Panic disorder occurs when you experience recurring unexpected panic attacks. The DSM-5 defines panic attacks as abrupt surges of intense fear or discomfort that peak within minutes. People with the disorder live in fear of having a panic attack. You may be having a panic attack when you feel sudden, overwhelming terror that has no obvious cause. You may experience physical symptoms, such as a racing heart, breathing difficulties, and sweating.
Most people experience a panic attack once or twice in their lives. The American Psychological Association reports that 1 out of every 75 people might experience a panic disorder. Panic disorder is characterized by persistent fear of having another panic attack after you have experienced at least one month (or more) of persistent concern or worry about additional panic attacks (or their consequences) recurring.
Even though the symptoms of this disorder can be quite overwhelming and frightening, they can be managed and improved with treatment. Seeking treatment is the most important part of reducing symptoms and improving your quality of life.
Symptoms of panic disorder often begin to appear in teens and young adults under the age of 25. If you have had four or more panic attacks, or you live in fear of having another panic attack after experiencing one, you may have a panic disorder.
Panic attacks produce intense fear that begins suddenly, often with no warning. An attack typically lasts for 10 to 20 minutes, but in extreme cases, symptoms may last for more than an hour. The experience is different for everyone, and symptoms often vary.
Common symptoms associated with a panic attack include:
- racing heartbeat or palpitations
- shortness of breath
- feeling like you are choking
- dizziness (vertigo)
- sweating or chills
- shaking or trembling
- changes in mental state, including a feeling of derealization (feeling of unreality) or depersonalization (being detached from oneself)
- numbness or tingling in your hands or feet
- chest pain or tightness
- fear that you might die
The symptoms of a panic attack often occur for no clear reason. Typically, the symptoms are not proportionate to the level of danger that exists in the environment. Because these attacks can’t be predicted, they can significantly affect your functioning.
Fear of a panic attack or recalling a panic attack can result in another attack.
The causes of panic disorder are not clearly understood. Research has shown that panic disorder may be genetically linked. Panic disorder is also associated with significant transitions that occur in life. Leaving for college, getting married, or having your first child are all major life transitions that may create stress and lead to the development of panic disorder.
Although the causes of panic disorder are not clearly understood, information about the disease does indicate that certain groups are more likely to develop the disorder. In particular, women are twice as likely as men to develop the condition, according to the National Institute of Mental Health.
If you experience symptoms of a panic attack, you may seek emergency medical care. Most people who experience a panic attack for the first time believe that they are having a heart attack.
While at the emergency department, the emergency provider will perform several tests to see if your symptoms are caused by a heart attack. They may run blood tests to rule out other conditions that can cause similar symptoms, or an electrocardiogram (ECG) to check heart function. If there is no emergency basis to your symptoms, you will be referred back to your primary care provider.
Your primary care provider may perform a mental health examination and ask you about your symptoms. All other medical disorders will be ruled out before your primary care provider makes a diagnosis of panic disorder.
Treatment for panic disorder focuses on reducing or eliminating your symptoms. This is achieved through therapy with a qualified professional and in some cases, medication. Therapy typically involves cognitive-behavioral therapy (CBT). This therapy teaches you to change your thoughts and actions so that you can understand your attacks and manage your fear.
Medications used to treat panic disorder can include selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant. SSRIs prescribed for panic disorder may include:
Other medications sometimes used to treat panic disorder include:
- serotonin-norepinephrine reuptake inhibitors (SNRIs), another class of antidepressant
- antiseizure drugs
- benzodiazepines (commonly used as tranquilizers), including diazepam or clonazepam
- monoamine oxidase inhibitors (MAOIs), another type of antidepressant that is used infrequently because of rare but serious side effects
In addition to these treatments, there are a number of steps that you can take at home to reduce your symptoms. Examples include:
- maintaining a regular schedule
- exercising on a regular basis
- getting enough sleep
- avoiding the use of stimulants such as caffeine
Panic disorder is often a chronic (long-term) condition that can be difficult to treat. Some people with this disorder do not respond well to treatment. Others may have periods when they have no symptoms and periods when their symptoms are quite intense. Most people with panic disorder will experience some symptom relief through treatment.
It may not be possible to prevent panic disorder. However, you can work to reduce your symptoms by avoiding alcohol and stimulants such as caffeine as well as illicit drugs. It is also helpful to notice if you are experiencing symptoms of anxiety following a distressing life event. If you are bothered by something that you experienced or were exposed to, discuss the situation with your primary care provider.