Editing Panic attack (section)

==Causes==
[[File:The Fight or Flight Response.png|thumb|The Fight or Flight Response that may present with symptoms that can induce a panic attack.]]
Panic attacks can be caused by a mix of factors. Biological factors that may lead to panic attacks include psychiatric disorders such as [[post-traumatic stress disorder]] (PTSD) and [[obsessive–compulsive disorder]] (OCD), heart conditions, low blood pressure, and an overactive thyroid. Imbalance of the [[norepinephrine system]], which is responsible for coordinating the body's [[fight-or-flight response]], has been linked to panic attacks as well.<ref name="Abnormal Psych">{{cite book |last1=Nolen-Hoeksema |first1=Susan |title=(Ab)normal Psychology |date=2013 |publisher=McGraw Hill |isbn=978-0-07-803538-8 |edition=6th}}{{page needed|date=January 2021}}</ref>

Panic disorder tends to arise in early adulthood, though it can occur at any age. It is more common in women and usually arises more in individuals with above-average intelligence.<ref>{{Cite web|last=Marquardt|first=David Z. Hambrick, Madeline|title=Bad News for the Highly Intelligent|url=https://www.scientificamerican.com/article/bad-news-for-the-highly-intelligent/|access-date=26 January 2021|website=Scientific American|date=March 2018 |language=en|archive-date=27 January 2021|archive-url=https://web.archive.org/web/20210127153342/https://www.scientificamerican.com/article/bad-news-for-the-highly-intelligent/|url-status=live}}</ref><ref>{{Cite journal | title=Gender Differences in Panic Disorder | url=https://www.psychiatrictimes.com/view/gender-differences-panic-disorder | access-date=26 January 2021 | journal=Psychiatric Times | series=Psychiatric Times Vol 21 No 1 | date=January 2004 | volume=21 | issue=1 | last1=Gregory a. Leskin | first1=PhD | archive-date=23 January 2021 | archive-url=https://web.archive.org/web/20210123182650/https://www.psychiatrictimes.com/view/gender-differences-panic-disorder | url-status=live }}</ref> Research involving identical twins has shown that if one twin has an anxiety disorder, the other is likely to have one too.<ref>{{cite journal |last1=Davies |first1=Matthew N. |last2=Verdi |first2=Serena |last3=Burri |first3=Andrea |last4=Trzaskowski |first4=Maciej |last5=Lee |first5=Minyoung |last6=Hettema |first6=John M. |last7=Jansen |first7=Rick |last8=Boomsma |first8=Dorret I. |last9=Spector |first9=Tim D. |title=Generalised Anxiety Disorder – A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression |journal=PLOS ONE |date=14 August 2015 |volume=10 |issue=8 |pages=e0134865 |doi=10.1371/journal.pone.0134865 |pmid=26274327 |pmc=4537268 |bibcode=2015PLoSO..1034865D |doi-access=free }}</ref>

Panic attacks may also occur due to short-term stressors. Major personal losses, like the end of a romantic relationship, life transitions such as jobs or moving,  and other significant life changes may trigger a panic attack. Individuals who are naturally anxious, need a lot of reassurance, worry excessively about their health, have an overcautious view of the world, and have cumulative stress are more likely to experience panic attacks.<ref name="Bourne2005" /><ref name="Panic disorder">{{cite journal |last1=Taylor |first1=C Barr |date=22 April 2006 |title=Panic disorder |journal=BMJ |volume=332 |issue=7547 |pages=951–955 |doi=10.1136/bmj.332.7547.951 |pmc=1444835 |pmid=16627512}}</ref> For adolescents, social transitions, such as changes in classes and schools, may also be a contributing factor.<ref>William T. O‘Donohue,· Lorraine T. Benuto, Lauren Woodward Tolle (eds, 2013). Handbook of Adolescent Health Psychology, Springer, New York. {{ISBN|978-1-4614-6632-1}}. Page 511</ref>

People often experience panic attacks as a direct result of exposure to specific fears or [[phobia]]s. A situation can become associated to panic if someone has had a previous reaction before in similar contexts. 

Substances may also induce panic attacks. For example, discontinuation or reduction in the dose of a drug ([[drug withdrawal]]) without tapering can cause panic attacks. Other substances that are commonly known to be associated with panic attacks include [[Cannabis (drug)|cannabis]] and nicotine.<ref name="Harvard Mental Health Letter, 2010">{{cite web |title=Medical marijuana and the mind - Harvard Health |url=http://www.health.harvard.edu/mind-and-mood/medical-marijuana-and-the-mind |url-status=live |archive-url=https://web.archive.org/web/20160821162716/http://www.health.harvard.edu/mind-and-mood/medical-marijuana-and-the-mind |archive-date=21 August 2016 |access-date=14 August 2016}}</ref><ref>{{cite journal |last1=Zvolensky |first1=Michael J. |last2=Gonzalez |first2=Adam |last3=Bonn-Miller |first3=Marcel O. |last4=Bernstein |first4=Amit |last5=Goodwin |first5=Renee D. |date=February 2008 |title=Negative reinforcement/negative affect reduction cigarette smoking outcome expectancies: Incremental validity for anxiety focused on bodily sensations and panic attack symptoms among daily smokers |journal=Experimental and Clinical Psychopharmacology |volume=16 |issue=1 |pages=66–76 |doi=10.1037/1064-1297.16.1.66 |pmid=18266553}}</ref>

===Panic disorder===
{{Main|Panic disorder}}

People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of [[anxiety disorder]]s in that panic attacks are often sudden and unprovoked.<ref name="familydoctor">[http://familydoctor.org/familydoctor/en/diseases-conditions/panic-disorder.html Panic Disorder – familydoctor.org<!-- Bot generated title -->] {{webarchive|url=https://web.archive.org/web/20140203235458/http://familydoctor.org/familydoctor/en/diseases-conditions/panic-disorder.html |date=3 February 2014 }}</ref> However, panic attacks experienced by those with panic disorder may also be linked to or heightened by exposure to certain places or situations, making daily life difficult.<ref>[http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Anxiety_Disorders.htm "Anxiety Disorders"] {{webarchive|url=https://web.archive.org/web/20140412144344/http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Anxiety_Disorders.htm |date=12 April 2014 }}</ref>

If a person has repeated and unexpected panic attacks, this could be a potential sign of panic disorder.<ref name="NIH2013" /> According to the DSM-5, panic disorder can be diagnosed if a patient has not only recurrent panic attacks but also experiences at least a month of anxiety or worry about having additional attacks. This concern may lead to the person to modify their behavior to avoid situations that triggered the attack. Panic disorder cannot be diagnosed if the patient has another disorder that is causing the panic attacks (e.g., [[social anxiety disorder]]).<ref name=":4" />

Patients affected by panic disorder can struggle with depression and a diminished quality of life. Compared to the general population, they are also at increased risk for [[substance abuse]] and [[addiction]].<ref name=":4" />

===Agoraphobia===
{{Main|Agoraphobia|Hikikomori}}
Panic disorder frequently presents with [[agoraphobia]], which is an [[anxiety disorder]] where the individual presents with fear of a situation from which they cannot leave or escape, especially if a panic attack occurs. People who have had a panic attack in certain situations may develop [[phobia]]s of these situations and begin to take measure to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house, preferring the comfort of remaining in a safe and known place.<ref>{{Cite journal |last1=Shin |first1=Jin |last2=Park |first2=Doo-Heum |last3=Ryu |first3=Seung-Ho |last4=Ha |first4=Jee Hyun |last5=Kim |first5=Seol Min |last6=Jeon |first6=Hong Jun |date=2020-07-24 |title=Clinical implications of agoraphobia in patients with panic disorder |url=https://journals.lww.com/md-journal/fulltext/2020/07240/clinical_implications_of_agoraphobia_in_patients.104.aspx |journal=Medicine |language=en-US |volume=99 |issue=30 |pages=e21414 |doi=10.1097/MD.0000000000021414|pmid=32791758 |pmc=7387026 }}</ref> At this stage, the person is said to have panic disorder with agoraphobia.<ref>{{Cite journal |last1=Perugi |first1=Giulio |last2=Frare |first2=Franco |last3=Toni |first3=Cristina |date=2007 |title=Diagnosis and treatment of agoraphobia with panic disorder |url=https://pubmed.ncbi.nlm.nih.gov/17696574/ |url-status=live |journal=CNS Drugs |volume=21 |issue=9 |pages=741–764 |doi=10.2165/00023210-200721090-00004 |issn=1172-7047 |pmid=17696574 |s2cid=43437233 |archive-url=https://web.archive.org/web/20210224161207/https://pubmed.ncbi.nlm.nih.gov/17696574/ |archive-date=24 February 2021 |access-date=3 February 2021}}</ref>

In Japan, people who exhibit extreme agoraphobia to the point of becoming unwilling or unable to leave their homes are referred to as ''[[Hikikomori]]''.<ref>{{Cite journal|last1=Bowker|first1=Julie C.|last2=Bowker|first2=Matthew H.|last3=Santo|first3=Jonathan B.|last4=Ojo|first4=Adesola Adebusola|last5=Etkin|first5=Rebecca G.|last6=Raja|first6=Radhi|date=3 September 2019|title=Severe Social Withdrawal: Cultural Variation in Past Hikikomori Experiences of University Students in Nigeria, Singapore, and the United States|url=https://doi.org/10.1080/00221325.2019.1633618|journal=The Journal of Genetic Psychology|volume=180|issue=4–5|pages=217–230|doi=10.1080/00221325.2019.1633618|issn=0022-1325|pmid=31305235|s2cid=196616453}}</ref> This term is used to describe both the person and the phenomenon. After first being defined by the Japanese Ministry of Health, Labor, and Welfare, a national research task force refined the definition as "the state of avoiding social engagement (e.g., education, employment, and friendships) with generally persistent withdrawal into one’s residence for at least six months as a result of various factors."<ref>{{Cite journal |last1=Teo |first1=Alan R. |last2=Gaw |first2=Albert C. |date=June 2010 |title=Hikikomori, a Japanese Culture-Bound Syndrome of Social Withdrawal?: A Proposal for DSM-5 |url=https://journals.lww.com/00005053-201006000-00010 |journal=Journal of Nervous & Mental Disease |language=en |volume=198 |issue=6 |pages=444–449 |doi=10.1097/NMD.0b013e3181e086b1 |issn=0022-3018 |pmc=4912003 |pmid=20531124}}</ref>