Panic Disorder
Panic disorder involves unexpected panic attacks and ongoing worry or avoidance. Understand the symptoms, how diagnosis works, and options for treatment and support.
Ready for Help?
Understanding Panic Disorder
Panic disorder involves repeated, unexpected panic attacks and lasting worry or behavior changes related to those attacks. An attack is a sudden surge of fear or discomfort that can bring intense physical symptoms, even when there is no clear danger. Having a panic attack does not automatically mean you have panic disorder.[1]
The fear of another attack can become a problem between attacks, too. You might start avoiding exercise, driving or places where you have felt panicky. Treatment can help you respond differently to those sensations and return to activities you have been avoiding.[1]
- A panic attack is an episode. Panic disorder is a condition involving repeated unexpected attacks and ongoing worry or changes in behavior.[1]
- A racing heart, chest discomfort, dizziness and trouble breathing can occur during panic. Similar symptoms can have medical causes, so an assessment matters.[1]
- Cognitive behavioral therapy helps you change how you respond to panic sensations. This therapy, medication or both can help. The plan should reflect your symptoms, health, preferences and other conditions.[1]
- Panic-focused therapy may be available in person or online. Ask about the clinician’s experience helping people face feared sensations and return to activities they avoid.[1][2]
Panic Attacks, Anxiety and Panic Disorder
A panic attack is a sudden episode of intense fear or discomfort with physical and emotional symptoms. Attacks can happen unexpectedly, including during sleep. They can also occur in situations involving a specific fear. The repeated, unexpected attacks are central to panic disorder.[1]
People sometimes use “anxiety attack” to describe intense anxiety or a panic attack. It is not a separately defined diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a reference clinicians use to diagnose mental health conditions. Rather than deciding which label fits on your own, describe what happens, how quickly it starts and how it affects you.[3]
Generalized anxiety disorder involves a different pattern of ongoing, difficult-to-control worry. Panic disorder centers on unexpected attacks and concern or behavior changes related to them. A person can have more than one condition, and a clinician can help sort out the pattern.[4][1]
Signs and Symptoms of Panic Disorder
Panic disorder includes the attacks themselves and what happens between them. You may worry about another attack, fear what the sensations mean or avoid places where an attack has happened. These changes can affect work, school, relationships and everyday activities.[1]
Symptoms During a Panic Attack
The Merck Manual describes a panic attack as a sudden period of intense fear or discomfort accompanied by at least four symptoms. The list below shows the symptom groups. This alone does not establish panic disorder.[5]
- A pounding or racing heart
- Sweating
- Trembling or shaking
- Shortness of breath or a smothering sensation
- A choking sensation
- Chest pain or discomfort
- Nausea or abdominal discomfort
- Dizziness, lightheadedness or feeling faint
- Chills or feeling hot
- Numbness or tingling
- Feeling detached from yourself or that your surroundings are unreal
- Fear of losing control
- Fear of dying.[5]
An attack may last a few minutes to an hour or longer. Fear of another attack can continue after the episode has ended. Tell your clinician about both the episodes and the worry between them.[1]
When Physical Symptoms Need Urgent Care
Call 911 for sudden crushing, squeezing or pressure-like chest pain, or chest pain with shortness of breath, sweating, nausea or dizziness. Pain spreading to the jaw, arm or back is another emergency warning. Do not assume these symptoms are panic, even if you have had panic attacks before.[6]
If you have recurring attacks without emergency symptoms, arrange an appointment with a healthcare professional. You do not need to wait until attacks become frequent or you have stopped doing important activities to ask for help.[1]
How Panic Disorder Is Diagnosed
Diagnosis involves repeated, unexpected panic attacks. After an attack, persistent worry about further attacks or their consequences, or behavior changes intended to avoid them, must continue for at least a month. A single attack followed by a month of fear is not the complete diagnostic requirement.[1]
A clinician checks whether another medical or mental health condition better explains the symptoms. Alcohol, drugs, or the body’s reaction when someone reduces or stops them can also cause symptoms that resemble panic. The assessment may include a physical examination and questions about your health, medicines and what happens before and during attacks.[1][5]
What to Bring to an Appointment
- When attacks happen and how long they last.
- What you notice in your body and what worries you about it.
- Activities or places you have started avoiding.
- A list of medicines, supplements, alcohol or other substances you use.
These notes can help you explain the pattern, including what happens between attacks.[1][7]
Panic Disorder Causes and Risk Factors
There is no single established cause of panic disorder. Family history, the way the brain and body respond to fear, and stress may contribute. Researchers continue to study why the body’s fear response becomes active when there is no clear threat. A risk factor is something linked with a greater chance of a condition. It does not mean someone will develop it.[1]
Family History
Panic disorder can run in families, but it does not affect every relative. Scientists are studying how the brain’s fear response, stress and life experiences contribute. Family history alone cannot tell you whether you will develop the condition.[1]
Age and Sex
Panic disorder often begins in the late teens or early adulthood. It is reported about twice as often in women as in men. Age and sex alone cannot tell you whether you have panic disorder.[1][5]
Stress and Life Experiences
Stress and life experiences may play a role, but an unexpected attack may have no obvious trigger. Discuss major pressures or difficult experiences with your clinician without assuming that one event, your upbringing or something you did explains the condition.[1]
Panic Disorder and Other Conditions
Panic disorder can occur alongside depression, other anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder and other conditions. Having two conditions does not by itself show that one caused the other. A treatment plan should account for the full picture.[1]
Panic Disorder and Agoraphobia
Agoraphobia is a separate condition that can occur with panic disorder. It involves fear of situations where escaping or getting help could be difficult if panic-like symptoms occur. It is not simply another name for panic disorder or a general fear of leaving home.[1]
Alcohol, Drugs and Panic Symptoms
Some people use alcohol or other substances to cope with distress. Substance use and mental health conditions can influence one another, and using a substance for short-term relief can create additional problems. Tell your clinician about your use so both concerns can be assessed and treated together.[8]
If you have been drinking heavily for a prolonged period, seek medical help before abruptly stopping. Alcohol withdrawal is the body’s reaction to going without alcohol after prolonged heavy use. It can be dangerous and can include a rapid heartbeat or seizures. A clinician can help plan a safer recovery. Do not treat withdrawal symptoms as evidence that you simply need to manage anxiety better.[9]
Care for co-occurring addiction and mental health conditions may need to address both concerns. Physical dependence means the body has adjusted to repeated use of a medicine and can develop withdrawal symptoms when it is stopped or sharply reduced. This can happen with prescribed benzodiazepines, a group of anti-anxiety medicines. Get medical advice before changing or stopping them.[8][10]
Treatment for Panic Disorder
Panic disorder is treatable with talk therapy (psychotherapy), medication or both. The right approach depends on your needs, preferences, medical history and access to appropriate care. Improvement can take time, and a treatment plan may need adjustment. There is no single combination everyone must use.[1]
Cognitive Behavioral Therapy and Exposure
Cognitive behavioral therapy, or CBT, is a well-studied treatment for panic disorder. It helps you examine how you interpret bodily sensations and change responses that keep fear and avoidance going. For example, treatment may address the cycle of noticing a racing heart, thinking it means something terrible is happening and becoming more frightened.[1]
Exposure therapy means working with a therapist to face sensations or situations you fear instead of always avoiding them. One form, interoceptive exposure, focuses on physical feelings associated with panic, such as a pounding heart. The work helps you practice responding differently to those feelings.[1]
Exposure can also involve returning to activities you have avoided because you fear another attack. Ask how the therapist chooses exercises that fit your health and supports you through them. You do not need to work out an exercise plan on your own.[1]
Psychologist Simon Rego told the Anxiety and Depression Association of America that asking someone to face feared sensations involves a substantial leap of faith: “I need to earn their trust.” He describes working with patients to understand what brought them to treatment and create a plan together.[11]
Questions to Ask Before an Exposure Exercise
- What is this exercise meant to help me learn?
- How does it fit my health and medical history?
- How will you support me if I find it difficult?
Bring these questions into the plan you make together.
Therapy can help make attacks less frequent and reduce avoidance. Progress does not require a promise that you will never feel anxious again. Discuss changes in attacks and everyday activities with your therapist, along with any setbacks or exercises you find difficult.[1]
Medicines Used for Panic Disorder
Antidepressants are commonly used for panic disorder, even when someone does not have depression. They usually take several weeks to begin helping. A prescriber should discuss possible benefits, side effects, how it may affect other medicines you take and when you will check whether it is helping.[1][7]
SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are two groups of antidepressants used for panic disorder. Benzodiazepines are a different group of medicines that can relieve symptoms quickly but carry dependence and withdrawal risks. The names help you understand a prescribing discussion, rather than choose a medicine yourself.[1][10]
| Medicine class | Examples | What to discuss |
|---|---|---|
| SSRIs | Fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).[12][13][14] | These antidepressants are commonly used for ongoing treatment. Ask about side effects and how long to try the medicine before reviewing its effect.[1][7] |
| SNRIs | Venlafaxine extended-release, a form that releases the medicine slowly.[15][16] | This is another antidepressant option. Review other medicines, side effects and a plan for any dose changes with your prescriber.[7] |
| Benzodiazepines | Alprazolam (Xanax) and clonazepam (Klonopin).[17][18] | These can reduce symptoms quickly, but carry risks including dependence and withdrawal. They are generally considered for brief use. Your prescriber should plan how long you take them and how to reduce or stop them when appropriate.[1][10] |
Other medicines may be considered in particular circumstances. For example, beta-blockers can reduce some physical anxiety symptoms, but they are not commonly prescribed for panic disorder. Ask why a medicine is recommended for you rather than assuming every anti-anxiety medicine serves the same purpose.[1]
Do not drink alcohol with benzodiazepines. Combining them with opioids or other substances that slow brain activity and can make you drowsy can cause serious harm, including slowed breathing and death. Tell every prescriber what you take. Do not stop benzodiazepines suddenly or reduce the dose quickly without a clinician’s plan, because withdrawal can cause life-threatening seizures.[10]
Antidepressant treatment needs follow-up to check symptoms and side effects. Some people younger than 25 experience increased suicidal thoughts or behavior, especially early in treatment or after a dose change. People of all ages need check-ins for concerning changes. Contact your prescriber promptly about worsening symptoms, and do not stop a prescribed medicine on your own.[7]
If you are in crisis or thinking about suicide, call or text 988 or visit 988lifeline.org. Call 911 for a life-threatening emergency.[19]
Coping and Support Between Appointments
Self-care can support treatment, but it does not replace an assessment or panic-focused therapy. Regular sleep, exercise, balanced meals and support from people you trust can be part of your plan. Ask your clinician how caffeine, alcohol and other substances may affect your symptoms.[1][20]
Responding to a Familiar Panic Attack
After a clinician has evaluated your symptoms, make a plan for familiar attacks. It may include recognizing the pattern, using breathing or relaxation skills you have practiced, and noting what happened to discuss at your next visit. New or different symptoms still need appropriate medical attention.[1][3][6]
Breathing exercises, meditation or yoga may be useful coping practices for some people. Choose approaches that fit your treatment plan. They should not become a reason to delay care or blame yourself when symptoms persist.[21][20][1]
Support Groups and Help from Others
A support group can offer a place to share experiences with people facing similar concerns. Ask your therapist about local or online options. SAMHSA’s National Helpline can also refer you to support groups. Support from people with similar experiences can accompany professional care, but does not replace it.[21][22]
If someone close to you has panic disorder, ask what support they find helpful. Listen without dismissing the symptoms, encourage professional care when anxiety interferes with life, and recognize that progress can include setbacks. You can be supportive without taking responsibility for diagnosing or treating the condition.[1]
Finding a Panic Disorder Therapist Near You or Online
Look for experience treating panic disorder, not only a listing for general anxiety. A primary care clinician can help with assessment and referrals. When comparing providers near you or online, ask how they use panic-focused CBT and exposure, and how they work with your prescriber or medical clinician if you need medicine or further health checks.[1][2]
Online therapy can be an option for panic disorder. Online appointments still need an appropriate clinician, a suitable treatment approach and a plan for problems between sessions. Consider whether you have a private space and a reliable connection. A provider or platform name alone does not establish the right fit.[1][2]
Before booking, consider asking these questions:[2]
- How much experience do you have treating panic disorder, and do you provide panic-focused CBT and exposure?
- Are you licensed to treat me where I will be during appointments?
- What do visits cost, and what does my insurance cover?
- Can you work with my medical clinician or prescriber when needed?
- How will we review progress, and whom should I contact if symptoms worsen between visits?
For treatment referrals, use FindTreatment.gov or call SAMHSA’s National Helpline at 1-800-662-4357. The helpline provides free, confidential information and referrals around the clock in English and Spanish. It does not provide counseling.[22]
You can begin by telling a clinician how attacks and fear of another attack are affecting your life. Understanding related anxiety disorders can help you describe your concerns. When you are ready to explore care, find treatment help and ask about support for panic disorder.[1]
If you are in crisis or thinking about suicide, call or text 988 or visit 988lifeline.org. Call 911 for a life-threatening emergency.[19]
Frequently Asked Questions About Panic Disorder
What Are the Symptoms of a Panic Attack?
A panic attack can involve a racing heart, sweating, trembling, chest discomfort, breathlessness, dizziness, nausea, tingling and intense fear. Some people feel detached from themselves or their surroundings. These symptoms can overlap with medical problems, so do not diagnose panic from a checklist or assume new chest pain is harmless.[1][6]
What Causes Panic Disorder?
No single cause explains panic disorder. Family history, the way the brain and body respond to fear, stress, and life experiences or surroundings may contribute. Attacks can happen without an obvious trigger, and a risk factor does not determine who will develop the condition.[1]
What Are the Signs of Panic Disorder?
Signs include repeated unexpected panic attacks, ongoing fear about further attacks or their meaning, and changes such as avoiding activities or places. A clinician considers the pattern over time and checks other possible explanations. An isolated panic attack does not establish panic disorder.[1]
Does Panic Disorder Go Away?
Treatment can reduce attacks and avoidance and improve daily life. Cognitive behavioral therapy (CBT) helps you change how you respond to panic sensations. Medication, therapy or both may help. Some people have setbacks or need changes to their treatment plan. There is no guaranteed recovery deadline or promise that every symptom will disappear.[1]
Can Online Therapy Help with Panic Disorder?
Panic disorder therapy can take place online. Ask how the therapist helps people change their responses to panic and face feared sensations or situations. This work often uses cognitive behavioral therapy (CBT) and exposure. Ask what support is available between visits. Health checks, prescribing and medicine follow-up may need a separate appointment, depending on your needs and the service.[1][2]
Do I Have to Wait a Month to Ask for Help?
No. The one-month worry or behavior-change requirement helps clinicians diagnose panic disorder. It is not a waiting period for care. Seek an assessment when attacks or anxiety are concerning or interfering with your life. Emergency symptoms, including concerning chest pain, need urgent medical attention.[1][6]
Get Treatment Help
If you or someone you love is struggling with addiction, getting help is just a phone call away, or consider trying therapy online with BetterHelp.
Exclusive offer: 20% Off BetterHelp*Following links to the BetterHelp website may earn us a commission that helps us manage and maintain AddictionHelp.com. *Get 20% off your first month of BetterHelp. Offer valid for new BetterHelp users only. Offer cannot be combined with insurance.
- Fact-Checked
- Editor
