Panic Disorder and Panic Attacks

What Is Panic Disorder?

Panic disorder is when you’ve had at least two panic attacks (you feel terrified and overwhelmed, even though you’re not in any danger) and constantly worry and change your routine to keep from having another one. It’s a type of anxiety disorder.

One in 10 adults in the U.S. have a panic attack each year and they usually begin between the ages of 15 and 25. About a third of people have one in their lifetime. But most of them don’t have panic disorder. Only about 3% of adults have it, and it’s more common in women than in men.

What Are Panic Disorder Symptoms?

A panic attack is a sudden strong feeling of fear that can happen anywhere, at any time. You’ll have four or more of these signs:

• A sense of approaching danger
• Pounding or fast heartbeat
• Sweating
• Trembling or shaking
• Shortness of breath or a feeling of being smothered
• Throat tightness
• Cramps in your belly
• Headache
• A choking feeling
• Chest pain
• Nausea or stomach pains
• Feeling dizzy or faint
• Chills or hot flashes
• Numbness or tingling
• Feeling unreal or detached
• A fear of losing control or going crazy
• A fear of dying

An attack usually passes in 5 to 10 minutes, but it can linger for hours. It can feel like you’re having a heart attack or a stroke. So people with panic attacks often wind up in the emergency room for evaluation.

Many people with panic disorder relate an attack to what they were doing when it happened. They may think the restaurant, elevator, or classroom caused the attack. Then they'll avoid those places. That may lead to something called agoraphobia, the fear of leaving home or being in public places.

If you feel like you're having a panic attack, see your doctor right away. They aren’t dangerous, but they can get worse without treatment.

Also keep in mind that symptoms of a panic attack are similar to those for more serious conditions. If you're not sure if what you're having is a panic attack, call your doctor, just to be safe.

What Causes Panic Disorder?

Doctors don’t know exactly what causes panic disorder, but one possibility is that the brains of people who have it may be especially sensitive in responding to fear. There's a link between panic attacks and phobias, like school phobia or claustrophobia. There’s also a theory that panic disorder may come from an oversensitivity to carbon dioxide, which makes your brain think you're suffocating.

A few things can make you more likely to have panic disorder:

• Someone in your family has it (though it’s not clear how much of that is because of your genes or the environment you grew up in)
• High levels of stress
• Frequent negative feelings or trouble dealing with negative emotions

Some believe there are ties between panic attacks and:

• Depression
• Alcohol abuse
• Cigarette smoking
• Suicide risk
• Seasonal affective disorder, a type of depression that happens in winter

Most often, panic attacks come "out of the blue." One may even begin while you're sleeping. Using drugs or alcohol to try to deal with panic disorder can make the symptoms worse. Attacks may come after the use of mind-altering drugs. And some medications can cause panic attacks, including some antidepressants.

Panic disorder may start after:

• A serious illness or accident
• The death of a close friend
• Separation from family
• The birth of a baby

People with this disorder often also have major depression, although there is no evidence that one condition causes the other. If you're 40 or older and have panic disorder, you may have depression or another hidden medical condition. Talk to your doctor to find out what's going on.

How Is Panic Disorder Diagnosed?

There isn't a lab test specifically for panic disorder. Because the symptoms can feel a lot like those of a heart attack, your doctor probably will start by examining you and ruling out other health issues. If no other condition is causing your symptoms and you’ve had two or more random panic attacks and live in fear of a repeat episode, you probably have panic disorder.

How Is Panic Disorder Treated?

Your doctor may refer you to a specialist called a psychotherapist. They might recommend:

• A type of talk therapy called cognitive behavioral therapy that helps you learn how to change unhealthy thoughts and behaviors that bring on panic attacks
• Antidepressants, like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Benzodiazepines, which are sedatives that affect your central nervous system (These aren’t used for long because you can get dependent on them.)
• Anti-anxiety medications (Like benzodiazepines, these work better in the short term.)
• Cutting back on caffeine
• Regular exercise
• Limiting alcohol
• Deep breathing exercises

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