15 May 2009


Panic Disorder can terrify the toughest of South Africans. Here is how to recognise and how to deal with it.


“Suddenly I couldn’t breathe, it was like the room was too small and was closing in on me. I felt a blinding terror that I was going to die here, in front of my clients. I wanted to scream, couldn’t they see the danger? Instead I ran like the room was on fire.”

Jason, a 40-something advertising account executive, is not crazy, nor does he have a life-threatening disease. He suffers from Panic Disorder. Panic is a fairly common disorder that involves brief episodes of intense fear, accompanied by terrifying physical symptoms such as heart palpitations, dizziness, shortness of breath, and tingling in the fingers and toes. They usually occur completely out of the blue.

“The most frightening thing for me when I started getting these attacks was that I never knew when one would sneak up on me. One minute I’d be talking, interacting, working – just being Jason – and the next minute… WHAM… I couldn’t breathe, my heart was racing, and I thought I was going to have a heart attack. I even went to the emergency room a few times!”

Hidden symptoms
People sometimes assume that "panic" is just a matter of feeling nervous or anxious - the sort of feelings we all have felt and everyone is familiar with. However, even though people who experience panic attacks may show no outward signs of discomfort, the symptoms they have are so overwhelming that they really believe they are going to die, lose their minds or be totally humiliated. “Even though these things don’t happen, it seems very likely they will to the person who is suffering the panic attack”, says Johannesburg-based CBT psychologist Dr Colinda Linde.

Panic attacks are believed to happen when the brain’s normal way of dealing with a threat (the "fight or flight response") inappropriately gets triggered. Most sufferers say there was no threat, they were going about their daily business – shopping, talking with a friend, reading – when they suddenly felt terrified and left gasping for air.

"Most people with Panic Disorder feel so anxious about the possibility of having another panic attack that they avoid situations in which they believe these attacks are likely to occur," says Dr Linde.

“Panic sufferers develop an intense fear of having another attack," says Dr Linde. “This fear is present most of the time, and seriously interferes with the person's life even when the panic attack is not in progress.”

“I was constantly terrified of having another one of these ‘monsters’ rear up in my head. I just couldn’t bear the thought of having another one. I started avoiding places where I’d previously had an attack, and places where I thought I couldn’t escape from if I had one. And the more I avoided, the easier it was to keep on avoiding."

Jason is not alone in his avoidance. People suffering from Panic Disorder often develop intense fears about situations where a panic attack has occurred. “We’ve had callers who have had a panic attack while driving and feel like they can’t get behind the wheel again, even to drive down the road”, says SADAG's counselling manager, CasseyAmoore. Panic Disorder can make people’s lives increasingly limited and their work may suffer because they can't travel or get to work on time, relationships are often strained or marred by conflict of panic attacks, or the fear of them, rule the affected person and those around them.

“How would I describe a panic attack? Fear... I felt a sense of impending doom... I guess for me, panic is fear... and helplessness.”

Treatment of Panic Disorder is all about changing the helplessness and fear into power. Psychological treatment is essential for Panic Disorder in order to help the sufferer cope with the symptoms of panic attacks and learn to recognise the initial triggers in order to stop the attack. One therapy (Cognitive Behavioutal Therapy - CBT) in particular helps empower its users and has been shown to be the most effective treatment for Panic Disorder.

CBT helps Panic Disorder sufferers change the way they think about their surroundings and their symptoms. It focuses on identifying, confronting and testing negative and automatic thoughts and assumptions with reality.

“During a panic attack, the individual usually thinks something like 'I am having a heart attack' or 'I am going insane', but may not be aware of how those thoughts affect, even exacerbate, the attack’s symptoms”, says Dr Linde. “During CBT, people learn to recognise their earliest thoughts and feeling and modify their response to them – instead of 'I'm going to have a heart attack', rather think and say 'It's only uneasiness - it will pass'. It really does help to reduce the anxiety and ward off a panic attack.”

Many people know what feeling nervous or anxious about an upcoming event or situation feels like. We have all experienced butterflies in our stomach or dread an upcoming event we really didn’t want to attend. However, Panic Disorder is an illness. It can be incredibly disabling but it can also be effectively treated. Panic Disorder is not caused by personal weakness. Take an active role in your recovery. Most importantly, remember you can overcome Panic Disorder. (South African Depression and Anxiety Group, May 2009)

For help and support
Contact SADAG's call centre whicht is open from 8am to 8pm seven days a week: 0800 20 50 26.

Symptoms of a panic attack

  • Overwhelming fright or terror
  • Racing heart
  • Chest pains
  • Dizziness and nausea
  • Difficulty breathing
  • Tingling or numbness in the hands and feet
  • Hot flushes or cold chills
  • A sense of unreality and being disconnected.
  • Fear of losing control
  • Fear of dying

Self-help for panic

  • Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.
  • Time how long the actual attack lasts it is less than you realise - only a few minutes. Then it will become less overwhelming for you.
  • Understand that what you are experiencing is only an exaggeration of your normal bodily reactions to stress.
  • Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.
  • Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!"
  • Remain focused on the present. Notice what is really happening to you as opposed to what you think might happen.
  • Label your fear level from zero to 10 and watch it fluctuate. Notice that it does not stay at a very high level for more than a few seconds.
  • When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backwards from 100 in 3's.
  • Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
  • When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
  • Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

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