Panic Disorder

What Is Panic Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists panic disorder as a type of anxiety disorder. Someone who has a panic disorder will experience unexpected panic attacks regularly.

Having panic attacks doesn’t automatically mean you have panic disorder. According to the American Psychiatric Association, to qualify as a panic disorder, someone has to have at least one panic attack followed by at least one month of constant fear of having another.

The fear of having another panic attack is so intense and debilitating that it changes their behavior to the point where they might begin to actively avoid situations that can lead them to have another panic attack.

Learn more about this disorder, including how it is diagnosed and treated and what you can do if panic attacks are affecting your quality of life.

What Is the Difference Between Panic and Anxiety?

While panic and anxiety both have to do with feelings of fear, they are considered two separate experiences.

Anxiety is more like a sense of looming dread, worry, or fear. Anxiety attacks are often brought on by an outside stressor. An anxiety attack also tends to come on gradually.

Panic, on the other hand, is crippling fear. A panic attack can be expected, like if a person suddenly encounters a phobia, but they are often unexpected.

Both types of attacks involve the body’s fight-or-flight response and have similar symptoms, including racing heartbeat, chest pain, and shortness of breath. Both can also cause feelings of dread and other sensations, like depersonalization (feeling like you are detached from your body).

However, panic attacks are typically much more severe and are considered more rare than anxiety attacks.

Symptoms of Panic Disorder

Someone with panic disorder will often experience a panic attack for no reason.

Some of the mental and physical symptoms of a panic attack as it relates to a panic disorder include:

• Increased heart rate, pounding heart, or heart palpitations
• Sweating
• Chest pain
• Feeling of choking
• Trembling, shaking
• Feeling detached from your body (i.e., depersonalization)
• Intense fear of dying
• Fear of losing control
• Shortness of breath
• Feelings of unreality (i.e., derealization)
• Nausea
• Dizziness or lightheadedness
• Numbness or tingling
• Chills or hot flashes
• Constant worry about when the next panic attack will hit
• Avoiding places where panic attacks have occurred in the past

For someone with panic disorder, their panic attacks might feel like they are having a heart attack, stroke, or other life-threatening medical condition.

While the DSM-5 states a panic disorder requires four or more of the above symptoms, you should contact your healthcare provider immediately if you experience any of the symptoms listed.

Panic Disorder Causes and Risk Factors

While doctors don’t exactly know what causes panic disorder, there are some causes and risk factors they have found that can increase the likelihood that someone will develop a panic disorder.

Genetics

Someone with a family history of panic disorder is far more likely to develop it themselves.

If a direct family member has a panic disorder, you can also be up to eight times more likely to develop the condition. If that family member developed a panic disorder before age 20, the likelihood could increase up to 20 times.

Age and Gender

Panic disorder is most often detected and diagnosed during a person’s teenage or early adulthood (18-35) years. Panic disorder is also far more common in women than men, with women more than twice as likely to develop a panic disorder.

Environment and Life Events

A child’s upbringing environment plays a significant role in their overall mental health and well-being as they get older.

A child who grows up in an environment full of stress, anxiety, high demand, and expected perfectionism is far more likely to develop an anxiety disorder as they get older, particularly a panic disorder.

Experiencing traumatic life events can also increase the risk of panic disorder, including:

• Death of a family member or loved one
• Witnessing or being the victim of abuse
• Witnessing or being in a major car accident
• Living through a natural disaster

Co-Occurring Conditions

It is not uncommon for someone with a panic disorder to have another significant mental health condition.

In some cases, the other mental health issue can lead to a panic disorder, while in others, the panic disorder can cause another mental illness.

Mental health conditions that often co-occur with a panic disorder include:

• Depression
• Anxiety
• Post-Traumatic Stress Disorder (PTSD)
• Generalized Anxiety Disorder (GAD)
• Obsessive Compulsive Disorder (OCD)
• Social Anxiety Disorder
• Seasonal Affective Disorder (SAD)
• Specific phobias such as agoraphobia

Panic Disorder and Addiction

For some people dealing with panic disorder, the short-term relief from drugs or alcohol might tempt them into self-medicating.

Research indicates that about 10-20% of individuals with an anxiety disorder self-medicate with drugs or alcohol; individuals with panic disorder tend to favor alcohol or other sedatives.

In the short term, substance abuse might seem like it is working, and you might begin to feel better. However, it can also worsen your panic disorder symptoms while causing additional health problems, including dependency and even addiction.

Panic Disorder Treatment Options

With the right combination of therapy, medication, and lifestyle adjustments, people with panic disorder can better manage this mental health condition.

Typically, your doctor or therapist will work with you to develop a treatment plan that’s tailored to you as an individual.

Typical treatment options available for panic disorder can include:

• Psychotherapy
• Medication
• Support groups
• Home remedies

Psychotherapy

Sometimes referred to as talk therapy, psychotherapy has been proven effective in treating many mental health conditions, including panic disorder.

One form of psychotherapy commonly used to treat panic disorder is cognitive-behavioral therapy (CBT). CBT helps patients learn more about their disorder—particularly how it shows up for them and impacts their lives.

CBT patients usually see significant improvement over time by identifying potential triggers and learning to apply new coping techniques.

Some patients also do well in exposure therapy, a specific type of CBT that exposes them to triggers in a controlled environment.

During exposure therapy sessions, patients can work through their feelings of panic in real-time with the guidance of their therapist until, eventually, they can self-manage or not experience panic at all from these triggers.

Medication

Medication can help treat panic disorder because it can lessen the symptoms of panic attacks and help stabilize a person’s mood so they are less likely to experience a panic attack.

Your doctor or mental health professional may prescribe short- or long-term medications (or both) as part of your treatment plan for panic disorder.

Effective medications that have been FDA-approved for treating panic disorder include:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants that help the brain manage its serotonin, which in turn reduces a person’s overall anxiety and likelihood of being triggered into a panic attack. Usually prescribed for long-term treatment.

Common SSRIs used for panic disorder include:

• Fluoxetine (Prozac®)
• Paroxetine (Paxil®)
• Sertraline (Zoloft®)
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Another long-term treatment solution, these antidepressants help the brain manage both serotonin and norepinephrine, creating a more stable overall mood.

Common SNRIs used for panic disorder include:

• Venlafaxine (Effexor XR®)
• Benzodiazepines: An anti-anxiety medication used for short-term treatment. Benzodiazepines can be taken during a panic attack or periods of peak anxiety to significantly lessen symptoms.

Common benzodiazepines used for panic disorder include:

• Alprazolam (Xanax®)
• Clonazepam (Klonopin®)

Support Groups

For those who have a panic disorder and feel they have nobody they can talk to, a support group is a safe and supportive environment for them to share what they are going through with others who have experienced the same or similar issues.

The Anxiety and Depression Association of America has a resource page for people with mental health conditions like panic disorder to help them find support groups in their area and online.

However, there are plenty of local and online support groups for both panic disorder and overall anxiety disorders. You can find them through searching online or by speaking with your therapist (or even your primary care physician) for recommendations.

Self-Help Techniques

While professional intervention can be incredibly helpful when dealing with panic disorder, there are several self-help strategies you can put into practice as well.

Relaxation techniques, regular exercise, and even adjusting your diet can all help lessen the effects of panic disorder.

Below are some home remedies that can help manage panic attacks and panic disorder:

• Cut down on your caffeine intake or eliminate it entirely
• Exercise regularly
• Adopt a healthy diet
• Limit or eliminate alcohol intake
• Yoga
• Meditation
• Deep breathing
• Mindfulness

Find Help For Panic Disorder

If you or someone you know is regularly getting panic attacks or suspects they have panic disorder, it is helpful to seek support right away.

You can contact your healthcare provider or a licensed treatment professional for treatment options or visit the SAMHSA online Behavioral Health Treatment Services Locator to find treatment solutions near you.

SAMHSA also offers a free, confidential helpline at 1-800-662-4357, where you can talk to someone and find out what mental health services are in your area.