Panic Disorder: The Complete Guide Singapore (2022)

Updated: Jan 12


The complete guide to panic disorders in Singapore (2021)

Panic disorders are frequent panic onsets and can be hard to manage. frankie tells you all the need-to-knows about panic disorders.


In this article

  1. What are panic disorders?

  2. What are the different types of panic disorders?

  3. What causes panic disorders?

  4. What are the symptoms of panic disorder?

  5. How can panic disorders affect your life?

  6. Panic disorders vs anxiety disorders

  7. How are panic disorders diagnosed?

  8. What are the treatments for panic disorders?

  9. Where can I get treatment for panic disorders in Singapore?

  10. Self-care for panic disorders

  11. How can you prevent panic attacks?


What are panic disorders?


Panic disorders are a type of anxiety disorder characterized by recurring panic attacks. Panic attacks are periods of overwhelming fear that occur suddenly and peaks quickly. Due to the unpredictability, and sometimes irrationality of panic attacks, it was mistaken as a neurochemical disorder. [1]


What are the different types of panic disorder?


There are several ways of categorizing panic disorders. In the Japanese Journal of Psychiatry and Neurology, it is categorized into four types. [2] However, the DSM-V definition of panic disorders are only diagnosed after a recurrence and, effectively has three types:

  • Type 1: recurring panic attacks with neurotic or depressive symptoms

  • Type 2: recurring panic attacks and the development of comorbidities such as other anxiety disorders, hypochondriasis

  • Type 3: recurring panic disorders with depressive symptoms that develop during it. Type 3 is further divided into subtypes.

  • Type 3-1: symptoms of depression emerge and becomes major depression alongside panic disorder

  • Type 3-2: panic disorder morphs into just major depression

  • Type 3-3: panic attacks and depressive symptoms are separate from each other.

The most common types of panic disorders are type 2 and type 3-1. Agoraphobia was initially considered a type 2 panic disorder. However, in the DSM-V, agoraphobia became a separate condition from panic disorder because of accounts of the presence of agoraphobia without panic disorder. [3]


The American Psychiatric Association also published a review that outlined panic disorders differently:

The different panic disorder subtypes

Nocturnal panic subtype

Nocturnal panic attacks are when an individual wakes suddenly due to a surge of fear and discomfort. An average attack lasts from two to eight minutes. The condition appeared to be relatively common within the panic disorder population, with 58% of panic disorder patients reporting having experienced waking up in a panic attack. [4]


Non-fearful panic subtype

It sounds unusual, but Non-fearful Panic Disorder (NFPD) is seen in some medical patients. They don’t feel fear of dying or losing control like in most panic disorders but retain many of the same symptoms outlined by the DSM-V. [5]

Respiratory subtype

Though most panic attacks do present respiratory abnormalities, respiratory subtypes diagnosis would have to include four out of five of these symptoms: [6]

  • Feeling smothered or choked

  • Shortness of breath

  • Discomfort or pains in chest area

  • Numbness

  • Fear of dying


Cognitive subtype

This diagnosis is given to patients who feel overcome by intense fear but lack the physical symptoms of a panic attack. [7]


What causes panic disorders?

The exact causes are not clear. Some theories that explain why panic disorders happen are [8]:


Genetics

There is not enough research definitive of panic disorders being hereditary. However, there still is research showing the increased manifestation of the condition in families with histories of panic disorder. [9]


In the journal article Neuroanatomical Hypothesis of Panic Disorder, it reasons that though fear is learned, a more sensitive central nervous system can be passed down to offspring. [10] [11]


Traumatic events

Panic attacks are a common symptom of Post-Traumatic Stress Disorder. Reliving the past negative memories or being reminded of them may trigger intense fear. Trauma survivors reported that panic attacks could be both triggered or out of the blue. [12]


What are the symptoms of panic disorder?


Someone experiencing a panic attack will go through a whole laundry list of symptoms.

Some physical tell-tales of panic disorders are [13] :

  • Heart palpitations or increased heart rates

  • Sweating or having chills

  • Trembling

  • Feeling smothered or having difficulty breathing

  • Feeling of being choked

  • Pain of discomfort in the chest

  • Nausea

  • Feeling faint

  • Numbness and tingling sensations

Apart from these physical symptoms, the individual suffering may also go through these cognitive symptoms [14]:

  • Derealization or depersonalization

  • Fear of dying

  • Fear of losing control or going crazy



How can panic disorders affect your life?


People who experience frequent panic attacks might struggle to work or perform at school due to interruptions to their day. Due to the symptoms of panic attacks, though it has been proven to be rare, there is a possibility of fainting.


Even without fainting, symptoms also hinder daily activities, and can be potentially dangerous. For example, carrying a cup of hot coffee and spilling due to shaking hands could burn you. Driving while feeling faint and nauseous could result in accidents.


In a study of symptoms between panic disorder (PD) and post-traumatic stress disorder (PTSD) patients, PD patients faced twice as many intrusive thoughts as compared to PTSD patients. Both groups also experienced dissociating as a form of coping mechanism. [15]


Untreated, panic disorder can lead to other comorbidities and even social isolation.


Panic disorders vs anxiety disorders


Panic disorders are a subset of anxiety disorders. While panic disorders and anxiety orders do share some similar physical symptoms, they are not the same thing. [16] To start, anxiety attacks are not officially written into the DSM-V.


Anxiety attacks demarcate the threshold of anxiety that an individual has. Anxiety attacks are usually the peak of a build-up of worry about certain stressors. Individuals experiencing anxiety attacks usually feel better after the event they were concerned about has passed.


In comparison, panic attacks take over more abruptly and sometimes do not have any triggers that the individual can identify. During a panic attack, fear is so overwhelming it presents itself in physical symptoms. Symptoms of panic attacks exhibit themselves physically, while anxiety attacks may not.


How are panic disorders diagnosed?


To diagnose panic disorders, doctors need to rule out other potential illnesses. A physical exam will typically take place to ensure that there are no other underlying conditions that may result in panic attacks.


One common physical ailment with panic attacks as a symptom are thyroid diseases. Problems within the thyroid gland can affect mood in a major way, often causing comorbidities such as anxiety and depression. One symptom of thyroid disease is panic attacks. [17]


Since the main diagnostic criteria for panic disorders are recurrent panic attacks, there aren’t any other tests that doctors need to conduct. However, an individual getting diagnosed with panic attacks may be asked a series of questions to better understand the symptoms that they experience.


This is so that treatment can be created specifically to target pressing problems that come with panic attacks such as suicidal ideation or dissociation.


What are the treatments for panic disorders?


Panic disorders can be debilitating and difficult to manage, especially if the individual and the people around them are not aware of the condition. Individuals experiencing panic attacks should seek treatment immediately.


The most effective form of treating panic disorders is usually a combination of psychotherapy and pharmacotherapy.


Psychotherapy

Two types of psychotherapy commonly used to manage psychotherapy are cognitive behavioral therapy and exposure therapy.

  • Cognitive behavioral therapy (CBT)

Panic disorders might be unpredictable, and the lack of preventive measures make it difficult to get a handle on.


With CBT, the individual is given help to restructure thinking surrounding their immediate thoughts about the severity of what they are experiencing. For example, during a panic attack, patients report a paralyzing fear of death. CBT helps to remind themselves that the episode will pass without the feared outcome.


Due to the heightened comorbidities of panic disorders like anxiety or depression, CBT can also target those problems.


In a study, people were also more receptive to psychotherapy. Patients who dropped out of CBT were 5.6% as compared to those who need not upkeep with medicine intake at 19.8%. Combined treatment methods, although most effective when completed, had a drop-out rate of 22%. [18]

  • Exposure therapy

Used to anxiety and panic disorders, exposure therapy is used to help people get over their fears by facing them. There are different types of exposure therapy to overcome different types of fears.

  • In vivo exposure: This is the standard type of exposure therapy. The patient is directly exposed to the thing that they fear.

  • Imaginal exposure: Using this type of exposure therapy, the patient will be asked to visualize their fears. Describing the details of the situation that they fear might help to put things in perspective and reduce the fear. This is commonly used in treating PTSD.

  • Virtual reality exposure: In instances where in vivo exposure is not feasible, AI can help to create a safe space for the patient to face their fear.

  • Interoceptive exposure: This type of exposure works on emotions and how things feel. For example, someone who experiences panic attacks may develop a fear of increased heart rates. Doctors conducting the therapy ask the person to do other activities that increases the patient’s heart rate, to show that it is the body’s natural response to a lot of things and not just the fear of dying.


Where can I get treatment for panic disorders in Singapore?


Organization

Address

Cost of treatment (Subsidised)

Cost of treatment (Unsubsidised)

National University Hospital

5 Lower Kent Ridge Road Singapore 119074

$38 -$56

$109.14 -$145.52

Singapore General Hospital

Singapore General Hospital Outram Road Singapore 169608

$39 (S’porean)

$59 (PR)


$114.49 - $149.59 (private patient)

$126.26 - $161.57 (non-resident)


Sengkang General Hospital

Sengkang General Hospital 110 Sengkang East Way Singapore 544886

$41

$65

​Changi General Hospital

2 Simei Street 3,

Singapore 529889


Only by referrals. Contact medical centre for cost information

/

Institute of Mental Health

Buangkok Green Medical Park 10 Buangkok View Singapore 539747

$42

$46 (Children and adolescents)


$105 - $155

$120 - $180 (Children and adolescent)


Mount Elizabeth

​3 Mount Elizabeth

Singapore 228510


Contact medical centre for cost information

/

Promises Healthcare

​#09-22/23, Novena Medical Center, 10 Sinaran Drive, Singapore 307506

Contact medical center for cost information

/

MindCare Clinic

​1 Farrer Park Station Road #10-19 Farrer Park Medical Centre Connexion Singapore 217562

Contact medical center for cost information

/

Zenith Medical Clinic

266C Punggol Way, #01-374 Singapore 823266

$35 and above

/

Incontact Counselling and Training

7 Maxwell Road, #04-04, Annexe B, MND Complex, Singapore 069111

$100 - $400

(check the website for full price listing)


/

Psychology Blossom

308 Tanglin Road #02-15

Phoenix Park, Singapore 247974


$100 - $270

/


Self-care for panic disorders


Suffering panic attacks alone might be very daunting. For people experiencing panic attacks and don’t have the resources to seek help, they might not have the same exposure to helpful strategies.


What can I do if I get a panic attack when I’m alone?



There are several self-help strategies to help get through a panic attack alone.

  • Find a safe space

Panic attacks often are misunderstood and call unwanted attention to the person. Safe spaces give them somewhere they can let go and experience the panic attack without judgement, less fear, and the necessity to explain themselves.


In addition, safe spaces can help ensure the person is physically safe. Individuals who experience dizziness may be prone to accidentally hurting themselves during the attack. A safe space can be a way to make sure that no detrimental harm comes to their person.

  • Grounding

During panic attacks, it is very common to lose touch with the physical world. Your focus shifts to your fears and all the activity in your brain.


The goal of grounding is to shift that focus to the individual’s physical environment. The most popular method of grounding is known as the 5-4-3-2-1 technique.


Patients list off in a countdown method, things that they feel, smell, taste, hear and see in any order. This helps the person bring attention back into their body and away from the mind, and helps with breathing.


How can you prevent panic attacks?


There are no ways to prevent panic attacks due to the nature of the attacks – they occur abruptly and sometimes without any known triggers. However, by practicing grounding methods and restructuring the way the brain thinks about certain emotions and physical changes in the body like accelerated heart rate, it may lessen the frequency of these attacks.


Conclusion


Panic disorders can be scary ordeals to go through. Remind yourself that the fear is often times irrational, or don’t have the same severity you think that it actually does. If possible, seek professional help, especially if you suspect other comorbidities.


 

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About Our Writer

Rachel is an anxious INFJ with a slightly concerning obsession with coffee and true crime. She loves feeling smart and dislikes playing games she knows she will lose. Learning about mental health is her way of helping people around her. If the world was perfect, she wishes she could bring her friends flowers in a little red wagon.

 

This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.

 

References:

1. Clark, D. M., & Salkovskis, P. M. (1991). Panic Disorders. Springer https://oxcadatresources.com/wp-content/uploads/2018/06/Cognitive-Therapy-for-Panic-Disorder_IAPT-Manual.pdf


2. Takeuchi, T., Hasegawa, M., Ikeda, M., Hayashi, R., Tomiyama, G., Nemoto, T., & Hoshino, K. (1992). Four clinical types of panic disorders. The Japanese journal of psychiatry and neurology, 46(1), 37–44. https://doi.org/10.1111/j.1440-1819.1992.tb00817.x


3. Asmundson, G. J. G., Taylor, S., & A. J. Smits, J. (2014). PANIC DISORDER AND AGORAPHOBIA: AN OVERVIEW AND COMMENTARY ON DSM-5 CHANGES. Depression and Anxiety, 31(6), 480–486. https://doi.org/10.1002/da.22277


4. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H. U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. FOCUS, 9(3), 389–398.


5. Kushner, M. G., & Beitman, B. D. (1990). Panic attacks without fear: an overview. Behaviour research and therapy, 28(6), 469–479. https://doi.org/10.1016/0005-7967(90)90133-4


6. Song, H. M., Kim, J. H., Heo, J. Y., & Yu, B. H. (2014). Clinical characteristics of the respiratory subtype in panic disorder patients. Psychiatry investigation, 11(4), 412–418. https://doi.org/10.4306/pi.2014.11.4.412


7. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H. U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. FOCUS, 9(3), 389–398. https://doi.org/10.1176/foc.9.3.foc389


8. Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. https://doi.org/10.1136/bmj.332.7547.951


9. Na, H. R., Kang, E. H., Lee, J. H., & Yu, B. H. (2011). The genetic basis of panic disorder. Journal of Korean medical science, 26(6), 701–710. https://doi.org/10.3346/jkms.2011.26.6.701


10. Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. https://doi.org/10.1136/bmj.332.7547.951


11. Gorman, J. M. (2000). Neuroanatomical Hypothesis of Panic Disorder, Revised. American Journal of Psychiatry, 157(4), 493–505. https://doi.org/10.1176/appi.ajp.157.4.493


12. Nixon, R. D., Resick, P. A., & Griffin, M. G. (2004). Panic following trauma: the etiology of acute posttraumatic arousal. Journal of anxiety disorders, 18(2), 193–210. https://doi.org/10.1016/S0887-6185(02)00290-6


13. Sanderson, W. C., & Bruce, T. J. (2007). Causes and Management of Treatment-Resistant Panic Disorder and Agoraphobia: A Survey of Expert Therapists. Cognitive and Behavioral Practice, 14(1), 26–35. https://doi.org/10.1016/j.cbpra.2006.04.020


14. Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617–624. https://www.aafp.org/afp/2015/0501/p617.html?utm_medium=referral&utm_source=r360


15. Pfaltz, M. C., Michael, T., Meyer, A. H., & Wilhelm, F. H. (2013). Reexperiencing Symptoms, Dissociation, and Avoidance Behaviors in Daily Life of Patients With PTSD and Patients With Panic Disorder With Agoraphobia. Journal of Traumatic Stress, 26(4), 443–450. https://doi.org/10.1002/jts.21822


16. Martin P. (2003). The epidemiology of anxiety disorders: a review. Dialogues in clinical neuroscience, 5(3), 281–298. https://doi.org/10.31887/DCNS.2003.5.3/martin


17. T., Hanaoka, A., & Koshino, Y. (2005). Relationship between anxiety and thyroid function in patients with panic disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 29(1), 77–81. https://doi.org/10.1016/j.pnpbp.2004.10.008


18. Gould, R. A., Ott, M. W., & Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15(8), 819–844. https://doi.org/10.1016/0272-7358(95)00048-8