Before we describe dual diagnosis, we will shortly discuss what panic disorder and addiction is and then confer about the link of panic disorder and addiction in terms of treatment.

Panic Disorder:

        Panic disorder is characterized by intense anxiety attacks reaching to the peak within seconds which may last for 10min. During the attack, a variety of physical, emotional and cognitive symptoms are experienced. Emotional symptoms include fear of losing control, getting faint or dying. The patient feels agitated, restless and anxious. Cognitive symptoms include, a rush of thoughts expecting a real danger. They misinterpret and catastrophize a minor sensation such as rapid heartbeat as having a heart attack or going crazy. Physical symptoms which are particularly prominent in panic attack include sweating, numbness in limbs, rapid heartbeat, lump in throat, chest pain or congestion, hot flashes or chills, heavy breathing, trembling or shaking, and nausea etc. Once, a person experiences a panic attack, he becomes fearful of having another attack. They may start avoiding situations where escape would be difficult during panic attack such as shopping malls, crowded areas, rush places, enclosed places such as plane or car etc. This condition is called Panic disorder with Agoraphobia.

Mehwish-MursaleenMehwish Mursaleen is MPhil in Clinical Psychology and pursuing her PhD in similar field from Institute of Clinical Psychology, University of Karachi. She has provided mental health services to people having different psychological problems coming from different age groups and backgrounds. Her research work is based on IQ, Emotional Intelligence, Academic achievement and Aggression in adolescents. She also has published case studies on CBT for depression and panic disorder. Her interests are in the areas of counselling, psychotherapy, and psychological assessment.

Editor: Samreen Masud

Due to repeated panic attacks, it becomes very difficult for to focus on anything else. Headaches, light-headedness, sleep disturbance and high blood pressure are commonly reported by patients. The symptoms of panic disorder are disturbing to the extent they mimic heart-attack. Such people go for extensive medical check-ups while their reports show normal results. Their psychosocial life gets disturbed to the extent that they become home-bound. Sometimes they suffer from associated symptoms of depression and eating disturbance.

The effective treatment of panic disorder is supposed to be cognitive behavioural therapy (Mehwish &Uzma, 2015). Psychotropic medications used for Panic attacks include anti-anxiety drugs and benzodiazepines. Benzodiazepines are the group of psychoactive drugs which are highly addictive and may produce withdrawal effects when a patient stops taking medicine. Moreover, when these drugs are taken along with substances such as alcohol/ sedatives, analgesics, or tranquilizers may cause lethal effects. These may also cause severe side effects.



      Addiction involves compulsive use of something which is considered gratifying despite its adverse consequences. It is considered rewarding and pleasurable therefore person uses it repeatedly. Addiction can be chemical (i.e. drugs) or non-chemical (i.e. gambling, gaming, internet, smartphone etc.). In any form, addiction is a brain disease involving dysfunction of reward system. Drug addiction is characterized by use of single or multiple addictive substances such as sedatives, stimulants, hallucinogens, opioids, and prescription or non-prescription drugs. Upon increased intake of these drugs, person’s brain and body develop tolerance or dependence. Gradually the person needs more amount of drug to maintain the previous level of pleasure. When the substance is abused in heavy amount, it can produce intoxication i.e. development of psychological symptoms such as hallucination, delusions, grandiosity, sleep disturbance and many others depending upon the nature of drug taken. When a person tries to quit the substance, his body produces withdrawal symptoms such as agitation, irritation, depression, anxiety etc. Thus, an addict gets trapped by the drug and can’t stop its use because of the changes brought up in his brain due to that drug.