The price of life in the fast lane

Six months ago, Jilly E Hurley was admitted to hospital feeling shaken, breathless and exhausted. Panic attacks are now part of daily life for young, successful women, she says - and there's no cure

It is the "trendy disease du jour", according to The Wall Street Journal. Their cynical spin is telling. Panic disorder is little understood; or rather, widely misunderstood. One extensive US study found that a staggering 35 per cent of people had had at least one panic attack - that's 87 million Americans. Figures in the UK are significantly lower, around 10 per cent, but that still accounts for an awful lot of people. For some years now, the medical profession has taken the disorder for the serious, debilitating condition that it is. Unfortunately, however, this hasn't yet filtered down to the layman. In the popular imagination, panic disorder is still typically misassociated with mere anxiety, as if feeling "panicky" involved anything like the trauma or process of a full-blown attack. But surely, this is soon to change, with a new breed of sufferers: young, educated, successful and, interestingly, predominantly women.

It is the "trendy disease du jour", according to The Wall Street Journal. Their cynical spin is telling. Panic disorder is little understood; or rather, widely misunderstood. One extensive US study found that a staggering 35 per cent of people had had at least one panic attack - that's 87 million Americans. Figures in the UK are significantly lower, around 10 per cent, but that still accounts for an awful lot of people. For some years now, the medical profession has taken the disorder for the serious, debilitating condition that it is. Unfortunately, however, this hasn't yet filtered down to the layman. In the popular imagination, panic disorder is still typically misassociated with mere anxiety, as if feeling "panicky" involved anything like the trauma or process of a full-blown attack. But surely, this is soon to change, with a new breed of sufferers: young, educated, successful and, interestingly, predominantly women.

I am a paradigm case. Late twenties, university educated, holding down a good job in the City. After a number of years working and travelling around the world, life as a metropolitan professional took me by surprise. Returning to the UK, I tumbled into, and promptly out of, drama school; then headlong into the vertiginous glamour of PR... not quite knowing how I got there. Four years on, an incipient anxiety was brewing. Bound by the conventional rhythm of city living, I hadn't yet realised the life I had hoped for myself.

Six months ago, the cracks began to show. Having braved a number of diverse and challenging experiences in my pre-PR existence - from lecturing Japanese businessmen in Tokyo, to tackling the Himalayan byways - I had been confident that the most I would suffer in an English urban jungle was a touch of ennui. So I was as surprised as anyone to find myself in the Royal Free Hospital, in north London, shaken, exhausted and breathless, having had my first panic attack. It was horrible, and very frightening. I genuinely thought I was going to die. An extended trip to Cambodia provided the trigger: not the exhilaration of Angkor Wat, or the horrific sights of the Khmer Rouge torture camps, it was coming back to the insidious pressure of my London life that so overwhelmed me. In the long break away, I had relaxed fully for the first time in four years - then thrust back into the throng, guard down, I found that London life hit me full in the face.

It was cold comfort to learn that an increasing number of young women are now suffering from similar stress and anxiety, such that panic disorder is rife, and on the rise. It is a terrifying condition that renders the sufferer powerless to frequent attacks: periods of intense fear in which a number of physical symptoms occur, including shortness of breath or hyperventilation, palpitations or accelerated heart rate, trembling and intense chest pain. It follows that most sufferers are unaware that the physical affliction is the symptom, not the cause.

High-achieving young women are putting an increasing amount of pressure on themselves. They are so determined to succeed that there is little time or energy left to devote to that most elusive thing, personal happiness. Dr Stuart Shipko, founder of The Panic Disorders Institute in California, and author of Surviving Panic Disorder: What You Need to Know, sees women as particularly vulnerable, as they have also to contend with a cocktail of destabilising hormones. That is why attacks often cluster before the onset of menstruation as a pre-teen, around the age of 40 (the start of the pre-menopause) and around 50 (menopause). Attacks during the twenties are not likely to be exacerbated by an increase, or destabilisation, of hormone levels, but generally come from external stimuli. But that means that we can do something about it.

Take Katherine, an actors' agent from London, who, as long as I have known her, has always been outgoing, accomplished and adventurous. Until she developed panic disorder. Since then, her confidence has been severely eroded. Having had a number of frightening attacks while travelling on the Tube, for instance, she is now unable to face it. Consequently, her meagre salary is gobbled up by taxi fares, so that she often struggles to make ends meet. She is particularly frustrated that she hasn't received the help she desperately needs: "I've been prescribed a few courses of drugs, but no one has really tried to find a permanent solution to my attacks."

Along with countless other sufferers, having benefited from little information, reassurance or effective treatment, Katherine feels that panic disorder is an affliction that she will probably have to bear for the rest of her life. Often, patients do not receive the treatment they need because they are embarrassed and scornful of their condition, and so ignore it. But help and understanding are now readily available. Although doctors often initially look for physical reasons for the attacks - thyroid problems, low blood pressure - they do eventually consider psychological possibilities. Treatment varies, but diagnosis of panic disorder will more than likely have your doctor reaching for the prescription pad, providing a course of tricyclic antidepressants or benzodiazepines "for the bad times". But studies show that up to a third of people who take tricyclics will start to have panic attacks as soon as they stop taking them. Medication of this sort can be helpful in the short-term, but pills only treat the symptom, not the cause, so they do not offer a viable long-term solution.

Another very popular option is cognitive behavioural therapy, a psychological approach that can help a person learn to manage the physical discomfort of panic attacks. Once they learn that the attacks are distressing but not dangerous, anticipation, a critical element in fuelling the attacks, is greatly reduced. Patients work to understand the relationship between thoughts, feelings and behaviour. They are taught a number of techniques to help them cope with the attacks, and, in some cases, prevent them. These techniques include relaxation, distraction, breathing exercises and visualisation.

But again, this doesn't address whatever it is that precipitates the problem. Patients are usually recommended a course of three to four sessions, so quickly pass along the conveyor-belt of requisite treatment.

To turn this treatment on its head, to tackle the root, some kind of self-contemplation or psychotherapy is required. "The literature is clear," Dr Shipko suggests, "that people who are treated with psychotherapy have a better long-term prognosis than those who are treated with drugs." Unfortunately, in the UK at least, psychotherapy is too often seen as a recourse for the mad or the indulgent. This in itself may seem a little bit mad and indulgent since, in our society as it is - secular, splintered and self-seeking - there are few opportunities to address inner personal development. From a professional point of view, Dr Shipko notes that this brand of treatment "is not in fashion right now": in our Western, results-driven healthcare industry, it cannot compete, being "less tangible and difficult to quantify".

Of course, there are numerous reasons why a person develops panic disorder, and a number of ways to treat it. It seems to me, however, that the only satisfactory method of overcoming it is to tackle that which prompted it: the negative impact of stress is not felt in hours, or days or even weeks; it accrues over months and years. So, it makes sense that treatment might require a similar time-frame, as well as a change in the lifestyle that generated these conditions of stress. This runs against the grain of contemporary taste. Our world is so fast-paced (which is, of course, part of the problem in the first place) that we expect fast-paced solutions. Preferably those that can be paid for over the counter. And then forgotten about. So that life can go merrily along as before.

Christine Ingham, author of Panic Attacks, suggests that "people who panic tend to show a high degree of conformity: always doing what's expected of them". They are often "over critical and disapproving" of themselves, often using language such as "should" and "must". Certainly, any attempt to redress the problem must be centred on the personality of the individual. If this is to end on an uncertain note, one thing at least is clear. That the physical reaction equivalent to the fight-or-flight mechanism that occurs during a panic attack is far from "trendy": it is your body telling you that it can't take any more. So, listen to your body. Don't try to shut it up with pharmaceutical palliatives.

As for me, the advent of motherhood (I am now five months pregnant) has largely put an end to my attacks. No doubt there is some hormonal panacea that attends pregnancy, some primal instinct perhaps, but I have also tried to take heed of my own words. I have tried to transform my life - from within. And it feels wonderful.