Have you ever experienced a sudden and intense rush of fear or discomfort? If so, you may be one of the 30% of people who has had a panic attack at some point during their lifetime. The symptoms of a panic attack can vary. Some people feel their heart start to race, whereas others experience sweating, trembling and shaking, stomach distress, or tingling sensations. A panic attack can often feel overwhelming, and it can be a very frightening experience. Although panic attacks can sometimes take people by surprise, they are often related to the kinds of fears that people have, so they come to be expected in certain situations.

Some people with social anxiety disorder tend to get panic attacks when they are in an anxiety-provoking social situation, like giving a speech or talking to a stranger. This means that their panic attacks are related to their social anxiety disorder. This overlap of social anxiety and panic attacks happens so often that a major change was introduced in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—a "panic attack specifier" can now be applied to any psychiatric diagnosis. In other words, a person whose panic attacks are related to their social anxiety disorder would now receive a diagnosis of "Social Anxiety Disorder with Panic Attacks." Assigning diagnoses this way certainly helps give clinicians a better understanding of their patients' symptoms. But, what else does it tell us? Do socially anxious patients who get panic attacks differ from those who do not in other important ways?

When Panic Attacks and Social Anxiety Combine

Together with colleagues from Columbia University, we have been studying these questions and more. We wanted to find how a panic attack specifier may help us better understand people with social anxiety disorder. In one study, we examined the responses of 1,138 people with social anxiety disorder who had taken part in a large national survey of mental disorders; about one-quarter of these individuals experienced social anxiety-related panic attacks.

Our observations suggest that there is a significant difference between social anxiety disorder with versus without panic attacks. Those with social anxiety-related panic attacks seemed to have more severe and complicated cases of social anxiety disorder. They exhibited the following:

  • Stronger social anxiety. They had a stronger fear of social situations and they were more likely to avoid feared social situations.
  • Harmful coping skills. Our findings show a higher likelihood to use alcohol and illicit drugs to cope with their social anxiety.
  • Higher risk for other psychiatric disorders. They were also more likely to have other kinds of psychiatric disorders in addition to social anxiety disorder.

We were surprised to find that those with panic attacks were much more likely to have received a new diagnosis of a psychotic disorder by the end of the survey. However, this suggests that the panic attack specifier might highlight people with social anxiety disorder who are especially at risk for developing serious mental illness.

Why The Panic Attack Specifier Is Important

One thing remains clear from our findings: social anxiety disorder isn't a blanket diagnosis. Determining whether social anxiety is accompanied by panic attacks or not is crucial to better understanding one's mental health.

Since many other studies have found similar implications of the panic attack specifier within other types of psychiatric disorders, future research should focus on examining why people who get panic attacks are more at risk for experiencing complicated and impairing mental health issues. Are panic attacks a manifestation of an underlying biological or psychological vulnerability? Getting to the bottom of panic attacks and how they affect our overall mental health can help guide the development of effective prevention programs for a broad range of psychiatric disorders.

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