Can Panic Attacks Lead to Self-Medicating Behaviors?
Simply having a panic attack is not considered to be a mental health disorder. Panic attacks consist of periods of extreme anxiety (and they are sometimes referred to as anxiety attacks) that are experienced by many people. Panic disorder represents a formal diagnosable mental health disorder that consists of having recurrent panic attacks and then engaging in certain types of compensatory and dysfunctional behaviors to avoid having future panic attacks.
Panic Disorder vs. Panic Attacks
A panic attack consists of an abrupt search of intense feelings of fear that typically reaches its peak within a few minutes and consists of a set of diagnosable symptoms. According to the American Psychiatric Association (APA), there are 13 potential symptoms that can be used to diagnose the presence of a panic attack. In order for an individual to experience a formal panic attack, they must exhibit four or more of the 13 symptoms. According to the professional diagnostic manual published by the APA to be used in the diagnosis of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), the 13 potential symptoms that can identify a panic attack are:
- An accelerated heart rate, heart palpitations, or pounding heart
- Shaking or trembling
- Feelings of choking or gagging
- Sensations of being smothered or shortness of breath
- Significant abdominal distress or nausea
- Chest discomfort or chest pain
- Sensations of being overheated or experiencing chills
- Feeling lightheaded, dizzy, unsteady, or even faint
- Feeling numbness or tingling sensations (paresthesias)
- Feeling detached from one’s body (depersonalization) or feeling that things are not real (derealization)
- Fearing dying or feeling like one may be dying
- Feeling that one is losing their mind or losing control
Numerous medical conditions can produce symptoms that are similar to panic attacks (e.g., issues with the thyroid gland, seizure disorders, and even cardiovascular conditions). Individuals who use/abuse stimulant medications may experience panic attack-like symptoms. Even though these conditions may produce anxiety attacks that are very similar to panic attacks, they would not be formally diagnosed as panic attacks, as true panic attacks are not considered to have traceable physiological causes. True panic attacks typically appear to come out of nowhere, produce very intense feelings of anxiety and at least four of the above symptoms, and then dissipate. In some cases, individuals may experience panic attacks that are associated with specific situations; these panic attacks are often referred to as expected panic attacks.
According to the DSM-5, simply having panic attacks is not diagnosable as a formal mental health disorder. Panic disorder is a true psychological/psychiatric disorder where the individual experiences recurrent panic attacks and then engages in a period lasting for one month or longer of one or both of the following:
- Persistent concern, worry, or rumination about having additional panic attacks or consistent worry about the consequences of having additional panic attacks
- Engaging in a maladaptive change in behavior related to concern for having panic attacks, such as trying to avoid situations where an attack may occur (e.g., never leaving their home)
Individuals cannot be diagnosed with panic disorder if their behaviors/symptoms are due to the use of some substance of abuse or medication, some other medical condition (e.g., hyperthyroidism or hypothyroidism), or can be better explained by some other mental health disorder.
Facts about Panic Disorder and Panic Attacks
According to APA and other sources, such as the book Kaplan and Sadock’s Synopsis of Psychiatry:
- The 12-month prevalence for panic disorder in the US is approximately 2-3 percent.
- The 12-month prevalence estimates for panic attacks in the US is around 11.2 percent in adults.
- Panic attacks may occur in children, but they are relatively rare until children reach puberty when the prevalence rates for panic attacks increase. APA reports that the prevalence rate for panic disorder in children under 14 is less than 0.4 percent.
- Prevalence rates for panic attacks in older individuals are also lower than the general 12-month prevalence rate.
- The median age of onset for panic disorder is 24 years old.
- Females are far more likely to experience panic attacks and be diagnosed with panic disorder than males. Females are affected with panic disorder at a rate of 2:1 to males.
- Currently, there are no identified causes for panic disorder. Most researchers believe that the disorder represents an interaction between genetic factors and experience (environmental factors).
Panic Disorder, Panic Attacks, and Substance Abuse
The experience of having an occasional panic attack is a relatively common occurrence and is most likely not associated with the development of significant substance abuse. Many people experience transient issues with anxiety that dissipate over time. These rather typical experiences are not considered to be significant enough to dispose individuals to develop substance use disorders in most cases. In instances where the experience of occasional panic attacks is associated with individuals turning to drugs or alcohol as compensatory strategies, most sources propose that these individuals have some other co-occurring mental health condition prior to their substance use/abuse.
Panic disorder is classified as an anxiety disorder. Anxiety disorders are mental health disorders that have issues with dysfunctional anxiety as their main feature. All individuals who have any form of mental health disorder will experience some level of anxiety. In order for a disorder to be classified as an anxiety disorder, the primary feature associated with the disorder is the experience of dysfunctional anxiety; dysfunctional anxiety is generally denoted as anxiety that is out of proportion to a given situation or inappropriate given the situation.
Individuals who develop anxiety disorders are at an increased risk to develop other forms of mental health disorders, including an increased risk to develop substance use disorders. Numerous large-scale studies have demonstrated this relationship. The findings from the National Epidemiologic Survey on Alcohol and Related Conditions indicate that it is more common to have a co-occurring diagnosis of an anxiety disorder and a substance use disorder than to have a diagnosis of an anxiety disorder without a co-occurring substance use disorder.
Individuals who are diagnosed with panic disorder follow the same pattern as individuals diagnosed with other anxiety disorders regarding the relationship of substance abuse to their anxiety disorder. Overall, the research suggests that at least one-fifth of people diagnosed with panic disorder also have a co-occurring substance use disorder. The most common substances of abuse for individuals with anxiety disorders include alcohol, central nervous system depressant drugs (e.g., benzodiazepines, narcotic pain medications, sedatives, etc.), cannabis products, and tobacco products.
The significant association between being diagnosed with an anxiety disorder, such as panic disorder, and also being diagnosed with a co-occurring substance use disorder is not as simple to explain as it may appear. The notion that individuals with panic disorder begin to use substances in an effort to self-medicate their symptoms is valid in some cases, but it fails as an overall explanation of the relationship between substance abuse and panic disorder. Information provided by sources, such as APA, the National Epidemiological Survey on Alcohol and Related Conditions, and other research sources, indicates the following:
- Not everyone who has a dual diagnosis of a substance use disorder and an anxiety disorder reportedly experienced the symptoms of their anxiety disorder before they began using/abusing their drug of choice.
- Alcohol abuse is the most common form of drug abuse engaged in by individuals with anxiety disorders. While many people report that they begin using alcohol to decrease their issues with anxiety, they actually find that using alcohol worsens their anxiety or panic attacks. Even in cases where people find that the use of alcohol results in exacerbation of their anxiety, they continue to use the drug. This is counterintuitive to the self-medication hypothesis.
- Interestingly, research studies investigating the relationship between panic disorder and substance abuse have found that, in many cases, individuals developed a formal substance use disorder before their panic disorder was recognized. Again, this is counterintuitive to the self-medication hypothesis.
- A risk factor for developing certain conditions that are associated with significant amounts of dysfunctional anxiety (e.g., post-traumatic stress disorder) is having a prior substance abuse issue or a previous diagnosis of a substance use disorder. Again, this is counterintuitive to the self-medication explanation.
While it is true that in some cases individuals may begin to use drugs or alcohol to self-medicate and deal with their anxiety, research indicates that the relationship between substance abuse, substance use disorders, and anxiety disorders is quite complex and most likely involves significant genetic vulnerabilities interacting with experience that resulted in individuals being more vulnerable to develop any type of mental health disorder. Individuals who meet the diagnostic criteria for any formal mental health disorder are at an increased risk to be diagnosed with some other disorder, including a substance use disorder.
If an individual primarily used their substance of choice as an effort to self-medicate their issues with panic disorder then simply treating the panic disorder and removing the stress associated with that disorder would result in the individual regulating their substance use. Unfortunately, it is not that simple.
It is well known that whenever an individual has a dual diagnosis (a diagnosis of some formal mental health disorder and a co-occurring substance use disorder), both disorders must be treated at the same time. Attempting to treat one disorder while holding the other disorder constant or ignoring it often has disastrous consequences and does not result in the individual achieving any significant gains in the resolution of either disorder. In fact, treating a person’s panic disorder and ignoring their substance use disorder often results in the substance use disorder getting worse.