Fear and anxiety (intense nervousness) are normal reactions to stressful events in our lives. Panic disorder, however, is different. Panic disorder is a serious condition that strikes without reason, causing sudden attacks of fear and anxiety, as well as physical symptoms such as sweating and a racing heart. When a person suffers from panic disorder, these attacks—called panic attacks—continue to occur without warning. Over time, the person develops a constant fear of having another attack, which can affect daily functioning and general quality of life. Panic disorder often occurs along with other serious conditions, such as depression, alcoholism or drug abuse.
What are the symptoms of panic disorder?
People with panic disorder have repeated panic attacks. A panic attack is a period of intense fear that occurs in response to ordinary situations. During a panic attack, the fear response is out of proportion for the situation, which often is non-threatening. Panic attacks occur suddenly and without warning, and cannot be stopped. They can occur at any time and generally do not last long, usually reaching their peak of intensity within 10 minutes of onset. Symptoms of a panic attack include:
- Difficulty breathing
- Pounding heart or chest pain
- Intense feeling of terror
- Sensation of choking or smothering
- Dizziness or feeling faint
- Trembling or shaking
- Sweating
- Nausea or stomachache
- Tingling or numbness in the fingers and toes
- Chills or hot flashes
- A fear that you are losing control or are about to die
Beyond the panic attacks themselves, a key symptom of panic disorder is the persistent fear of having future panic attacks. The fear of these attacks can cause the person to avoid places and situations where an attack has occurred or where they believe an attack might occur.
What causes panic disorder?
Although the exact cause of panic disorder is not fully understood, studies have shown that a combination of factors, including biology and environmental stresses, might be involved. These factors include the following:
- Family history — Panic disorder has been shown to run in families. It might be passed on to some people by one or both of parents, like hair or eye color.
- Biological malfunction — Panic disorder might be caused by problems in parts of the brain and nervous system.
- Substance abuse — Abuse of drugs and alcohol can contribute to panic disorder.
- Major life stress — Stressful events and major life transitions, such as graduation from school or the death of a loved one, can trigger a panic disorder.
How common is panic disorder?
Panic disorder affects 2-3% of adult Americans. Panic disorder most often begins during late adolescence and early adulthood. It is twice as common in women than in men.
How is panic disorder diagnosed?
Panic disorder can be difficult for health care providers to recognize. Physical symptoms can be very strong, so much so that many people with panic disorder believe they have a physical illness, such as heart disease.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose panic disorder, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.
If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for panic disorder. The doctor bases his or her diagnosis on the patient’s report of the intensity and duration of symptoms—including the frequency of panic attacks—and the doctor’s observation of the patient’s attitude and behavior. The doctor then determines if the patient’s symptoms and degree of dysfunction suggest panic disorder. The standard reference manual used for the diagnosis of recognized mental illnesses in the United States is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
How is panic disorder treated?
A combination of the following therapies often is used to treat panic disorder:
- Psychotherapy — Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder.
- Cognitive-behavioral therapy — People suffering from panic disorder often participate in this type of therapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings. Therapy also aims to identify possible triggers for panic attacks.
- Medication — Anti-anxiety medications (such as alprazolam and clonazepam) and antidepressants (such as paroxetine and sertraline) are used to treat panic disorders. Sometimes, heart medications (such as beta blockers) are used to control irregular heartbeats.
Some people will respond well to treatment only to experience panic attacks later in life. When panic attacks continue after treatment has stopped, additional treatment might still help to control and reduce panic attacks. In addition, relaxation techniques—such as breathing retraining and positive visualization—might help a person get through a panic attack.
Complications of panic disorder
Panic disorder is highly treatable and, once treated, does not lead to any permanent problems. Without treatment, however, panic disorder can have serious consequences and can severely impair quality of life. Complications of untreated panic disorder include the following:
- Avoidance — A person might discontinue any activities that seem to trigger a panic attack. This can make a normal work and home life nearly impossible.
- Anticipatory anxiety — This refers to anxiety that is triggered merely by thinking about the possibility of having an anxiety attack.
- Agoraphobia — This is the fear of being in places or situations in which an attack might occur, or from which escape would be difficult or highly embarrassing. This fear can drive people to avoid public places and crowds, and might even progress to the point that the person will not leave his or her home. About one-third of people with panic disorder develop agoraphobia.
What is the outlook for people with panic disorder?
Panic disorder can be successfully treated, and sufferers can go on to lead full and satisfying lives. With appropriate treatment, nearly 90 percent of people with panic disorder can find relief. Unfortunately, many people with panic disorder do not seek treatment.
Can panic disorder be prevented?
Panic disorder cannot be prevented. However, there are some things you can do to reduce stress and decrease symptoms:
- Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
- Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
- Exercise daily and eat a healthy, balanced diet.