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Section 16
Panic Attack Target Populations

Question 16 | Answer Booklet | Table of Contents | Printable Page

All people experience various levels of anxiety as they go through life. Usually an individual's anxiety level shifts almost imperceptibly as he or she copes with a potentially difficult, fearful, or even dangerous situation.^ Anxiety is a typical and normal reaction to stress, and a certain amount of it may often be appropriate. Anxiety may be considered normal, but panic attacks—discrete periods of intense fear that occur in the absence of any real danger—are not. Panic attacks are accompanied by symptoms such as chest pain, sweating, trembling, shortness of breath and palpitations. During attacks people may feel that they are choking, losing control or "going crazy." They may express a fear of dying and feel the urge to escape. The attacks occur suddenly, usually peak within 10 minutes and may occur at night, waking the individual from
sleep.

Panic attacks
Panic attacks are discrete periods of intense fear that occur in the absence of any real danger (see Definitions and Annex). According to the 2002 CCHS, over 5 million people in Canada, or 2 1 % of the population aged 15 or older, had had a panic attack at some point during their lives (data not shown). Almost 2 million, or 8%, reported having had an attack in the year before their survey interview.  Women were more likely than men to be affected (10% versus 6%). Panic attacks were more common at younger ages; for example, 12% of 15- to 24-year-olds had had a panic attack in the past 12 months, compared with 4% of people aged 55 or older.

Panic disorder more common among women
According to the CCHS, 3.7% of the Canadian population aged 15 or older have suffered from panic disorder—recurrent, unexpected panic attacks—at some point during their lives. This rate is higher than expected based on other international community surveys.'" Because the CCHS did not apply the exclusion criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV*-TR)^ (see Limitations), the rates may be inflated. In 2002, the lifetime prevalence of panic disorder was higher for women (4.6%) than men (2.8%) a finding consistent with other studies.  In the CCHS, the female-to-male ratio was 1.7. An estimated 1.5% of Canadians had panic disorder in 2002 (current); another 2.1% had a past history of the disorder.

Mid-twenties onset
As seen in other studies of panic disorder first appears most often in the younger age groups. The CCHS results show that people younger than 55 were more likely to have current panic disorder than those aged 55 or older.  The average age of onset for lifetime panic disorder was 25; for 75% of those with the disorder, it had begun by age 33.

Marital status, education and income
In 2002, panic disorder {current and past) was more common among individuals who were separated or divorced than among those who were married, a finding consistent with other research/ The higher prevalence among this group may reflect an association between stressful life events and the development of panic disorder/" For example, a review that focused specifically on panic disorder with agoraphobia concluded that major life events— including marital and interpersonal problems—tend to occur in the period preceding the disorder/' Lower education and income levels were also associated with the presence of panic disorder. The prevalence of current panic disorder was higher among individuals whose education had ended with secondary graduation, compared with those who had postsecondary education. People with less than secondary graduation were no more likely to have current or past panic disorder than those with postsecondary graduation, in contrast to previous research.

People in lower household income groups were more likely to have current panic disorder than were those at higher income levels. It is possible that lower income is indicative of other stressful circumstances that contribute to the illness, or that the disorder itself leads to reduced income when people with panic disorder are unable to work. Although it has been suggested that panic disorder is most prevalent in urban areas/ this was not the case in the CCHS.

Other physical and mental illnesses
Among those with current panic disorder, three quarters {76%) reported at least one diagnosed chronic condition. Among people with past panic disorder, the proportion with at least one such illness was slightly lower {68%), yet it exceeded the figure for those who had never had panic disorder {54%).

The presence of other mental disorders is fairly common among people who have experienced panic disorder.  Almost half of those with current panic disorder {48%) had also had agoraphobia, social anxiety disorder, post-traumatic stress disorder, or a major depressive episode in the preceding 12 months. This is significantly more than the 20% of people with past panic disorder. Both groups were more likely to have had one of these mental illnesses in the past year than the rest of the population (7%).

Although many people with current panic disorder did not have another mental disorder in the year before the survey interview, they may have had one or more in the past: 22% had a history of agoraphobia, social anxiety disorder, or a major depressive episode (see Limitations). Among people with a history of panic disorder, 46% had an accompanying history of at least one of these other mental disorders.

Less likely to work
People aged 25 to 64 who had panic disorder in the 12 months before the CCHS interview were less likely to have worked at a job or business during that time (72%) than those who had panic disorder in the past (82%) or who had never had the condition (84%) (data not shown). Individuals with current panic disorder were also more likely to be permanently unable to work: 11 % compared with 2% for those with past panic disorder or who never had the condition. When sociodemographic factors were taken into account, individuals with current panic disorder had higher odds of being permanently unable to work than those who had never had the disorder. And even when other physical and mental health problems were also considered, these relationships held.

By contrast, there was no difference in work status— not working in the past year or being permanently unable to work—between those with a history of panic disorder and those who had never had the disorder. In other words, the work status of people who experience remission for a year or more and those with no history of panic disorder appears to be similar.

Seeking help
It has been reported that a high proportion of people with panic disorder use medical services a finding supported by results from the CCHS. All CCHS respondents were asked if they had ever seen or talked on the telephone to a professional about their emotions, mental health or use of alcohol or drugs.

About 70% of those with panic disorder (current or past) had consulted a medical professional (psychiatrist, family doctor, other medical doctor, or psychologist) about these concerns, compared with 18% of people who had never had panic disorder. Almost half (48%) of the people who currently had panic disorder had had a consultation in the past year. Even after demographic and other mental and physical health characteristics were taken into account, people with panic disorder had almost six times the odds of having consulted a medical professional about their mental health compared with people without the disorder.

CCHS respondents who had experienced recurrent unexpected panic attacks were specifically asked if they had consulted a medical doctor or other professional about their attacks (data not shown), The term "professional" was used more broadly in this question to include social workers, counselors, spiritual advisors, homeopaths, acupuncturists and
self-help groups. About 73% of people with panic disorder (past or current) reported such a consultation. Women were significantly more likely than men to have sought help: 77% compared with 65%.Those who had sought help for their attacks were asked if they had ever received helpful or effective treatment. Seven out of ten answered positively.

However, this means that, overall, just half of the people with current or past panic disorder received effective help. Some lack of satisfaction may result if the panic attacks remain undiagnosed or are misdiagnosed. Other studies have concluded that many people with panic disorder seek help at emergency departments where their disorder remains unrecognized or misdiagnosed.
- Ramage-Morin, Pamela; Panic Disorder Target Populations; Supplement to Health Reports; 2004; Vol. 15, p 31-39
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #2
The preceding section contained information about target populations for panic disorder.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 16
According to Ramage-Morin, what is the cut-off age for a high incidence of panic attacks? Record the letter of the correct answer the Answer Booklet.


Answer Booklet for this course
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The article above contains foundational information. Articles below contain optional updates.
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