Introduction

What are panic disorder and health anxiety?

Many people experience one or two panic attacks during their lifetime. However, if you encounter frequent and unexpected panic attacks that lack a clear trigger, this may be diagnosed as panic disorder. 

Health anxiety is an irrational and obsessive worry about having a serious medical condition. Also known as illness anxiety or formerly hypochondria, this condition involves imagining physical symptoms of illness. Alternatively, it can involve misinterpreting minor bodily sensations as symptoms of a serious illness despite reassurances from medical experts that there is no illness present.

How common are panic disorder and health anxiety?

Panic disorder is relatively common, affecting about 2-3% of the population worldwide. It can manifest at any age but most commonly develops in young adults. People assigned female at birth (AFAB) are twice as likely as those assigned male at birth (AMAB) to be diagnosed with panic disorder.¹

Health anxiety is also fairly common, affecting around 4-5% of the general population. It can occur in individuals of any age, gender, or cultural background, although it appears to be more prevalent in people AFAB and older individuals.²

Importance of understanding panic disorder and health anxiety

Understanding panic disorder and health anxiety is crucial, as these conditions can significantly impact an individual's quality of life, lead to other mental health conditions, and increase healthcare costs. Additionally, this understanding can help reduce stigma, promote early intervention and treatment-seeking behaviour, and improve patient outcomes. 

Symptoms of panic disorder

Panic attacks and their symptoms

Symptoms of panic disorder can include sudden and repeated episodes of intense fear or discomfort, also known as panic attacks. Panic disorder can also lead to persistent worry and avoidance of situations or places that may trigger a panic attack.

Physical symptoms of panic disorder

During a panic attack, individuals may experience physical symptoms such as:  

• Rapid heartbeat
• Sweating
• Trembling
• Shortness of breath

Cognitive symptoms of panic disorder

Cognitive symptoms of panic disorder may include:

• Intense fear or anxiety
• Worry about future panic attacks or their consequences 
• Catastrophic thinking (i.e. imagining the worst possible outcome)
• Feeling like you're losing control or going crazy

Individuals with panic disorder may also experience a sense of detachment from reality or themselves and may worry about the physical symptoms they are experiencing during a panic attack, such as a racing heart or shortness of breath. These cognitive symptoms can exacerbate physical symptoms and lead to a cycle of panic and anxiety.

Symptoms of health anxiety

Types of health anxiety

There are two types of health anxiety: somatic symptom disorder and illness anxiety disorder. Somatic symptom disorder involves distressing or disruptive physical symptoms. In contrast, illness anxiety disorder involves excessive and persistent worry about having or acquiring a serious illness, usually despite having no symptoms – or from identifying normal physical sensations as signs of serious illness. 

Physical symptoms of health anxiety

If you have health anxiety, you may experience a range of physical symptoms, including:

• Muscle tension 
• Headaches
• Fatigue 
• Dizziness 
• Nausea and/or gastrointestinal symptoms 
• Rapid heartbeat 
• Sweating 
• Shortness of breath 
• Tremors 
• Insomnia

Cognitive symptoms of health anxiety

Cognitive symptoms of health anxiety may include: 

• Persistent checking for signs and symptoms of illness
• Catastrophic thinking about health-related issues
• The belief that minor physical symptoms indicate a severe medical condition
• Difficulty concentrating on tasks due to preoccupation with health concerns
• Repeatedly seeking reassurance from doctors 
• Avoiding doctor appointments to avoid a diagnosis 

Causes of panic disorder and health anxiety

Biological causes

The exact biological causes of panic disorder are not completely known, but they may involve genetic and environmental factors. Imbalances in certain brain chemicals and abnormalities in a part of the brain responsible for emotions may contribute to the development of panic disorder. Furthermore, having a family history of panic disorder or experiencing stressful life events may increase the risk of developing the condition.

The biological causes of health anxiety are not fully understood, but research suggests that it may involve a combination of genetic, brain chemistry, and stress response system factors. However, more research is needed to understand the underlying mechanisms fully.

Psychological causes

Psychological causes of panic disorder may include learned behaviour from parents or caregivers, a history of abuse or trauma, chronic stress, and negative thinking patterns. Individuals with panic disorder may also have an exaggerated sense of personal responsibility and a tendency to catastrophise, which can make symptoms worse. Additionally, individuals with panic disorder may have a heightened sensitivity to physical sensations, leading to a heightened sense of anxiety and fear during panic attacks. 

The psychological causes of health anxiety can include how someone thinks about and interprets bodily sensations, personal experiences, and beliefs about health and illness. Stressful life events and chronic stress can also contribute to the development of health anxiety.

Environmental causes 

Environmental causes of panic disorder may include exposure to stressful life events, such as a traumatic event, significant life changes or transitions, or ongoing chronic stress. Additionally, substance use, including alcohol and drug use, can increase the risk of developing panic disorder. Environmental factors may interact with genetic and psychological factors to contribute to the development of panic disorder. 

Environmental causes of health anxiety may include exposure to media coverage of health-related issues, societal norms and expectations surrounding health and illness, and cultural attitudes towards healthcare-seeking behaviour. Additionally, family and peer influences, as well as access to healthcare and medical information, may also play a role in the development of health anxiety.

Diagnosis of panic disorder and health anxiety

Diagnostic criteria for panic disorder and health anxiety

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnostic criteria for panic disorder include:

1. Recurrent panic attacks that come unexpectedly; sudden periods of intense fear or discomfort 
2. At least one of the panic attacks is followed by intense concern or worry about additional panic attacks or their consequences and/or significant change in behaviour in the context of panic attacks
3. The panic attacks are not caused by direct physiological effects of a substance or medical condition
4. The panic attacks cannot be attributed to any other psychological condition, like social anxiety disorder or OCD
5. The panic attacks result in significant discomfort or limitations in social interactions or other aspects of one's life

Diagnostic criteria for health anxiety include:³ 

1. Preoccupation with having or getting a serious illness
2. Physical symptoms are either not present or mild, and the worry is excessive compared to any risk of getting seriously ill
3. A high level of anxiety about health
4. Excessive health checking or other health-related behaviours, including avoiding doctors and hospitals
5. Preoccupation has been present for over 6 months, even if the specific feared illness has changed
6. Preoccupation is not better explained by another mental health disorder, such as panic disorder, generalised anxiety disorder, or obsessive-compulsive disorder

Diagnostic tests for panic disorder and health anxiety

There are no diagnostic tests exclusively used for panic disorder. The diagnosis is typically made through a thorough clinical evaluation, including a detailed medical and psychiatric history, physical examination, and psychological assessment. Additionally, diagnostic criteria from the DSM-5 (mentioned above), as well as other standardised assessments and rating scales, may be used to aid in diagnosis and to track symptoms over time.

If you exhibit symptoms of health anxiety, your doctor will conduct a physical examination to rule out any possible underlying health conditions that may be causing them. If no medical issues are found, they may refer you to a mental health professional who will perform a psychological evaluation. This may include questions about your symptoms, personal history, family background, and substance use, as well as asking you to complete a self-assessment or questionnaire.

Treatment of panic disorder and health anxiety

Medication options for panic disorder and health anxiety

Medications used to treat health anxiety may include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, and sertraline, as well as benzodiazepines, such as lorazepam and clonazepam. These medications can help reduce symptoms of anxiety and depression that often accompany health anxiety or panic disorder. Other medications, such as beta-blockers, may also be prescribed to help reduce physical symptoms of panic attacks. However, medication should only be used under the guidance of a doctor.

Therapy options for panic disorder and health anxiety

Therapy options for panic disorder and health anxiety may include cognitive behavioural therapy (CBT), exposure therapy, and mindfulness-based therapies. 

1. CBT can help individuals identify and change negative thought patterns and behaviours associated with panic disorder and health anxiety 
2. Exposure therapy involves gradually exposing individuals to situations that trigger anxiety in a safe and controlled environment
3. Mindfulness-based therapies, such as meditation and yoga, can help individuals learn to regulate their emotions and reduce anxiety
4. Psychotherapy can be a highly effective treatment for panic disorder and health anxiety and is often used in conjunction with medication

Lifestyle changes for panic disorder and health anxiety

Lifestyle changes that may help manage symptoms of panic disorder and health anxiety include: 

• Regular exercise 
• Healthy eating 
• Avoiding stimulants like caffeine and nicotine
• Reducing alcohol and drug use. 

Practicing relaxation techniques, such as deep breathing and progressive muscle relaxation, may also be helpful. It's important to maintain a regular sleep schedule and to make time for enjoyable activities and social support. Making these lifestyle changes, along with seeking professional treatment, can improve overall well-being and reduce the impact of panic disorder and health anxiety on daily life.

Coping strategies for  panic disorder and health anxiety

Mindfulness techniques

Mindfulness techniques for panic disorder may include deep breathing exercises, progressive muscle relaxation, visualization, and mindfulness meditation. 

Breathing exercises

Breathing techniques for panic disorder may include diaphragmatic breathing, paced breathing (focusing on how long you inhale and exhale), and equal breathing (inhaling and exhaling for the same amount of time). These techniques can help regulate breathing, reduce hyperventilation, and reduce symptoms of panic attacks.

Progressive muscle relaxation

Progressive muscle relaxation is a relaxation technique for panic disorder that involves tensing and then relaxing different muscle groups in the body.

Summary

This article provides a brief overview of panic disorder and health anxiety. Panic disorder involves sudden and intense episodes of anxiety, accompanied by physical symptoms like rapid heart rate. Health anxiety, on the other hand, manifests as persistent fears of having a severe illness. Both conditions can significantly impact daily life. The article explores their common symptoms, potential causes, and available treatment options, emphasizing the importance of seeking professional help. Understanding these disorders is crucial for individuals, caregivers, and healthcare providers in fostering effective management and support.