Panic Disorder

overview

Panic Disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. People with panic disorder have frequent and unexpected panic attacks. These attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger. Since panic attacks can occur at any time, many people with panic disorder worry about the possibility of having another attack and may significantly change their life to avoid having another attack. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.[1]

Not everyone who experiences a panic attack will develop panic disorder. Every year, up to 11% of Americans experience a panic attack; approximately 2% to 3% develop panic disorder. While anyone can experience a panic attack, they typically first occur in the late teens or early adulthood. Women are twice as likely as men to develop panic disorder.[2]

Signs and Symptoms

Panic attacks occur suddenly and without warning. It’s virtually impossible to stop a panic attack after it starts and symptoms usually peak within 10 minutes after an attack commences.[2]

Signs of a panic attack include:

Chest pain
Chills
Choking or smothering sensation
Difficulty breathing
Fear of losing control
Feeling like you’re going to die
Intense feeling of terror
Nausea
Racing heart
Stomach pain
Sweating
Tingling or numbness in fingers or toes
Trembling or shaking
Weakness or dizziness[1,2]

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
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[1]

Complications

Although panic attacks are highly treatable and fairly common, many people unfortunately delay seeking help. Untreated panic attacks or panic disorder can interfere with one’s ability to function and enjoy life.

Untreated, co-morbid conditions may develop, such as:

Anticipatory anxiety: The possibility of having a panic attack triggers extreme anxiety.
Phobias/ Agoraphobia: A phobia is an extreme, unreasonable fear of something specific. Approximately two-thirds of people with panic disorder develop agoraphobia. This anxiety disorder causes one to be afraid in places or situations where a panic attack might happen. The fear can become so extreme that a person becomes too afraid to leave their home or other place of safety/refuge.[2]

Causes

Experts are still researching to determine why some people experience panic attacks or are prone to develop panic disorder. As the brain and nervous system play key roles in how one perceives and handles fear and anxiety, a person’s risk of having panic attacks increases with:

Family history: The presence of anxiety disorders, including panic disorders, often runs in families, leading to higher susceptibility.
Mental health issues: People who have anxiety disorders, depression or other mental health disorders are more prone to experiencing panic attacks.
Substance abuse: Alcoholism and drug addiction can increase the risk of panic attacks.[2]

Diagnosis

Medical or mental health providers can diagnose panic disorder and may do so if a person has experienced repeated panic attacks and:

Persistently worry about having more panic attacks and/or their consequences
Obsess about losing control during a panic attack.
Change one’s behaviors to avoid situations that may trigger a panic attack.[2]

Treatment

Psychotherapy, medications or a combination of the two are very effective at stopping panic attacks. Duration of treatment is dependent on the severity of one’s disorder as well as how well one responds to treatment. Options include:

Psychotherapy: Cognitive behavioral therapy (CBT) helps a person identify panic attack triggers so they can change their related thoughts, behaviors and reactions. As one begins to respond differently to their specific panic triggers, the attacks decrease and ultimately stop.[2] Exposure therapy is a common CBT method that focuses on confronting the fears and beliefs associated with panic disorder to help one engage in activities they have been avoiding. Exposure therapy can be used along with relaxation exercises.[1]
Medication: Based on your history, symptoms and severity, a psychiatrist will be able to determine what the best type and dose of medication is for you. One may need to try different medications before finding the ideal one for their specific situation, thus working with a psychiatrist who has experience utilizing a wide range of different medications for panic attacks/disorder can be especially helpful. The following three types of medications are currently most-effective:[1]

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
Beta-blockers
Anti-anxiety medications, such as benzodiazepines

A healthy lifestyle also can help combat panic disorder[1], which includes getting enough restorative sleep, exercising, spending time in nature/outdoors, consuming a healthy diet, and having a strong and stable support network (e.g., family and/or friends).

For more information, click here to access an Interview with Psychologist Kevin Chapman on Panic & Social Anxiety.

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

References

1 “Panic Disorder: When Fear Overwhelms,” National Institute of Mental Health. (accessed 2-22-2022). www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

2 “Panic Disorder,” Cleveland Clinic. (accessed 2-22-2022) my.clevelandclinic.org/health/diseases/4451-panic-disorder