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Panic disorder is one of several anxiety disorders that are recognised by the American Psychiatric Association, and included in their diagnostic manual which is one the most widely used diagnostic tools in Western society. Panic disorder is characterised by frequent panic attacks which are unrelated to specific situations.
A panic attack is a sudden attack of intense worry, terror and feelings of impending doom. Sufferers may also experience feelings of being outside their bodies, or feelings that the world is not real. Physical symptoms of panic attacks can be just as worrying, and include laboured breathing, heart palpitations, nausea, chest pain, feelings of being smothered, dizziness, sweating and trembling. Due to the occurrence of these panic attacks in a variety of situations, sufferers cannot explain why they occur and as many as 90% worry that they are dying or going crazy (Kring et al, 2007).
Case studies are developed and published by practitioners for several reasons. They give an insight in to what it is actually like to live with a particular disorder, and can reveal factors in a person's life that may have led to its onset. They are also useful in highlighting the differences between patients' experiences and differences in the effectiveness of treatments.
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Case Study of Panic Disorder: Mr.A (Frances & Ross, 2001)
Mr. A is a 28 year old unemployed accountant who suffers from panic disorder with agoraphobia. He cannot tolerate being left alone, and cannot go outside without a companion. Although he had been suffering the symptoms of panic disorder on and off for several years, his symptoms have worsened in the last three months, since his girlfriend left him. He has fears of losing his mind and has moved back in with his parents. He is very attached to his mother, who he fears is dying, and is dependent upon her for most things. Similarly, his mother feels very bonded to him and is willing to sacrifice her relationship with her husband and her social life to cater to him. However, despite his reliance on them, Mr.A blames both his parents for his difficulties and both loving him too much and not loving him enough.
As a child, Mr.A had severe separation anxiety and was subject to many minor illnesses. He presented with mild school refusal and was always more comfortable in the company of adults than with his peers. He remained at home throughout college and business school, and relied on his mother to act as his matchmaker. During his 20s Mr. A made several attempts to separate from his parents. However, his anxiety always got the better of him and he soon returned to the safety of his family.
Mr. A reports feeling inferior and expects criticism from others. However, he is very critical of others and reports constantly feeling let down. Anti-depressants and anti-psychotics have not had any effect on him and he has a strong tendency to become addicted to minor tranquilizers. He has also had several unsuccessful attempts at psychotherapy.
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Case Study of Panic Disorder: Julie (Barlow, 2008)
Julie is a 33 year old mother of two and has been married for 8 years. She began suffering panic attacks and anxiety three years ago. Her first experience of a panic attack was whilst driving alone on the freeway on the way to see her dying grandmother. Although her next panic attack also occurred on the freeway, they soon began occurring in other instances. She found the feelings of unreality most disturbing and became scared of anything that produced these feelings, such as alcohol or drugs. For this reason, she rarely takes her medication although she feels safer keeping it on her person at all times.
Julie experienced some separation anxiety as a child and was shy as a child and teenager. However, her anxiety improved throughout her 20s until the onset of the panic attacks. The only similar feeling Julie can report is a negative reaction to marijuana in her early 20s. This feeling of being out of control scared her and she has abstained from drugs since.
Julie can still function fairly well in her day to day life as long as she is within her self-defined safety region. She will not travel further than 10 miles from home, will not use the freeway and will avoid crowds due to both the stimulation and the fear of beginning to panic in front of others.
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Case Study of Panic Disorder: Jane (Weinstock & Gilman, 1998)
This case study gives an insight into how panic disorder was dealt with before it was well known among practitioners.
Jane was the youngest of seven children and was always shy and nervous. She was also particularly attached to her mother. Her father drank heavily which caused arguments between him and her mother, which led to her feeling very anxious. At age 17, Jane's father was murdered. Jane married at 21 and had three children between the ages of 23 and 30. Her panic attacks began at age 26, and she was particularly concerned about the physical symptoms such as a pounding heart and feelings of breathlessness. Her panic attacks occurred mostly at night and increased in frequency over a ten year period. She began to fear panic attacks each night and so did not sleep much. She was light headed most of the time and lost her appetite, causing her to become significantly underweight.
Over this ten year period Jane saw over 200 different doctors. She was misdiagnosed with a variety of ailments, which resulted in unnecessary and brutal 'treatments'. These 'treatments' included electro-convulsive therapy, the removal of her tonsils, the pulling of all her teeth, and a series of ineffective medications. Jane believed she had cancer and that she was dying, despite being told she was in good health by many of the doctors.
When Jane was 37 her husband died of a heart attack. Surprisingly, her panic attacks subsided as she was busy raising her children and working. She remarried at age 42 and continued to feel well until her new husband began drinking; causing the anxiety that had been present in her childhood to return.
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Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.
Frances, A. & Ross, R. (2001) DSM-IV-TR case studies: a clinical guide to differential diagnosis. Arlington, VA: American Psychiatric Publishing. Read about Mr.A here.
Barlow, D.H. (2008) Clinical handbook of psychological disorders: a step by step treatment manual. New York: The Guildford Press. Read about Julie here.
Weinstock, L. & Gilman, E. (1998) Overcoming panic disorder: a woman's guide. Lincolnwood, Illinois: Contemporary Books. Read about Jane here.