What Is Panic Disorder? Symptoms, Causes, Diagnosis, and Treatment

Panic disorder is an anxiety disorder characterized by spontaneous, unexpected panic attacks. (1) Panic attacks are sudden episodes of intense fear that also feature physical symptoms. (2) People who have panic disorder are very worried about having another panic attack. (1) They often try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. As a result, panic disorder can significantly interfere with daily life. (1)

The physical symptoms of a panic attack are those of the fight-or-flight response to danger — except that no threat is present.

“The fight-or-flight system is hardwired for us humans to manage dangerous situations, and those of us with anxiety have an activated fight-or-flight response when the trigger is not really dangerous,” says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety and Related Disorders and former board president of the Anxiety and Depression Association of America.

“Our heart races and our circulation favors our large muscle groups, so we can run away, and we in turn get dizzy because the blood is flowing in a different way. Our body is readying us to try to get away from the danger,” she explains.

Noah Clyman, a licensed clinical social worker and the director of NYC Cognitive Therapy in New York City, says he works with patients to help them realize that these often scary physical symptoms can be tolerated, and need not be feared. “A main goal of treatment is for the client to learn that panic sensations are normal and uncomfortable, but not dangerous,” he says.

The hallmark symptom of panic disorder is the persistent fear of having future panic attacks. (3) If you experience repeated panic attacks and are constantly worried about having another one, you may have panic disorder.

A panic attack includes at least four of the following symptoms: (1)

• Palpitations, pounding heartbeat, or accelerated heart rate
• Sweating
• Trembling or shaking
• Feeling like you are short of breath or being smothered
• Sensations of choking
• Chest pain or discomfort
• Nausea or digestive trouble
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Numbness or tingling sensations
• Feelings of unreality or being detached from yourself
• Fear of losing control or “going crazy”
• Fear of dying

In addition to the above symptoms, a panic attack usually has the following characteristics:

• It happens suddenly, and it’s difficult to to stop it. (3)
• Your fear doesn’t make sense or is overblown, given the actual situation.
• Panic attacks typically peak in 10 minutes or less and then begin to subside. But attacks can continue to recur for hours. (1,3)

Learn More About Signs and Symptoms of Panic Disorder

The exact causes of panic disorder are unclear. But there is some evidence for the following factors: (3)

Life Transitions Major life events, such as graduating from college, getting married, or having a first child, seem to be connected to panic disorder. The recent loss of or separation from a loved one has also been linked to panic disorder.

Genetic Predisposition If you have a family member that has panic disorder, you have an increased risk of having it yourself, particularly during stressful times in your life.

Physiological False Alarm Some experts suspect that panic disorder could also be rooted in a physiological false alarm, in which the fight-flight-freeze system turns on in the absence of danger, due to a biological malfunction. But more research needs to be done.

A Physical-Psychological Combination A person may interpret physical symptoms from other causes as the onset of a panic attack, and as a result have an actual panic attack. For example, if you have a racing heartbeat caused by drinking coffee, exercising, or taking a medication, but you think you’re having a panic attack, you may trigger an actual panic attack.

Risk Factors

Factors that may increase your risk of having panic attacks or panic disorder include: (4)

• Major life stressors, such as when a loved one is seriously ill
• Traumatic events such as sexual assault or a serious accident
• Smoking or excessive caffeine intake
• Being physically or sexually abused in childhood

To diagnose panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these criteria: (5)

• You have recurrent, unexpected panic attacks.
• At least one of your attacks has been followed by one month or more of persistent concern about having another attack or the consequences of an attack, or significant changes in your behavior related to the attacks.
• Your panic attacks aren’t due to medication use or substance abuse, a medical condition, or another mental health condition.

In order to determine whether you have panic disorder, your doctor may conduct: (4)

• A physical exam
• Blood tests to check your thyroid and for other possible conditions that can cause similar symptoms
• Tests on your heart, such as an electrocardiogram (ECG or EKG)
• A psychological evaluation

Your doctor may also ask you about alcohol or other substance use, and have you fill out a psychological self-assessment or questionnaire.

Prognosis of Panic Disorder

Panic disorder is highly treatable. (3) Most people get better with proper treatment. (6) Some people may continue to experience situational avoidance or anxiety, and may require further treatment. (3)

Panic disorder may be long-lasting. Some people respond to treatment after a few months, while others may need more than a year. (1,6)

The consensus among experts is that a consultation with a licensed therapist is the best way to begin to address panic disorder. (3) In some cases, medication may also be used.

Psychotherapy, particularly a specific type known as cognitive behavioral therapy (CBT), is an effective first-line treatment for panic disorder. CBT teaches you different ways to react to the feelings of fear and physical symptoms brought on by a panic attack. (7)

With CBT, your therapist may work with you to gradually simulate the symptoms of a panic attack in a safe environment. (4) Over time, the physical symptoms of a panic attack will no longer feel dangerous, and the attacks can begin to disappear. If you’ve been avoiding any situations out of fear that they will trigger a panic attack, CBT can help with that, too.

Medication Options

Although therapy is the treatment of choice for panic disorder, medications are sometimes used. Most often these are medications that are also used to treat depression and anxiety. (3) Sometimes, heart medications (such as beta-blockers) are used to control irregular heartbeats.

Benzodiazepines, which are sedatives, can reduce panic symptoms, but they can also cause tolerance and dependence, so your doctor may prescribe them only for brief periods if you need them. (7)

Alternative and Complementary Therapies

Relaxation techniques like breathing retraining and positive visualization can help people with panic disorder “flow through” a panic attack. (3) People with panic disorder may have slightly higher than average breathing rates, and learning to slow this rate can help them cope with a panic attack and prevent future attacks. Additionally, finding a support group with others who also have panic disorder can be very helpful to some people when used in conjunction with treatment.

Learn More About Treatment for Panic Disorder: Medication, Alternative and Complementary Therapies, and More

Prevention of Panic Attacks

You can’t prevent panic disorder, but you may be able to prevent panic attacks by learning what your personal triggers are. (8)

You can also help reduce the frequency and severity of panic attacks with the following lifestyle modifications: (6)

• Avoid alcohol
• Have regular mealtimes
• Get regular exercise
• Get enough sleep
• Reduce or avoid caffeine, certain cold medicines, and stimulants

These tips can also reduce your chances of having a panic attack: (9)

• Eat a healthy diet
• Manage stress
• Talk to your doctor before taking herbal supplements or over-the-counter medications, because certain substances can increase anxiety

Getting treatment for panic attacks as soon as possible can prevent them from getting worse or happening more often. (4) It’s also important to follow your treatment plan to prevent relapses and keep your symptoms from getting worse.

Panic disorder can have complications if it’s not treated, according to the APA. These complications include: (3)

• Panic disorder often leads to a phobia, because once you’ve experienced a panic attack, you may start to avoid situations like the one you were in when the attack took place (called “situational avoidance”). This can then lead to a phobia. For example, you have a panic attack while driving, begin to avoid driving, and then develop an actual phobia about driving.
• One serious complication of panic disorder is when you develop agoraphobia, or fear of being in situations where a panic attack is likely and escaping from the situation could be difficult — for example, being in a movie theater or eating in a restaurant.

People who have panic disorder are also:

• More prone to alcohol and other drug abuse
• Have a greater risk of attempting suicide
• Spend more time in hospital emergency rooms
• Spend less time on hobbies, sports, and other enjoyable activities
• Tend to be financially dependent on others
• Report feeling emotionally and physically less healthy than people who don’t have panic disorder
• May be afraid of driving more than a few miles away from home

Symptoms of panic disorder often start in the late teenage years or early adulthood. (4) While panic disorder usually begins after age 20, children can also have the condition, and many experience panic-like symptoms (“fearful spells”). (1)

About 2 to 3 percent of Americans experience panic disorder in a given year, and the condition is twice as common in women than in men. (1)

About two-thirds of people who have panic disorder develop agoraphobia. (9) People who have agoraphobia are extremely fearful of two or more of the following situations: (10)

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone

Panic disorders also often lead to phobias. People who have specific phobias (also called simple phobias) have intense fear or anxiety about specific types of objects or situations. Specific phobias include fear of the following:

• Flying
• Heights
• Certain animals, such as spiders, dogs, or snakes
• Receiving injections
• Blood

RELATED: What Is Agoraphobia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Anxiety and Depression Association of America

The ADAA aims to improve the quality of life for people with anxiety, depression, and related disorders. Their website has information about the symptoms and treatment of panic disorder.

National Institute of Mental Health

The NIMH is the leading federal agency for research on mental disorders and is part of the National Institutes of Health (NIH), the largest biomedical research agency in the world. Their website offers information about the prevalence of panic disorder, along with causes, symptoms, and treatment.

American Psychological Association

The APA is the leading scientific and professional organization representing the field of psychology in the United States. Their website has information about causes, side effects, and treatment of panic disorder.

Additional reporting by Carlene Bauer.