Panic attacks and panic disorder

A great many people describe the same evening. Chest tight, heart hammering, hands cold and shaking, air that will not go all the way in. A certainty — not a worry, a certainty — that this is a heart attack. Then a car to the emergency room, an ECG, blood tests, and a doctor saying that everything is normal. Relief, and then, within a day or two, something worse than relief: if nothing is wrong, what was that?

People describe it coming out of nothing. In a lift. In traffic on Shahrah-e-Faisal. In a meeting, at a wedding, in bed at 2am having been asleep an hour earlier. They describe the feeling of being about to faint or lose control in front of everyone, and of the whole thing peaking within minutes and then draining away, leaving them exhausted for the rest of the day.

Part of why it is so frightening is that it is genuinely physical. What people are describing is the body's alarm response — the same surge that would be useful if there were something to run from — firing hard and fast when there is nothing there. That is why it is felt in the chest and the breath and the hands rather than as a thought.

Then the second thing arrives, and for most people it is the bigger problem. Not the attack: the waiting for the next one. People describe checking their own pulse. Sitting near the door. Not driving on the bridge. Not going alone. Not going. A life narrowing, one avoided thing at a time, around an event that lasts ten minutes.

One thing worth saying plainly: chest pain and breathlessness have medical causes too. Having a doctor rule those out is a sensible first step and not a waste of anybody's time. Recognising yourself in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess you, and there is nothing here for you to score yourself against.

Once medical causes have been looked at, the question becomes a psychological one, and it is a reasonable one to bring after a single episode.

What a clinician pays attention to is recurrence and cost. More than one episode, or one episode that has left a lasting fear of another. Days now being planned around avoiding the places, journeys or situations where it happened. An emergency room visited more than once with the same result.

You do not need to wait until you can explain it before you come. Most people cannot.

Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that what you are describing is described often, and that it is a reasonable thing to bring.

PHC is an assessment-first practice. Before therapy begins there is an initial session, and its job is to work out what is actually happening rather than to start treating it.

1. An initial sessionWe ask what has been going on, for how long, and what it is costing you. We will ask whether a doctor has looked at the physical side, and if not we may suggest that first. Nothing is administered before this conversation.
2. Emotional assessment and symptom screeningA structured screening of emotional functioning and what you are presenting with, using internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need.
3. A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit.
4. Therapy, reviewed as it goesFor recurrent panic the modality most often indicated is Cognitive Behavioural Therapy (CBT), which PHC uses for anxiety, depression and negative thought patterns. Some people also use the Hypno-yoga at PHC DHA alongside their sessions, in a group, four days a week. Sessions are 50 minutes, in clinic at our PECHS clinic or in DHA, or online.

• Anxiety
• Social anxiety
• Sleep disturbance
• Emotional assessment
• CBT at PHC