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Anxiety Attacks and Anxiety Disorders

Common Problems for People With Bipolar Disorder

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Updated August 25, 2009

Anxiety attacks are fairly common in people who have bipolar disorder. In fact, researchers involved with STEP-BD -- the largest treatment study of bipolar disorder conducted to date -- found that more than half the study participants with bipolar disorder also had a comorbid anxiety disorder.

What Is an Anxiety Attack?

There is no formal psychiatric definition of "anxiety attacks." When the term is used, people are most often referring to a panic attack, which does have one. In a panic attack, a person feels sudden and intense fear, even to the point of terror, without the presence of actual danger. Some symptoms are pounding heart, chest pain, sweating, light-headedness, nausea, shortness of breath or choking sensations, trembling, and feeling detached from reality. Many people who first experience such an anxiety attack think they are having a heart attack.

There are few figures available on the comorbidity of bipolar disorder and panic attacks, but one limited study published in 2004 found that 32% of the participants with bipolar disorder experienced panic attacks.

Panic Disorder

In panic disorder, a person suffers from sudden and frequent panic attacks. Some studies have found that around 20% of people with bipolar disorder also have panic disorder. Thus, if you are experiencing what you call anxiety attacks, take them seriously and talk to your mental health provider.

Agoraphobia is a type of intense fear that can develop in people who have panic disorder. It can also occur without accompanying panic symptoms. People with agoraphobia are afraid to be in any place that might cause or be hard to escape anxiety attacks. Agoraphobia can be so severe that the sufferer refuses to leave his or her home.

Here is an overview of anxiety disorders that may co-occur with bipolar disorder. As such, they could cause those with BP to suffer anxiety attacks:

Generalized Anxiety Disorder (GAD)

GAD is a condition characterized by excessive worry and physical symptoms of anxiety that have been present for at least six months. The anxiety can be related to a situation or event or can be irrational. The person has significant difficulty controlling the anxiety, and the anxiety causes substantial distress or problems in everyday life. For GAD to be diagnosed, at least three of these additional symptoms of anxiety must be present as well: restlessness, muscle tension, fatigue, sleep disturbances, concentration problems and irritability. Persons who have GAD may suffer anxiety attacks.

GAD has been widely reported to accompany bipolar disorder. However, additional research is needed in this area.

Post-Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that develops after a traumatizing event such as rape, assault, disasters (natural or otherwise), accidents or military combat. There are many symptoms of PTSD. Some of the most common are flashbacks to the event, recurring nightmares, having difficulty remembering all or part of the event, sleep disturbances, outbursts of anger, and having strong negative reactions to reminders of the event. Symptoms must be present for more than a month for PTSD to be diagnosed.

More than one study has found that people with bipolar disorder often report having suffered childhood abuse (physical and/or sexual). In one such study of 330 veterans with bipolar disorder, most of them men, almost half the men had undergone some kind of abuse in children. Thus, it is not surprising that PTSD and bipolar disorder are often diagnosed together.

Anxiety Attacks from Medications

Some psychiatric medications can cause anxiety attacks as a side effect, especially during the first days or weeks of use. Whenever you start a new medication, check the literature that accompanies it so you will recognize a side effect if it occurs. You may also check our Side Effects Library if you are experiencing anxiety attacks or any other symptom you believe may be a side effect of one of your medications.

If you do experience anxiety symptoms after starting a new medication, contact your doctor as soon as possible.

Want to learn more about what could be causing your anxiety? Visit the About.com Symptom Checker for a personalized possibility assessment.

Sources:

Brown, GR, et al. Impact of childhood abuse on the course of bipolar disorder: a replication study in U.S. veterans J Affect Disord. 2005 Dec;89(1-3):57-67. Epub 2005 Oct 4.

Chen, YW, Dilsaver, SC. Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area Survey. Am J Psychiatry. 1995; 152:280-282.

Doughty, CJ, et al. Bipolar-panic disorder comorbidity within bipolar disorder families: a study of siblings. Bipolar Disorders. 2004 Jun;6(3):245-52.

Yatham, Lakshmi, and Kusumakar, Vivek, ed. Bipolar Disorder: A Clinician's Guide to Biological Treatments. 2nd Edition. New York: Routledge, 2009 (227).

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