What Is Panic Disorder?

Everyone experiences feelings of anxiety and panic at times. It's a natural response to stressful or dangerous situations. But someone with panic disorder has feelings of anxiety, stress, and panic regularly, often with no warning or obvious trigger.

The National Institute of Mental Health (NIMH) reports that approximately 2.7% of the adult U.S. population experiences panic disorder each year. Approximately 44.8% of these individuals experience cases of panic disorder that are classified as "severe." 

Even though the symptoms of panic disorder can be very overwhelming and frightening, they can be managed and improved with treatment. Seeking treatment is the most crucial part of reducing symptoms and improving your overall quality of life.

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If you or a loved one are struggling with panic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

How Does Panic Disorder Affect People?

Panic disorder causes recurring and regular panic attacks, often for no apparent reason. Panic attacks can be terrifying, particularly when you experience one for the first time. They involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep.

According to the 2013 release of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, a panic attack is characterized by four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes

The DSM-5 lists two separate and distinct types of panic attacks: expected panic attacks and unexpected panic attacks.

  • Expected panic attacks are anticipated when a person is subjected to specific cues or panic triggers. For instance, someone who has a fear of enclosed spaces (claustrophobia) may expect to have panic attacks in a cramped area.
  • Unexpected panic attacks don't accompany any conscious cues, such as having fearful thoughts, feelings of intense dread and anxiety and happen without warning.

Panic disorder typically begins in late adolescence or early adulthood. Although panic disorder often begins between the ages of 21 to 35, it's still possible to develop this condition in childhood or late adulthood.

Findings from the National Comorbidity Survey suggested that panic disorder occurs more frequently in women than in men. A study based on data from the survey found that a diagnosis of lifetime panic disorder was about 2.5 times more common in female than in male respondents.

Prevention

There are some techniques you can try and stop a panic attack when it starts:

  • Deep breathing: Breathing exercises have been shown to help manage panic attacks. Try to breathe slowly and deeply, concentrating on each breath.
  • Relax your body: Letting go of tension throughout your body can really help you remain calm during a panic attack. Mentally go through each area of your body, and intentionally relax that area. 
  • Find a peaceful spot: Sights and sounds can often intensify a panic attack. If possible, try to find a peaceful spot where you can focus on breathing and other coping strategies.
  • Remember it will pass: During a panic attack, it can help to remember that these feelings will pass, however scary they feel at the time. Try acknowledging that this is a brief period of concentrated anxiety, and that it will be over soon.

How Do I Know if I Have Panic Disorder?

Symptoms

People with panic disorder may have:

  • Sudden and repeated panic attacks of overwhelming anxiety and fear.
  • A feeling of being out of control, or a fear of death or impending doom during a panic attack.
  • Physical symptoms during a panic attack, such as a pounding or racing heart, sweating, chills, trembling, breathing problems, weakness or dizziness, tingly or numb hands, chest pain, stomach pain, and nausea.
  • An intense worry about when the next panic attack will happen.
  • A fear or avoidance of places where panic attacks have occurred in the past.

Diagnosis

Not everyone who has panic attacks has panic disorder. To receive a diagnosis of panic disorder, a person must be experiencing spontaneous panic attacks, without an obvious trigger.

In addition, at least one panic attack is followed by one month or more of the person fearing that they will have more attacks and causing them to change their behavior, which often includes avoiding situations that might induce an attack.

It's important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack (or event that feels like one):

  • The attacks are not due to the direct physiological effects of a substance (such as drug use or a medication) or a general medical condition.
  • The attacks are not better accounted for by another mental disorder. These may include a phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety disorder.

Causes of Panic Disorder

As with many mental health conditions, the exact cause of panic disorder isn't fully understood. It's thought that panic disorder is probably caused by a combination of factors:

  • Age: Panic disorder typically develops between the ages of 21 to 35.
  • Gender: According to the National Institute of Mental Health, women have more than twice the risk of panic disorder than men.
  • Genetics: If you have a close biological family member with panic disorder, you are much more likely to develop the condition. Although up to half or more of people with panic disorder do not have close relatives with the condition.
  • Trauma: Experiencing a traumatic event, such as being the victim of physical or sexual abuse, can increase risk of panic disorder as well.
  • Life transitions: Going through a life transition or difficult life event, including the death of a loved one, divorce, marriage, having a child, or losing a job may increase also risk.

How Can I Get Help if I Have Panic Disorder?

The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms.

The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If a panic disorder is diagnosed, a mental health professional can work with you on the best treatment.

The main treatment options are psychotherapy and medications, with self-care also playing a part.

Psychotherapy

A type of psychotherapy (talk therapy) called cognitive behavioral therapy (CBT) is recommended by the American Psychiatric Association as a useful first-line treatment for panic disorder. CBT teaches you different ways of thinking, behaving, and reacting to the feelings that come on with a panic attack. The attacks can begin to disappear once you learn to react differently to the physical sensations of anxiety and fear that occur during panic attacks.

Medication

Medications will not cure anxiety disorders but can give significant relief from symptoms. Doctors may prescribe different types of medications to help treat panic disorder:

  • Selective serotonin reuptake inhibitors (SSRIs): These are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): Like SSRIs, these are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder.
  • Benzodiazepines: which are sedative medications, are powerfully effective in rapidly decreasing panic attack symptoms, but they can be habit-forming, causing mental or physical dependence. Therefore, your doctor will only prescribe them for brief periods if you need them.

SSRIs and SNRIs may also cause side-effects, such as headaches, nausea, or difficulty sleeping. Talk to your doctor about any side effects and never discontinue a prescription medication without speaking to a medical professional.

Self-Care

While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage symptoms:

  • Get physically active: Not only can regular exercise help reduce stress and anxiety, but it's been found to lessen the frequency of panic attacks as well.
  • Avoid caffeine, alcohol, smoking and recreational drugs: All of these can trigger or worsen panic attacks.
  • Get sufficient sleep: Sleep disturbances and panic disorder can be a vicious cycle. People with panic disorder often have trouble sleeping and the resulting sleep deprivation can result in greater panic disorder symptoms.
  • Try mindfulness meditation: Learning mindfulness meditation techniques has proven effective for those with anxiety disorders who are prone to frequent worrying, feelings of nervousness, and negative thinking.

Alternative Medicines

Some people with panic disorder will seek out complementary and alternative medicine such as herbal supplements as a way to help manage their symptoms.

A systematic review of 24 studies in 2010 found strong evidence exists for the use of herbal supplements containing extracts of passionflower or kava as treatments for anxiety symptoms and disorders.

You should be aware of the risks of the taking of herbal remedies and in particular, their potential for interacting with prescription medication. Always speak to your doctor before taking any supplements.

A Word From Verywell

Panic disorder can be a frightening, but ultimately treatable condition. It's vital that you seek medical help as soon as possible. Left untreated, panic disorder can become a very debilitating and isolating illness. With talking therapy, medication and lifestyle changes, it can be possible to manage panic disorder effectively. 

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