have situationally triggered attacks as well, which are often but not always associated with a trigger or particular situation.  Attacks which almost always occur in a particular situation, and which are almost immediate, can also occur, but are less common.

How often attacks occur, and how severe they are vary widely.  Some people have attacks once a week (moderate) that may happen for months at a time.  Others may have more frequent attacks, like daily for a week, and then weeks or months without any attacks or with less frequent occurrences for many years.  Limited symptom attacks are identical to full attacks except that the sudden fear or anxiety is accompanied by less that 4 of the 13 other symptoms.  These are common with this disorder as well.

People with a Panic Disorder usually develop concerns or reasons for having their attacks, or struggle with ideas about the consequences of the attacks.  Many fear the attacks are a sign of an undiagnosed, life threatening illness.  They may fear they are having a heart attack or seizure.  These thoughts can persist even after extensive medical testing and reassurance that they are healthy.  Many people fear that attacks are a sign that they are going "crazy", losing control or just plain weak.  Some people make significant changes in their behavior, like changing jobs or stopping driving, in response to having attacks and attempts to control them or to avoid having them in the future.

Often individuals with this disorder report constant or intermittent feelings of anxiety that are not focused on any specific situation or event.  Some become intensely apprehensive about what will happen in routine activities, especially those involving health or separation from a loved one.  They may imagine a catastrophic outcome from mild physical symptoms or medication side effects, like thinking a headache signifies a brain tumor or stroke.  Before diagnosis, people with a Panic Disorder may suffer chronic severe anxiety, and have frequent visits to their doctor or emergency room.

At times, a loss or interruption of important relationships occur with the start or worsening of this disorder.  Divorce is not uncommon.  Leaving home to live independently can be interfered with.  Many people struggle with feelings of discouragement, shame, or unhappiness about the difficulties of going about a normal routine.  They can become demoralized, and conclude that their symptoms indicate that they are weak or have a flawed character.

Major Depression occurs frequently in individuals with a Panic Disorder (50 to 65%).  About a third of the time depression occurs before attacks start.  In the other two thirds, depression can occur at the same time or after attacks start.

A number of people with this disorder will self medicate with alcohol or other medications, a behavior which can often develops into an addiction or substance abuse disorder in itself.  Social Phobia, Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder are also associated with this disorder.  Some cultures associate attacks with witchcraft or magic, or fear religious implications.

Age of onset is typically in late adolescence through the early 30's.  A small number begin in early childhood.  Looking back in people's histories, the course is usually chronic, with periods of more or less frequent or severe attacks.  Agoraphobia may develop at any point, but is most common within the first year of recurrent attacks.  In some cases Agoraphobia can persist after symptoms of the panic remit.

People with a close relative with a Panic Disorder have a 4 to 7 times greater risk of developing the disorder.  However, as many as half to three quarters of people with the disorder do not have an affected relative.  Twin studies suggest there may be a genetic factor.

Treatment for this disorder can be very effective and helpful.  Usually individual therapy, family therapy, and coordination and planning with the child's school are required.  Understanding the disorder is a crucial first step for the child or adolescent and their parents, so education is a first step.  Training to develop coping skills is a second step.  Relaxation training or self hypnosis can be useful, and are pleasant to learn.  The book Don't Panic, by Wilson Reid is extremely helpful in these two steps.  Cognitive therapy and behavioral therapy are common interventions.  Medication is also frequently necessary, at least initially in managing overwhelming symptoms.  Anti-depressants are the most helpful, although they take 10 days to 3 weeks to become effective.  Somatostatin Reuptake Inhitibors (SSRI's) or Norepinephrine Reuptake Inhibitors should be considered if medication is necessary.  Anti-anxiety medications are also frequently utilized, although these can be addicitive and are usually employed on a short term basis.  Medication to help with sleep is also frequently utilized.

If you think that your child or adolescent might have a Panic Disorder,  you should talk to a professional about what to do and how to get help.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  See the Cranberry Counseling, P.C. page of this web site for more information, or use the Contact Us form.