Panic Disorder

Know More: Panic Disorder

Trustworthy information, straight from the source. Education is the first step in an empowering healthcare plan. Learn more about panic disorders from prevention to diagnosis and treatment.

Sad woman meets with provider

Condition Overview

What is a panic disorder?

Panic disorder is a distinct type of anxiety disorder that is defined by recurrent and unpredictable panic attacks that reach distressing levels and interfere with normal functioning. After having several attacks, most patients develop the second component of the syndrome, anticipatory anxiety. Patients fear the onset of further attacks and develop high levels of intercurrent anxiety. Later, approximately two thirds of patients develop phobic avoidance or agoraphobia, the third component of the disorder.

What is a panic attack?

A panic attack is a period of strong fear or discomfort. You may feel as though something very bad is going to happen but do not know what it is. A panic attack occurs suddenly and usually lasts about 10 minutes. It may occur at any time and without warning. You may also have the following symptoms during a panic attack:

  • Fast or pounding heartbeat.
  • Sweating, trembling, or shaking.
  • Shortness of breath or trouble breathing.
  • Feeling of choking or having a lump in your throat.
  • Chest pain or discomfort.
  • Nausea or abdominal pain.
  • Feeling dizzy, unsteady, lightheaded, or faint.
  • Feeling that you or the things around you are not real, or you are outside of your body.
  • Fear of losing control, going crazy, or dying.
  • Numbness or a tingling feeling.
  • Chills or hot flashes.

Risk Prevention

Causes and increased risk of panic disorder

Anxiety disorders are the most prevalent psychiatric conditions in the U.S. Panic disorder affects women approximately twice as often as men. Panic disorder typically begins in late adolescence or early adulthood, with a peak at 25 years of age. There is a second peak between the ages of 35 and 44 years. Onset after age 45 is rare. Adults with panic disorder and agoraphobia frequently say they were shy and had histories of childhood separation anxiety, such as school phobia.

Emergence of anxiety symptoms early in life, including a history of separation difficulties during childhood, also represents a risk factor for panic attacks. Children of parents with panic disorder, when compared with control subjects, have a higher rate of behavioral inhibition to the unfamiliar.

Diagnosis & Treatment Options

What are the signs and symptoms of panic disorders?

The hallmark component of panic disorder is an abrupt and time-limited acute panic attack. Typically, patients complain of palpitations, chest pain, dyspnea, paresthesia, light-headedness, and gastrointestinal discomfort. Accompanying the physical symptoms are fears of impending death and loss of control. Sufferers experience terrifying attacks generally lasting 10 to 30 minutes, which motivate them to seek immediate medical attention.

How are panic disorders diagnosed?

Testing in patients with panic symptoms should be selective and guided by the clinical findings. If general screening seems warranted, especially in a patient presenting for the first time with an attack, a complete blood count, standard blood chemistries (e.g., hepatic and renal function), serum thyroid-stimulating hormone (TSH), urinalysis, and electrocardiogram (ECG) should be considered.

How are panic disorders treated?

All patients presenting with symptoms of panic disorder require close questioning about any thoughts of suicide, especially if they appear depressed. Urgent referral is necessary if there is a concern that the patient may attempt suicide. Suicidal ideation and attempts are relatively common in patients with panic disorder, especially in association with a depressive disorder. The person threatening suicide is in immediate crisis, and requires hospitalization and specialized psychiatric care. Patients with comorbid substance abuse disorders may need detoxification, which may also require hospitalization. Otherwise, patients with panic disorder rarely require hospitalization.

Cognitive Behavioral Therapy (CBT) Psychotherapy, especially cognitive behavioral therapy, may be beneficial in the treatment of panic disorder. CBT encompasses a range of treatments, each consisting of several elements. Examples of CBT elements include:

  • Breathing retraining.
  • Psychoeducation.
  • Continuous panic monitoring.
  • Development of anxiety management skills.
  • Cognitive restructuring.
  • In vivo exposure.

CBT is only effective if patients are committed to actively participate in therapy. Patients may also benefit from a patient support group to learn that they are not unique in experiencing panic and to possibly learn different coping strategies.

Drug therapies may include:

  • Benzodiazepines.
  • Antidepressants.
  • Seretonin Reuptake Inhibitors.
  • Monamine Oxidase Inhibitors.

Preparing for Care

How can I manage panic disorders?

  • Keep a diary of your panic attacks. Write down how often you have panic attacks, how long they last, and the symptoms you had. Write down whether or not there was anything that happened right before the panic attack. Write down whether there were things that helped to ease or stop your panic attack. Bring your diary with you every time you see your provider.
  • Living a life of balance can help to reduce anxiety and decrease the incidence of panic attacks. Patients are recommended to eat a nutritionally healthy diet, obtain sufficient sleep, exercise regularly, and they may pursue complementary practices that may increase their overall feeling of well-being. Hypnosis, yoga, meditation as well as acupuncture, massage therapy, and chiropractic treatments have assisted some patients in finding relief.
  • Avoid self-medication, particularly with alcohol, as this may have significant consequences of increasing panic symptoms in the long-term and contributing to the development of an abuse or addictive disorder. Overuse of caffeine may as well contribute to anxiety and panic, so caffeine-containing substances should be limited. Over-the-counter stimulants (e.g., pseudoephedrine) and other psychostimulants should be avoided as they may produce anxiety and contribute to panic.

When should I seek immediate care or call 911?

  • You feel lightheaded, too dizzy to stand up, or you faint.
  • You feel like harming yourself.
  • You have chest pain, tightness, or heaviness that spreads to your shoulders, arms, jaw, neck, or back.

When should I contact my healthcare provider?

  • You have new symptoms since you last saw your healthcare provider.
  • Your worry keeps you from doing daily tasks such as work or caring for yourself or your family.
  • Your symptoms are getting worse.
  • You have questions or concerns about your condition or care.

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