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Panic Disorder

  • Definition

    Panic disorder is a type of anxiety disorder characterized by recurrent and unpredictable bursts of terror known as panic attacks. A panic attack is accompanied by physical symptoms that may feel similar to a heart attack or other life-threatening condition.
    Intense anxiety often develops between episodes of panic. As panic attacks become more frequent, people begin avoiding situations that could trigger them. Panic attacks can lead to agoraphobia. This is a fear of being trapped in places or situations where escape could be difficult or impossible.
  • Causes

    Panic disorder is likely to be an interaction of:
    • Genetics
    • Changes in brain function or metabolism
    • Psychosocial stressors that combine to influence the brain's fear networks
  • Risk Factors

    Panic disorder is almost twice as common in women than in men. Other factors that may increase your chance of panic disorder include:
    • Family history of anxiety
    • Poor coping skills
    • History of physical or sexual abuse
    • Stressful life events
    • Increased sensitivity to physical sensations
    • History of another anxiety disorder or anxious temperament
    • Cigarette smoking during adolescence and young adulthood
  • Symptoms

    Panic attacks usually occur unexpectedly and repeatedly. Panic attack symptoms may include:
    • Sudden and intense episodes of fear
    • Racing, pounding, or skipping heartbeat
    • Chest pain, pressure, or discomfort
    • Difficulty breathing
    • Choking sensation or lump in the throat
    • Excessive sweating
    • Lightheadedness
    • Nausea
    • Tingling or numbness in parts of the body
    • Chills or hot flashes
    • Shaking or trembling
    • Feelings of unreality or being detached from the body
    • An urge to flee
    • Fear of impending doom, such as death, a heart attack, suffocation, loss of control, or embarrassment
    • Stomach pain
    Symptoms of Anxiety
    Physiological effects of anxiety
    Copyright © Nucleus Medical Media, Inc.
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will also be done. The diagnosis can be made if you have had a panic attack with at least 4 of the symptoms listed above and persistent worries about the attack for more than 1 month.
    Tell your doctor about your physical symptoms and how the symptoms make you feel. Your doctor will want to know if the panic attacks interfere with your normal activities. You should also tell your doctor if you:
  • Treatment

    The goal of treatment is to decrease the frequency and intensity of panic attacks. Studies support a combination of treatment methods to achieve success. Talk to your doctor about the best treatment plan for you.
    Options include:
    General Education
    Education helps people to better understand what panic disorder is and how it can be treated. It focuses on the concepts that symptoms are not life-threatening and are common. It also helps the person to understand the course of treatment and develop realistic goals for overcoming the disorder. People who undergo treatment have an improved quality of life.
    In some people, learning about panic disorder is enough to help relieve symptoms.
    Cognitive Behavioral Therapy
    Cognitive-behavioral therapy (CBT) can prepare you for situations that may trigger panic attacks. Therapy focuses on:
    • Learning how to recognize what causes your fears
    • Gradually forming healthier thinking patterns
    • Doing breathing exercises to increase relaxation
    • Reducing fear and feelings of terror
    Your doctor may recommend:
    • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs)
    • Benzodiazepines—may cause dependence
    Dietary Changes
    Some people find that avoiding caffeine may help reduce panic attacks. Caffeine is found in many products, like coffee, tea, chocolate, and soft drinks.
  • Prevention

    To help reduce your chance of panic disorder:
    • Avoid drinks that contain caffeine.
    • Avoid abusing alcohol and drugs.
    • Get plenty of rest.
    • Schedule a regular quiet time for yourself at home.
    • Participate in regular exercise—aim for at least 30 minutes per day most days of the week.

    Anxiety and Depression Association of America

    Mental Health America


    Canadian Psychiatric Association

    Canadian Psychological Association


    Answers to your questions about panic disorder. American Psychological Association website. Available at: Accessed January 26, 2016.

    Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: Updated December 23, 2014. Accessed January 26, 2016.

    Panic disorder. EBSCO DynaMed website. Available at: Updated May 21, 2015. Accessed January 26, 2016.

    Panic disorder and agoraphobia. Anxiety and Depression Association of America website. Available at: Accessed January 26, 2016.

    8/22/2006 DynaMed's Systematic Literature Surveillance Furukawa TA, Watanabe N, Churchill R. Psychotherapy plus antidepressant for panic disorder with or without agoraphobia: systematic review. Br J Psychiatry. 2006;188:305-312.

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