Panic Disorder

Panic disorder is a diagnosis of repeated, unexpected panic attacks and a persistent worry about having more attacks. It can be treated with medication, therapy, or a combination.

What is panic disorder?

Panic disorder is a type of anxiety disorder. It is diagnosed in people who have recurring panic attacks and who live with a constant worry that another attack will occur. It can significantly impact a person’s quality of life, particularly if they look to avoid circumstances that may trigger a panic attack or situations where having a panic attack would be particularly problematic. For example, people with panic disorder may avoid stressful situations and crowded spaces. Some may develop agoraphobia, other specific phobias, or alcohol and drug problems.^[1]

What do panic attacks feel like?

A panic attack is a sudden, intense feeling of fear that lasts a few minutes. They usually occur when awake, but some people are succeptible to nocturnal panic attacks too. Someone having a panic attack may experience some or all of the following symptoms:^[2]

• Racing heartbeat, palpitations, or a feeling like your heart is pounding
• Sweating
• Shaking or trembling
• Difficulty breathing
• A choking sensation
• Chest pains
• Nausea or stomach pains
• Dizziness or feeling faint
• Chills or feeling too hot
• Numbness or tingling
• Derealization (feeling detached from your surroundings) or depersonalization (feeling detached from yourself)
• Fear that you are going ‘crazy’
• Fear of death

As so many panic attack symptoms are physical sensations, it can feel as though you are having a medical emergency such as a heart attack.^[3]

Just over one in ten people a year will have a panic attack, but only a small number will develop panic disorder.^[2]

How long do panic attacks last?

Panic attacks come on very quickly and can last up to 20 minutes. Symptoms usually peak at around 10 minutes.^[4] A panic attack can be a terrifying experience. If you have a panic attack, try to:

• Concentrate on your breathing. Breathe through your nose for four seconds, hold it for four seconds, and breathe out through your mouth for four seconds. Repeat until the panic subsides.
• Try grounding techniques to help you focus on the moment until it passes. Describe what you can see, hear, smell, taste, and feel with your fingertips.
• Remind yourself that it is temporary. Remembering that it is a panic attack and will pass can help you stay calm until it’s over.

Panic attack vs. anxiety attack

The terms ‘panic attack’ and ‘anxiety attack’ are often used interchangeably, but they are different experiences. Some of the symptoms – such as increased heart rate, shaking, and sweating – are similar, but there are some key differences:

• Panic attacks come on suddenly, whereas anxiety attacks will build more slowly.
• Panic attacks are short and over quickly, whereas anxiety attacks are likely to last longer.
• Panic attacks include intense fear, whereas anxiety attacks tend to feel more like you are on edge and unable to relax or concentrate.

Diagnosing panic disorder

Diagnosing panic disorder is not always straightforward.

According to the Diagnostic and Statistical Manual of Mental Disorders ^[5], used by mental health professionals in the US to diagnose mental health problems, diagnosis starts with an assessment of the panic attacks a person has been experiencing. They must satisfy the following criteria:

• They must include at least four of the panic attack symptoms listed above.
• A person must have experienced more than one panic attack. The frequency of panic attacks varies a lot between different people. Some people may experience them regularly, for example, every week, while others may experience them in clusters a few months apart.
• While most panic attacks are unexpected, without an obvious cause or trigger, some do have a clear cause, which may be linked to another medical condition. For example, if you have a phobia, you may experience a panic attack when exposed to the object of your dread. In panic disorder, the attacks come out of the blue.

In addition to recurring, unexpected panic attacks, a person with panic disorder will also be very worried about having another attack and may go to some lengths to avoid certain circumstances as a result. This may include avoiding situations that may trigger an attack, such as stressful or crowded environments. It can also include avoiding situations where having a panic attack would be particularly distressing, such as in public.

Before panic disorder can be diagnosed, a doctor or mental health professional must also rule out other possible causes of the physical symptoms of a panic attack, such as heart problems or adverse effects from medication. You may be sent for medical tests as part of your assessment.

Patients with panic disorder often have other mental health conditions as well, including:^[5]

• Another anxiety disorder, in particular, agoraphobia
• Depression
• Bipolar disorder
• Substance abuse problems

They may also have co-existing physical health problems, including:^[5]

• Dizziness
• Heart problems
• Thyroid problems
• Asthma
• Lung problems
• Irritable bowel syndrome

Causes of panic disorder

The causes of panic disorder are not well understood, but there are some known links, including ^[6]

• Other mental health problems. You are more like to have panic disorder if you have, for example, anxiety or depression.
• Family history. Panic disorder appears to run in families, but we don’t yet know whether this is because of genetics or because people who live in the same environment are often exposed to the same difficult circumstances.
• Traumatic events in either childhood or adulthood.
• Excessive consumption of alcohol, tobacco, caffeine or illicit drugs.

Prevention of panic disorder

There are several ways you can lessen the risk of having a panic attack:^[7]

• Look after your physical well-being by exercising regularly, eating healthily, and developing good sleeping habits.
• Avoid alcohol, tobacco, caffeine, and illicit drugs.
• Practice mindfulness to help you stay focused on the present and deal with anxious thoughts.
• Keep your stress levels in check and take steps to reduce or avoid stress.
• Seek treatment from a doctor or mental health professional.

Treatment for panic disorder

The main treatments for panic disorder are medication and therapy.

Medication

Your doctor may prescribe:^[3]

• Antidepressants, especially those that work on controlling serotonin levels in the brain.
• Pregabalin, an epilepsy medication that can help with anxiety.
• Beta-blockers, which help with physical symptoms such as heart rate and trembling.
• Benzodiazepines, which are tranquilizers that can help with anxiety.

Therapy

Cognitive behavioral therapy (CBT) is the most common therapy for panic disorder. It helps by identifying triggers for anxiety and panic attacks and teaching coping skills.

The American Psychiatric Association also recommends panic-focused psychodynamic psychotherapy (PFPP) ^[8] to uncover the underlying reasons for a person’s panic attacks.

Helping someone with panic disorder

Living with someone who has a mental illness can be challenging. Panic attacks can be as frightening to observe as they are to experience, while living with someone anxious about leaving the house and being in public can affect your daily life too.

There are many things you can do to support your loved one:

• Look after yourself. It can be too easy to neglect ourselves when trying to support someone else, but it’s important to ensure you are looking after your own physical and mental well-being. Take time for yourself, do things you enjoy, eat healthily, stay active, and get good sleep. If you are struggling with your mental health, seek help.
• Read up. Learn as much as possible about panic disorder and how it affects people.
• Creating a safe space for you both to talk about panic disorder and how it affects your relationship can help. Make sure you listen, without judgment, to what they tell you about how they feel and what they are going through. Even if it is hard for you to understand, show them you care and are there to support them.
• Get to know their triggers. If you both understand the circumstances that can trigger a panic attack, you can work together to avoid unnecessary difficulties and overcoming challenging situations.
• Learn how to support them through a panic attack. Guiding them through deep breathing exercises and grounding techniques can help keep them calm until the attack passes.
• Encourage them to seek help – but don’t force them. If they are not ready to seek help, you need to accept that as their individual choice. But if they are willing, you can offer to research sources of support and go to appointments with them, for example.
• Know what to do in a crisis. Research how to support someone in crisis so you know what to expect and how to react. If you are concerned that they pose an immediate risk to themselves or someone else, call your local crisis mental health service.

FAQs about panic disorder

What happens if you leave panic disorder untreated?

If left untreated, panic disorder can develop into more complex problems such as anxiety and phobias. Agoraphobia is a particular risk, as people with panic disorder seek to avoid situations that might trigger or worsen a panic attack.

However, most people with panic disorder can and do recover with effective treatment plans and self-care.

Should I be worried about having panic disorder if I’ve had a panic attack?

Not necessarily. Panic attacks are relatively common, and only a small number of people develop panic disorder.

Just over one in ten people a year will have a panic attack. While frightening, most are one-off events that aren’t a cause for serious concern.

Panic disorder affects around 2-3 percent of Americans. Women are more likely to be diagnosed with panic disorder than men.^[9]