Panic Attacks In Obsessive-Compulsive And Related Disorders (OCRDs)

Panic attacks are a physiologic response to extreme fear. Panic attacks are not unique to OCRDs and may occur in the context of several mental disorders. Nonetheless, since OCRDs involve varying degrees of fear, it is important to become familiar with panic attacks. In particular, panic attacks may occur in the context of certain types of treatment such as exposure and response prevention.

Panic attacks are sudden, extreme feelings of fear and/or discomfort lasting for a distinct period of time. This sudden surge peaks in intensity within a few minutes, at which point it begins subside. There is often a sense of doom and gloom and a powerful desire to escape. To meet the definition of a panic attack, a person must have 4 of a possible 13 symptoms: These are:

• Palpitations and/or pounding heart;
• Sweating;
• Trembling or shaking;
• Shortness of breath or a sense of being smothered;
• Feelings of choking;
• Chest pain or discomfort;
• Nausea;
• Feeling dizzy, unsteady, lightheaded, or faint;
• Hot flashes or chills;
• Numbness or tingling sensation;
• Derealization (feelings of unreality) or depersonalization (feeling detached from oneself);
• Fear of losing control or “going crazy”
• Fear of dying.

When someone experiences less than four symptoms, this is known as a limited-symptom panic attack. The most common symptom of limited-symptom panic attacks is shortness of breath, due to hyperventilation.

Panic attacks are different from other anxiety symptoms because they tend to have a sudden onset. They are accompanied by intense fear or terror, and a powerful desire to escape.

Because panic attacks occur in the context of many different disorders, it is important for the clinician to distinguish between two different types of panic attacks: 1) expected (cued), 2) unexpected (un-cued).

Unexpected (uncued) panic attacks seem to come from “out of the blue.” They do not have an identifiable source that sets them off. It is believed these uncued panic attacks are in response to some kind of life stress. However, this stress is often outside the immediate awareness of the person experiencing it. For example, suppose a woman who recently lost her job, is out shopping for groceries. Suddenly, she feels short of breath and dizzy. She senses her heart is racing. Naturally, she becomes alarmed by these sensations that just “came out of the blue” for no apparent reason. This would be considered an un-cued panic attack. It is quite likely the attack was brought about by the necessity of having to shop for food, even though she has lost her job.

Expected (cued) panic attacks are attacks with an obvious cue or trigger. They invariably occur when a person is exposed to certain situations or objects where panic attacks have previously occurred. The onset is sudden and occurs immediately upon exposure. This is the type most commonly observed with OCRDs.

Many people with an OCRDs will never experience panic attacks. Those that do usually will have limited symptom panic attacks.