Panic Disorder

Panic Disorder

Do you tend to panic without any obvious trigger? Panic disorder can make you feel overwhelmed, anxious and terrified even in the absence of any obvious threat. If it occurs repeatedly and is left untreated, panic attacks can adversely affect your life.

Table Of Contents

What Is Panic Disorder?

Panic disorder is a form of anxiety disorder involving unreasonable, unexpected and recurring panic attacks, which are intense and sudden episodes of excessive anxiety and fear. Panic attacks can occur even in situations that are not threatening or dangerous. It can result in certain physical symptoms, like numbness, trembling, sweating, shortness of breath and palpitations. The sufferer may be afraid of further attacks in future and may avoid situations and places that may trigger them.

MindJournal explains “Panic disorder is primarily observed in individuals who are prone to experiencing sudden and spontaneous panic attacks. Moreover, these people also tend to be highly preoccupied & obsessed with the fear and anxiety of a reoccurring attack.You may experience panic attacks anywhere and at any time, even while waking up from sleep. Many people with panic disorder feel like having a heart attack or losing control over themselves as fear takes over them completely. It is normal to experience a 1 or 2 panic attack in your lifetime, however, if you experience constant panic attacks persistently, then you may develop panic disorder.

Although panic attacks may not be fatal, it can significantly affect someone’s life and lead to the development of other mental health disorders. However, with effective treatment and care, the sufferer can recover completely over time.

Understanding Panic Attacks And Disorder

Individuals with panic disorder live with the constant fear of experiencing another episode of a panic attack for no obvious cause. Most people experience at least one or two panic attacks in their lives which may last for 5-20 minutes. However, people with this disorder can experience multiple panic attacks of varying intensities for several hours. It can often feel like one panic attack is transforming into the next. Some sufferers may have one or two attacks in a month, while other patients may experience them multiple times in a week. The frequency of panic attacks largely depends on the severity of the disorder.

According to the American Psychological Association (APA), 1 out of every 75 people may experience this disorder, usually during their teens or early adulthood. The Perelman School of Medicine at the University of Pennsylvania reports that “An estimated 2-3% of Americans have panic disorder at some point in their lives. It is observable before 14 years of age, but the prevalence is low in this age category.” However, it generally peaks during adulthood. Moreover, women are twice as likely to develop the panic disorder as men.

During episodes, the sufferer may experience an increase in heart rate, trembling and tingling profuse sweating and may become extremely alert. All these symptoms of this disorder are generally the human body’s “fight or flight” response, even in the absence of any physical threat. “At the height of a panic attack, there may be a frightening feeling that the environment has somehow become unreal or detached. The person may worry about dying, having a heart attack, losing control or going crazy,” explains Harvard Health.

As panic attacks can be an overwhelming and terrifying experience, sufferers may not only worry about “the psychological pain and physical discomfort of the panic attack but also that their extreme behaviour during a panic episode might embarrass them or frighten others,” adds Harvard Health Publishing. Although panic attacks may occur unexpectedly during the initial stages, the sufferer may begin to expect them in specific situations eventually. Hence, they may begin to avoid such situations to avoid triggers for further attacks and this can lead to the development of agoraphobia.

According to a 2006 study 1, panic disorder, whether in the presence or absence of agoraphobia, “is one of the most common and important anxiety disorders in the general population in the Western world with a prevalence in one year of 2-3% in Europe.” The study also revealed that this condition is also associated with other psychiatric conditions, like PTSD, depression & other anxiety disorders. It adds “About a third of patients with depression present with panic disorder.”

Symptoms Of Panic Disorder

People with panic disorder experience episodes of intense anxiety during panic attacks. It may occur without warning and may peak within 10 minutes. Although a panic attack can’t be stopped once it has begun, these are usually short-lived. But, it may last for around 20 minutes or for more than an hour. Symptoms of this disorder may be observed in teens and young adults below 25 years of age. The condition can feel different for different individuals and so the symptoms may vary from person to person.

“The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress,” explains the American Psychiatric Association. These following symptoms can occur during a panic attack:

  • Rapid heart rate and palpitations
  • Chest pain
  • Trembling or shaking
  • Sweating
  • Dizziness and lightheadedness
  • Chills or hot flashes
  • Shortness of breath or smothering sensations
  • Numbness or tingling
  • Nausea or abdominal pains
  • Feelings of choking
  • Feeling detached from oneself
  • Fear of insanity or of losing control
  • Fear of death


As the symptoms can be intense, most sufferers often think that they have a life-threatening disease like a heart attack. The Perelman School of Medicine report adds “The outward symptoms of a panic attack frequently result in social difficulties, such as embarrassment, stigma, or social isolation.”

Causes Of Panic Disorder

Although the exact causes of panic disorder is not known, researchers believe that a number of factors contribute to the development of the condition. Some of the most common risk factors of developing panic disorder include:

  • Genetics
  • Brain structure and function
  • Temperament
  • Major life stress
  • Traumatic experiences
  • Major changes in life
  • History of childhood abuse
  • Excessive nicotine or caffeine intake


Let us take a look at some of leading factors that may cause this mental disorder:

1. Genetics

Like most anxiety disorders, the panic disorder tends to run in families. Inheritance can play a significant role in determining who may be affected. Moreover, this condition is often observed along with certain other genetic conditions like bipolar disorder & alcoholism. According to a recent 2020 study 2 by Curt Cackovic, “First-degree relatives have a 40% risk of developing the syndrome if someone in the family already has been diagnosed with the disorder.”

As it may be an inherited fight or flight response, close relatives of people with the disorder are 4 to 8 times more likely to be affected by the illness than individuals with no family such history, as per Harvard Health. However, people without a family history of any anxiety disorders may also develop it.

2. Brain structure

The National Institute of Mental Health (NIMH) states that people with this mental illness often tend to misunderstand non-threatening bodily sensations as dangerous threats. An NIMH report 3 states “Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety.” Malfunction in certain regions of the brain like the amygdala or the adrenaline glands, can result in an overproduction of specific chemicals that may lead to the physical symptoms of panic disorder.

The Harvard Health report adds that researchers “believe that the illness involves a disturbance in brain pathways that regulate emotion.” The 2020 study by Curt Cackovic and associates reveals that chemical imbalances, such as “abnormalities in gamma-aminobutyric acid, cortisol, and serotonin” can also play a crucial role. It adds “neural circuitry may have a greater role in panic disorder whereby certain areas of the brain are hyperexcitable in individuals and that would make them prone to developing the disorder.”

3. Other factors

Various other temperamental factors, like anxiety sensitivity & neuroticism; environmental factors like abuse and drugs or alcohol addiction; biological factors; overthinking, stressful life events can also contribute to the onset of panic disorder. Moreover, panic attacks may often be triggered by certain physical illnesses, medications and even major stressors. Moreover, people with post-traumatic stress disorder (PTSD) or too many responsibilities are more likely to develop it than others. According to the Perelman School of Medicine, “Some evidence suggests that hypoglycemia, hyperthyroidism, mitral valve prolapse, labyrinthitis, and pheochromocytoma may trigger or worsen the panic disorder.”

Research also indicates that adverse childhood conditions like poverty and physical, emotional or sexual abuse may also cause panic disorder in adulthood. Moreover, certain stressful life events & experiences, like loss and grief, unemployment or a divorce may also result in the initial development of the symptoms of panic disorder. Apart from these factors, substance abuse can also be a significant risk factor as around 30% of sufferers use alcohol and about 17% consume other psychoactive drugs.

Diagnosis Of Panic Disorder

Unlike most phobias, the primary feature 4 of this condition is multiple panic attacks which are usually unexpected, spontaneous and not triggered by any specific situation. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to be diagnosed with panic disorder, the patient must experience recurrent, unanticipated panic attacks. The sufferer must also experience anxiety and worry for having further panic attacks in the following one month. Moreover, the person must also exhibit some changes in behaviour and avoid situations that may trigger another attack.

However, if the symptoms or panic attacks are caused by other factors like illness, medications, substance use or specific situations, then it may not be diagnosed as panic disorder. Although there are no specific tests to diagnose this condition, a medical professional may conduct some examinations and tests to rule out medical issues. The doctor may ask questions about the patient’s family history; medical and psychiatric history; their thoughts, feelings and behaviors during attacks, stresses and anxieties and about consumption of caffeine, alcohol & drugs.

Treatment Of Panic Disorder

Treatment for this condition primarily focuses on relieving or eliminating the symptoms. Most experts agree that a combination of psychotherapy under a qualified professional and medication can help the sufferers to reduce anxiety and panic attacks. According to Mental Health America (MHA), treatment “can reduce or prevent panic attacks in 70 to 90% of people with panic disorder.” It has been observed that most patients experience substantial progress within a few weeks of treatment. Although they may experience relapses, it can also be treated effectively.

Here are some of the effective treatment options available for panic disorder:

1. Psychotherapy

Therapy for this condition generally involves cognitive-behavioural therapy (CBT), which is widely considered as a first-line treatment for its effectiveness. According to the NIMH, CBT helps to change the patient’s unhealthy thoughts, behaviours, actions and reactions so that they may gain a better understanding of the triggers and panic attacks and control their anxiety and fear. “In general, panic disorder can be effectively treated with pharmacological and psychological treatments such as cognitive-behavioural therapy and mindfulness interventions,” explains a 2019 study 5.

Moreover, a 2007 review by the international Cochrane Collaboration found that “either combination treatment or psychotherapy alone – rather than medication alone – should be the first options offered to patients with panic disorder.” Apart from CBT, various other therapy techniques may also be recommended by the mental health professional, such as –

  • Panic-focused psychodynamic psychotherapy
  • Psychoeducation
  • Interoceptive exposure
  • Vivo exposure
  • Respiratory training
  • Applied relaxation


For several patients, a combination of these therapy techniques, along with medications and lifestyle changes, can prove to be the most effective approach.

2. Medications

According to the NIMH, a doctor may prescribe certain medication to help relieve the symptoms of panic disorder. Some common types of medication prescribed for this condition include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Beta-blockers
  • Benzodiazepines


“SSRIs and SNRIs are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder,” suggest NIMH. However, the sufferer may need to take the medicines for several weeks to see any effect. Moreover, beta-blockers can help to regulate the physical symptoms of panic disorder, while benzodiazepines are effective in rapidly controlling the symptoms of panic attacks. According to a 2008 study 6 on pharmacotherapy of panic disorder, “different SSRIs such as paroxetine, fluoxetine, fluvoxamine, sertraline, citalopram, and escitalopram as well as the SNRI venlafaxine,” are the first-line acute pharmacological treatments for this condition.

Another 2019 study 7 showed that “new compounds such as SNRI duloxetine, NRI reboxetine, NaSSA mirtazapine, SARI nefazodone, atypical antipsychotic-risperidone and inositol have high efficacy and potency for treatment-resistant patients,” with panic disorder. However, some of these medicines may cause certain side effects. This is why it is imperative to consult a doctor and strictly follow their instructions for effective treatment.

When To Seek Professional Help

If a sufferer has experienced more than 2 episodes of panic attacks and is worried about further attacks for over a month, then they should see a doctor immediately. You should also remember that panic attacks may also hint at various other life-threatening and psychiatric diseases. Apart from agoraphobia, the sufferer may also develop other specific phobias, depression, anxiety disorders, experience suicidal behavior, substance abuse and other medical conditions.

When left untreated, panic disorder can adversely affect different aspects of a person’s life as well. Hence, it is crucial to seek medical help immediately.

Prevention Of Panic Disorder

There are no guaranteed ways to prevent panic attacks. However, certain steps can be taken to reduce the symptoms, such as –

  • Seeking medical treatment
  • Exercising regularly
  • Practising relaxation techniques like deep breathing, mindfulness meditation 8 and yoga
  • Avoiding nicotine, caffeine, alcohol and illicit drugs
  • Following a nutritious diet & avoiding sugary food
  • Getting good sleep
  • Changing lifestyle

Recovery Is Possible

According to Harvard Health, 30-40% of patients who seek treatment can recover fully for extended periods. Moreover, around 50% of patients experience only mild symptoms which don’t affect their lives on a daily basis. So if you are suffering from panic disorder, then there is still hope.

Seeking treatment and making some lifestyle changes can not only help you overcome the symptoms, but also empower you to live a healthier, happier life.

References:
  1. Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. https://doi.org/10.1136/bmj.332.7547.951 []
  2. Cackovic C, Nazir S, Marwaha R. Panic Disorder. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430973/ []
  3. National Institute Of Mental Health. (2016). NIMH » panic disorder: When fear overwhelms. NIMH » Home. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml []
  4. Fontaine, R., & Beaudry, P. (1984). Panic attacks and panic disorders. Canadian family physician Medecin de famille canadien, 30, 1383–1388. []
  5. Kim Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08 []
  6. Pull, C. B., & Damsa, C. (2008). Pharmacotherapy of panic disorder. Neuropsychiatric disease and treatment, 4(4), 779–795. https://doi.org/10.2147/ndt.s1224 []
  7. Zulfarina, M. S., Syarifah-Noratiqah, S. B., Nazrun, S. A., Sharif, R., & Naina-Mohamed, I. (2019). Pharmacological Therapy in Panic Disorder: Current Guidelines and Novel Drugs Discovery for Treatment-resistant Patient. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 17(2), 145–154. https://doi.org/10.9758/cpn.2019.17.2.145 []
  8. Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., Worthington, J. J., Pollack, M. H., & Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. The Journal of clinical psychiatry, 74(8), 786–792. https://doi.org/10.4088/JCP.12m08083 []
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