Mental Health special section

Tracking down panic attacks

Though women suffer more than men, it's a significant problem with a long list of symptoms that are often misinterpreted

By Marcello Palmieri

Numerous studies have shown that men and women aren't really equal — as far as panic disorder is concerned. Research not only shows that a greater proportion of women are affected by panic disorder, but that women also suffer from more respiration-related symptoms.

Research based on the National Comorbidity Survey showed that the prevalence rate of panic disorder was 2.5% for women aged 15 to 24 and 1.3% for men of the same age. And although the overall rates dropped for older women and men, there appeared to be an even bigger gap between genders. The rate for women aged 35 to 44 was 2.1% but only 0.6% among men of the same age.

Unfortunately, it doesn't get any better for women. A longitudinal study followed 412 men and women diagnosed with panic disorder for five years. After remission, panic symptoms reoccurred at twice the rate for women than men.

These statistics come from a review of the literature conducted by Dr Gregory A Leskin, a clinical psychologist at the Veterans Affairs Palo Health Care System and Dr Javaid I Sheikh, a professor of psychiatry at Stanford University School of Medicine. The survey appeared in the January 2004 issue of Psychiatric Times.

PANIC DEFINED
The Diagnostic and Statistical Manual of Mental Disorder characterizes panic disorder as repeated and unexpected panic attacks. The attacks are discrete events that consist of cardiorespiratory symptoms and physiological arousal. Sufferers often experience intense fear and an urge to flee. During an attack, at least four of the 13 established panic symptoms quickly develop and reach a peak of intensity within 10 minutes.

KEY SYMPTOMS
Drs Leskin and Sheikh also did their own study and were able to show that gender differences exist at the symptom level as well and that a significantly greater proportion of women suffered respiration-related symptoms. The researchers examined the frequency of panic symptoms in 274 men and women diagnosed with panic disorder and in 335 who experienced panic attacks.

Both sexes reported heart pounding as the most common symptom. In the panic disorder group, 72% of women experienced shortness of breath compared to 50% of men; 59% of women felt faint versus 45% for men; 60% of women felt smothered compared to 43% for men.

BUT WHY?
One explanation of the differences is that premenstrual hormonal fluctuations could cause the high number of respiratory-related symptoms in women. "As estrogen levels fall during ovulation, hyperventilation occurs in response to the higher carbon dioxide levels in expiratory respiration," stated the authors.

Dr Mark Berber, a psychiatrist at Markham-Stouffville Hospital in Markham, ON isn't exactly bowled over by this research. "I don't see it as knock-me-down research. It's more important to make physicians aware of the symptoms," said Dr Berber.

Watch for these 13 classic panic attack symptoms in your patients: sweating, trembling, unsteadiness, depersonalization, excessive heart rates, nausea, tingling, shortness of breath, fear of dying, fear of going crazy, chest pains, chills, choking.