Panic disorder is a chronic condition that involves repeated episodes of panic attacks, which are episodes of sudden-onset fear, discomfort, and/or other symptoms such as chest pain, shortness of breath, shaking, trembling, sweating, abdominal discomfort.
What Is Panic Disorder?
Panic disorder is a chronic condition that involves repeated episodes of panic attacks, as well as worry about future attacks or consequences of attacks, or unhelpful changes in behavior to avoid the attacks. Panic attacks are episodes of sudden-onset fear, discomfort, and/or other symptoms that may or may not be associated with a specific trigger.
Symptoms of panic attacks include chest pain, shortness of breath, shaking, trembling, sweating, abdominal discomfort, nausea, dizziness, heat or cold sensations, numbness or tingling, or fear of dying.
Treatment options include psychotherapy and antidepressant or anti-anxiety medications.
You should go see your primary care doctor, who can diagnose you by interview. Most people get better with treatment. Therapy can show you how to recognize and change your thinking patterns before they lead to panic. Medication may be beneficial.
Panic Disorder Symptoms
According to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) panic disorder is diagnosed by recurrent unexpected panic attacks . Panic attacks are surges of fear or discomfort that peak within minutes and are associated with four or more of 13 associated symptoms.
Symptoms that can be experienced during a panic attack include:
- Chest pain, discomfort, or sensation of a racing or pounding heart: These symptoms may feel similar to a heart attack.
- Choking or shortness of breath: This sensation may be described as a feeling of being smothered.
- Shaking, trembling, or sweating: This may be felt all over the body.
- Abdominal discomfort and/or nausea
- Dizziness, lightheadedness, unsteadiness: You may feel like you are about to pass out.
- Heat or cold sensations coming over the body
- Numbness or tingling: This may be felt all over the body.
- Fear of dying, losing control, or a sense of being separated from reality or oneself: Some people experiencing a panic attack feel they are "going crazy." They may get a sense that they are separated from reality ("derealization") or separated from oneself ("depersonalization").
In addition to recurring panic attacks, people with panic disorder experience at least one month of worry about future attacks or consequences of those attacks, or change their behavior in an unhelpful way to try to avoid the attacks. They may also develop agoraphobia, which is when they fear and avoid situations in which it may be difficult to leave if they develop a .
Panic Disorder Causes
The specific cause of panic disorder is not known but is generally believed to be a combination of predisposing factors combined with excessive life stressors. Panic disorder is more common among women and is most common during adolescence and the mid-30s.
Specific risk factors associated with developing panic disorder include the following.
- Genetic factors: People with first-degree relatives who have panic disorder have at least a six-fold risk of .
- Having an anxious nature: People with an anxious nature may react poorly to stress and interpret bodily sensations in a more catastrophic way.
- Experiencing stressful life events: Examples of stressful life events include illnesses, relationship issues, financial issues, loss, or exposure to threats. There is also a significant link between early development or and the development of panic disorder and related disorders.
- Increased activity in certain parts of the brain: For example, increased activity in a part of the brain (amygdala) involved in fear sensations, may predispose people to develop panic disorder.
- Having another psychiatric disorder: Having another psychiatric disorder such as major depressive disorder, , social anxiety disorder, or posttraumatic stress disorder is associated with an increased risk of having panic disorder. Approximately 37 percent of people with an anxiety disorder are not seeking treatment, and these conditions are considered easily treatable in most cases.
Treatment Options and Prevention for Panic Disorder
Panic disorder is a chronic condition that usually cannot be completed cured. Therefore, treatment focuses on managing the symptoms and reducing the frequency and severity of panic attacks.
Some people with a mild panic disorder that does not interfere with their normal functioning may opt for clinical monitoring without starting treatments. They may check in with their physician every few months to evaluate their symptoms and the need for starting treatment.
Some people with panic disorder may benefit from psychotherapy, or "talk therapy." There are many different kinds of psychotherapy.
- Cognitive behavior therapy (CBT): This is a form of psychotherapy that is very effective for . In cognitive behavioral therapy, the individual learns how to change their way of thinking to better manage their emotions. Cognitive behavioral therapy has been shown to be as effective as medications in treating panic disorder.
- Exposure therapy: This is an important part of psychotherapy for panic disorder, which involves incrementally exposing the individual to factors that they fear to make it less fear-inducing.
Some people with panic disorder may benefit from antidepressant and/or anti-anxiety medications.
- Selective Serotonin Reuptake Inhibitors (SSRIs): This is the most commonly used type of antidepressant medication, including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).
- Other medications: This includes duloxetine (Cymbalta), venlafaxine (Effexor), and imipramine (Tofranil), among others.
- Benzodiazepines: These include clonazepam (Klonopin) and alprazolam (Xanax), and are sometimes recommended for breakthrough anxiety or specific fear stimuli, but are associated with a risk of dependence and withdrawal.
When to Seek Further Consultation for Panic Disorder
If you develop any symptoms of panic disorder such as chest pain or discomfort, pounding or racing heartbeat, or difficulty breathing, you should see your physician. Your physician can evaluate you and possibly order laboratory or imaging tests to rule out other medical conditions that may cause similar symptoms. If you are diagnosed with panic disorder, your physician can offer you the appropriate treatment.
If you are having thoughts of hurting yourself or others
You should contact your physician right away, go the emergency room, call an ambulance, or call the national suicide prevention hotline (1-800-273-8255), which is available 24 hours a day. People with panic disorder have a greater likelihood of attempting suicide, and help and support are available to help you manage these symptoms.
Questions Your Doctor May Ask to Determine Panic Disorder
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Do you currently smoke?
- Have you lost your appetite recently?
- Have you experienced any nausea?
- Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617-624.
- Mental health disorder statistics. Johns Hopkins Medicine.
- Na HR, Kang EH, Lee JH, Yu BH. The genetic basis of panic disorder. J Korean Med Sci. 2011;26(6):701-710.
- Holt RL, Lydiard RB. Management of treatment-resistant panic disorder. Psychiatry (Edgmont). 2007;4(10):48-59.
- Facts & statistics: Anxiety and depression. Anxiety and Depression Association of America.
- Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G. Psychological therapies for panic disorder with or without agoraphobia in adults: A network meta-analysis. Cochrane. Published April 13, 2016.
- Taylor CB. Panic disorder. BMJ. 2006;332(7547):951-5.