What is panic disorder?

Anxiety disorders^[1] are conditions that cause chronic excessive worry and fear. Other anxiety disorders include generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive compulsive disorder (OCD). Panic disorder^[2] is a type of anxiety disorder that causes panic attacks. It is characterized by recurrent panic attacks and chronic fear of experiencing another panic attack. Generally, a diagnosis^[3] of panic disorder is made after someone experiences two or more panic attacks that occur without known triggers, followed by a period of at least one month in which the person fears having another attack.

Panic attacks

A panic attack^[4] is a sudden, intense episode of fear or anxiety. Panic attacks are often accompanied by multiple physical symptoms, including nausea, shaking, sweating, or dizziness. Someone having a panic attack may feel that they can’t breathe or fear that they are dying. Some people even mistake panic attacks for a heart attack. Panic attacks—also called anxiety attacks—can be very frightening, especially if you’ve never had one before. They often come on without any apparent reason, making it challenging to identify what may trigger your panic attacks. Panic attacks can last^[5] anywhere from a few minutes to multiple hours. They are often unexpected, in some cases even waking you from sleep. While they are not life-threatening, recurrent panic attacks can significantly diminish your quality of life. There are treatments available, however, to help you identify the underlying cause of your panic attacks and manage their signs and symptoms. Many people experience only one or two panic attacks in their lives. They may be triggered by stressful situations and go away once the stress has subsided. If you have frequent panic attacks, however, you may have a condition called panic disorder.

How common is panic disorder?

Roughly 2–3% of Americans^[6] are affected by panic disorder. The condition is two times more common in women than in men. Panic disorder most commonly begins^[7] in late adolescence to early adulthood.~~ ~~ Children^[8] can also have panic disorder, which can interfere with personal relationships, schoolwork, and emotional well-being. Children with panic disorder experience fear of panic attacks themselves and the symptoms that accompany them, rather than the things that cause their anxiety (such as storms, spiders, the dark, etc.).

Panic disorder causes

It’s not yet known exactly what causes^[9] panic disorder and panic attacks. It has been suggested that panic attacks involve the body’s fight-or-flight response. Normally, this response is triggered when you are threatened. During a panic attack, however, the fight-or-flight response can occur despite the absence of an external threat. Some studies have shown that a combination of biological and environmental factors^[10] may contribute to these conditions, including:

• Family history/genetics: Panic disorder has been shown to run in families. If someone in your family—especially one of your parents—has panic disorder, your risk for the condition increases.
• Major life stress: Periods in your life during which you’re under high levels of stress, such as major transitions or after the death of a loved one, may trigger panic attacks or panic disorder.
• Substance use: Drugs and alcohol can contribute to—and, in some cases, trigger—panic disorder.
• Traumatic events: Experiencing a traumatic event or having a history of physical, sexual, or emotional abuse may cause panic attacks or post-traumatic stress disorder.
• Biological problems: Sometimes, panic disorder results from problems in the brain and nervous system.

The first few panic attacks may come on without any prior warning. If you repeatedly experience panic attacks, however, you may be able to identify certain situations that trigger them over time.

Panic disorder symptoms

You may experience panic attacks only once in a while, or they may occur regularly. People with panic disorder experience recurrent panic attacks. Panic attacks often come on suddenly without any warning. They can happen at any time, whether you’re in bed, out with friends, or preoccupied with something else. Your heart may begin to race or your head might start spinning completely out of the blue, despite feeling normal just a moment ago. If you have had a panic attack before, you may come to know when one is coming on. You might recognize a feeling of being tingly or numb, have a sickly, creeping sense of unease, or feel a sudden, overwhelming wave of nausea. The signs and symptoms of a panic attack may start slowly and build, reaching peak intensity after roughly 10 minutes^[11]. Common signs and symptoms^[12] include:

• An abstract sense of impending doom or danger
• Fear of losing control
• Feeling that you are dying
• Fast, pounding heartbeat
• Shortness of breath, tightness in the throat, or feeling of being unable to breathe
• Shaking or trembling
• Chills or a cold sweat
• Hot flashes
• Nausea and abdominal cramping
• Headache, dizziness, lightheadedness, or fainting
• Chest pain or tightness
• Numbness or tingling

Some people may also experience the feeling of being detached from themselves or from reality. These sensations are characteristic of dissociative disorders^[13], which usually develop as coping mechanisms in response to trauma. You will likely feel exhausted after a panic attack. One of the worst things about experiencing a panic attack is the lingering, often intense fear of having another one. Because the signs and symptoms of panic attacks can be so scary, you may go out of your way to avoid situations that may trigger them in the future. If you think you have had a panic attack, talk to your healthcare provider. They will be able to assess your signs and symptoms, provide the right treatment, or refer you to a therapist or psychiatrist.

Panic attack or heart attack?

One of the biggest mistakes made by people having panic attacks is that they are having a heart attack. Especially if you are having your first panic attack, the intense signs and symptoms may lead you to believe that you are experiencing a medical emergency. There is considerable overlap^[14] between the signs and symptoms of panic attacks and those of heart attacks: both may cause dizziness, chest pain, shortness of breath, numbness, sweating, and shaking. In fact, it can be quite challenging^[15] to differentiate between a panic attack and a heart attack without medical evaluation and testing, such as an EKG. While frightening, panic attacks do not pose any immediate health dangers. Heart attacks, however, require emergency medical treatment. Women are especially at risk for confusing the symptoms of these two conditions, as their heart attacks often present with “atypical” symptoms. It may be a good idea to familiarize yourself with the differences between the symptoms of heart attack and panic attack. If you do experience a panic attack, it can be helpful to remind yourself, if possible, that you are not in any real physical danger. Common heart attack symptoms^[16] include:

• Pain that is triggered by physical exertion
• Shortness of breath
• Worsening chest pain that reaches peak severity after a few minutes
• Consistent pressure, pain, aching, or feeling of fullness in the chest
• Discomfort or pain that begins in the chest and radiates outward to other areas of the body, such as the throat, jaw, arms, abdomen, neck, shoulders, or back.

If you have had a panic attack in the past and are experiencing similar symptoms, it may be enough to practice deep breathing and meditation to help manage your symptoms. Ultimately, however, the most important thing to do if you’re unsure about your symptoms is to contact your healthcare provider. If you believe that you are having a heart attack, don’t hesitate to call 911.

Complications from panic disorder

Especially when left untreated, panic disorder can significantly impact your quality of life. You may be so afraid of experiencing another panic attack that you begin to avoid situations that could potentially trigger them. Some complications^[17] that may arise as a result of panic attacks and panic disorder include:

• Developing specific phobias, such as a fear of driving or agoraphobia^[18] (an anxiety disorder characterized by the fear-induced avoidance of situations that may trigger panic, embarrassment, or the feeling of being trapped)
• Interference^[19] with daily life, such as absence or declined performance at work or school
• Frequent visits to healthcare providers about health concerns or medical conditions
• Depression, anxiety disorders, or other mental health problems
• Increased risk or thoughts of suicide
• Harmful or maladaptive coping mechanisms, including dissociative^[20] behaviors or abuse of alcohol or other substances