Dr. Steven Pence is a licensed psychologist specializing in the treatment of child and adult panic disorder near Bloomfield Hills, Birmingham, and Troy with emphasis of treatment on exposure response prevention (ERP) treatment. 


Panic disorder often begins in adolescence, although it may start during childhood, and sometimes runs in the family. If not recognized and treated, panic disorder and its complications can be devastating and can lead to agoraphobia. A panic attack is characterized by discreet period of intense fear or discomfort in which at least four from a list of thirteen standard symptoms develop abruptly and reach a peak within 10 minutes. Panic disorder is highly treatable, however left untreated, panic attacks get worse and result in severe complications that affect almost every area of life. One can develop specific phobias, avoidance of social situations, problems at school or work, depression, increased risk of suicide or suicidal thoughts, alcohol or substance abuse, and financial problems. Many individuals find themselves going to urgent care or emergency hospitals.                            

Symptoms of a panic attack may include:
A feeling of imminent danger or doom
The need to escape
Heart palpitations
Sweating
Trembling
Shortness of breath or a smothering feeling
A feeling of choking or trouble swallowing
Chest pain or discomfort    
Nausea or abdominal discomfort
Dizziness or lightheadedness
A sense of things being unreal, depersonalization
A fear of losing control or "going crazy"
A fear of dying
Tingling sensation
Chills or heat flush

Since many of the symptoms of panic disorder mimic those of illnesses such as heart disease, thyroid problems, and breathing disorders, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced they have a life-threatening illness. A doctor or other health care provider must determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, that resembles panic symptoms. One may also have a complete physical exam, blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG) to help determine how well it's functioning, and an evaluation by your doctor or mental health provider to talk about your symptoms, stressful situations, fears or concerns, relationship problems, and other issues affecting your life. A doctor also needs to rule out severe psychiatric illness such as major depression and psychosis. Substance abuse including marijuana, cocaine, and methamphetamines can also mimic symptoms of panic disorder. One of the major symptoms of panic disorder is recurrent, unexpected panic attacks. 

Factors that may play a role or may increase panic attacks:
Major stress
Death or serious illness of a loved one
Genetics, family history of panic attacks or panic disorder
Certain changes or abnormalities in the way your brain functions
Temperament that is more susceptible to stress
History of childhood physical or sexual abuse
Experience of a traumatic event 
Substance abuse

For some people, panic disorder may include agoraphobia. Agoraphobia includes avoiding places or situations that cause you anxiety because you fear that you will not be able to escape or get help if you have a panic attack.

Treatment:
Cognitive Behavioral Therapy is the  most effective and well-documented psychotherapy for panic disorder. Approximately 80% of patients respond to CBT for panic disorder and the effects appear to be more robust and more long-lasting than medication treatment alone. The main techniques used in CBT for panic disorder are relaxation training, thought restructuring, and gradual exposures.  A component of effective treatment is psychoeducation for the client and significant others including symptoms, the disorder, and specific role of fear of bodily sensations, in vivo exposure to phobic situations that create panic, hyperventilation control, and the understanding of changing maladaptive thought processes. 

Medications can help reduce symptoms associated with panic attacks as well as depression. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Benzodiazepines

Treatment Planning for Panic Disorder/ Psychiatric Times:
http://www.psychiatrictimes.com/articles/treatment-planning-panic-disorder

Evidence-Based Treatment of Panic Disorder and Agoraphobia:
https://www.ranzcp.org/Files/Resources/Publications/CPG/Clinician/APY529-pdf.aspx

Agoraphobia is defined as an anxiety about being in places or situations in which escape may be difficult. Most people with agoraphobia experience some restrictions in what they are able to do, but they are able to leave their house, especially if they are accompanied by someone they know. 

Some of the situations avoided are:
Walking in a crowded mall away from exits
Flying in an airplane
Sitting in a theater away from exits
Enclosed places such as elevators, tunnels, or small rooms
Sexual activity
Driving on highways
Walking alone in neighborhoods

https://www.psychologytoday.com/conditions/agoraphobia



Panic Disorder and Children or Teenagers:
Panic disorder can look different in young people than adults because children tend to report the physical symptoms instead of the psychological symptoms accompanying panic attacks. If left untreated, panic disorder can lead to significant worry or limitations in other areas of the child’s life. Peer relationships, family relationships, or school functioning may suffer and comorbid depression may develop. Reluctance to go to school or engage in other age-appropriate activities may result from panic disorder. Adolescents with panic disorder may self-medicate, leading to substance abuse.


​​Panic Disorder Treatment