Panic Disorder: Signs, Symptoms & Treatments

What Is Panic Disorder?

Panic disorder is described as “a fear of fear” because people with the condition develop a deep fear and anxiety of future panic attacks and avoid certain situations they believe may trigger anxiety and a panic attack. While avoidance works to decrease anxiety in the moment, it reinforces the “false alarms,” increasing anxiety in the long run.¹ Over time, this reinforcement increases anxiety and avoidance to the point where it begins to interfere with a person’s normal routine and functioning, signaling the development of panic disorder.

How Common Is It?

Each year, between 2% and 3% of adolescents and adults will have a panic disorder. Rates increase through early adulthood and drop off after 64. Females are about twice as likely as males to have panic disorder.²

What Is a Panic Attack?

Panic attacks are short but intense symptoms of anxiety that develop quickly, often with little or no warning. People experiencing panic attacks often feel like they can’t breathe or mistake the panic attack for a heart attack or other medical emergency because of how intense or life-threatening their anxiety symptoms feel—although it’s incredibly unlikely that someone would die from a panic attack.

During a panic attack, a person will experience several of the following symptoms:²

• Heart palpitations or racing heart
• Shortness of breath
• Sweating
• Feeling choked
• Tightness or pain in the chest
• Nausea or stomach upset
• Shaking or trembling
• Dizziness or unsteadiness
• Feeling disconnected from themselves
• Feeling disconnected from their surroundings
• Fear of dying from such intense symptoms
• Fear of losing control or going crazy
• Numbness or tingling
• Feeling hot or cold

The symptoms of a panic attack are mainly physiological in nature, and tend to be experienced more intensely and for much shorter periods of time than other kinds of anxiety. Panic attacks can happen at night or during the day, and many are caused by a certain trigger. Panic symptoms are typically not dangerous, but they are very upsetting, scary, and uncomfortable. Research shows that people with panic disorder more frequently use medical and emergency services.³

If I’ve Had a Panic Attack, Do I Have Panic Disorder?

One of the main reasons that panic disorder is misunderstood is because there is a common misconception that anyone who has panic attacks has panic disorder. In reality, panic attacks can be a symptom of any mental health disorder.

Panic attacks are more commonly reported by people with disorders where anxiety is a predominant symptom, including:

• Posttraumatic stress disorder (PTSD)
• Obsessive compulsive disorder (OCD)
• Generalized anxiety disorder
• Social anxiety disorder
• Agoraphobia and other specific phobias, like fear of thunder storms

People with one of these conditions may experience panic attacks in response to specific triggers associated with their disorder. For instance, people with PTSD might have PTSD panic attacks during flashbacks and people with social anxiety could have panic attacks in large groups of people. People who experience panic attacks as a symptom of another disorder sometimes go on to develop panic disorder.

Panic Disorder Symptoms

The most obvious symptom of panic disorder is the experience of repeated panic attacks. People who develop panic disorder have a conditioned fear of future panic attacks that becomes a primary source of anxiety and leads to avoidant behavior that disrupts their normal routine.

Symptoms of panic disorder typically include:²

• The experience of recurrent unexpected panic attacks, where at least one of these attacks has been followed by a month or more of at least one of the following:
  • Persistent concern about additional attacks or the consequences of another attack like fearing losing control or going crazy
  • Significant maladaptive changes in behavior or routine related to the attack(s), like avoidance of a place or activity
• The attacks or resulting symptoms are not related to the use or effects of a substance or medication, and are not the result of an underlying medical issue
• The disturbance is not better explained by another mental disorder like a phobia, other anxiety disorder, PTSD, or OCD

Panic Disorder in Children

It is less common for children to be diagnosed with panic disorder, but when they are, their symptoms can present differently than in adults. Children with panic disorder may display more dramatic or emotional symptoms by having an outburst, crying, or screaming. Children who are diagnosed with the disorder might not have the language or ability to describe their experiences and may complain instead of a headache or stomach ache. Other times, children might appear irritable and on-edge instead of anxious or scared, making it more difficult to detect the underlying issue.⁴

Complications & Long-Term Effects

Out of all the anxiety disorders, panic disorder creates some of the most damaging complications and long-term effects. Some of the issues linked to panic disorder can include:²

• Frequent emergency room visits
• Absence from school and work
• Unemployed and dropping out of school
• Poor quality of life and physical disabilities
• Limited social relationships

Perhaps the most troubling issue is that panic attacks are linked to greater morbidity. Panic attacks can lead to severe impairment.

What Causes Panic Disorder?

There isn’t just one cause that explains why some people develop panic disorder, although certain factors make it more likely to occur. When a person doesn’t understand that their symptoms are anxiety-related, they are more likely to interpret them as dangerous or even life-threatening. These interpretations can create a cycle of anxiety and avoidance characteristic of panic disorder. The confusion and fear about the physical symptoms of anxiety is a central driving force in the development of panic disorder.

Genetics

People who have a family history of anxiety are at higher risk for the condition.⁵

Childhood Trauma

Certain childhood experiences also increase the risk of developing panic disorder, including having parents who were overly strict, unaffectionate, or critical. Experiencing trauma at any age is also believed to increase a person’s risk.^5,6

Other Mental Health Conditions

People who have an existing mental health condition, particularly an anxiety disorder, are more likely to develop panic disorder, especially if they have a history of panic attacks. There is a strong link between panic disorder and depression; these disorders often co-occur, and having one makes it much more likely the other will develop.⁶

Substance Use

The use of alcohol, drugs, and even caffeine also increases the risk of developing panic disorder.⁶

Risk Factors for Developing Panic Disorder

Not everyone has the same risk for developing panic disorder. Based on various factors, like life experience and inborn traits, some people may have a much higher or lower risk of panic disorder.

Possible risk factors for developing a panic disorder can include:²

• Negative childhood experiences, including abuse and trauma
• High stress from relationships or health issues
• Genetic predisposition due to family members with anxiety
• Being prone to unwanted emotions
• The view that anxiety is always harmful

How Is Panic Disorder Diagnosed?

Panic disorder can only be diagnosed by a licensed health or mental health professional. These professionals have the training and experience to be able to differentiate panic disorder from other disorders with similar symptoms. Even in cases when panic disorder is diagnosed, there is often another underlying disorder.

Criteria for Diagnosing Panic Disorder

When a mental health professional is determining if a person has panic disorder, they look for:

• Panic attacks that are recurrent and unexpected
• Worry about the next panic attack
• Emergence of negative coping skills to avoid or delay future attacks

To have a panic disorder diagnosis, the professional must also be sure that symptoms are not caused by another condition or from the use of a medication or substance.

Panic Disorder Treatment

Luckily, panic disorder is highly treatable. With therapy, medication, or a combination of both, many people with panic disorder are able to reduce symptoms, or even make a full recovery. Recovery might mean that they still experience panic attacks, but that they learn better methods of coping and can keep them from interfering with their daily lives.

Cognitive Behavioral Therapy

There are several different kinds of therapy that can be effective at treating panic disorder. Cognitive behavioral therapy (CBT) is one of the most effective treatments for anxiety disorders, including those struggling with panic disorder.^1,7 CBT is usually provided in individual therapy sessions with a licensed counselor, and involves learning strategies to interrupt and change anxiety-provoking thoughts and use coping skills early to prevent panic attacks.

Exposure therapy, a specific type of CBT, is also proven to be effective in treating panic disorder.¹ Exposure therapy involves the use of CBT coping skills in addition to gradually exposing a person to feared situations to help desensitize anxiety responses.

Other Forms of Therapy for Panic Disorder

CBT and exposure therapy are the most common types of therapy for panic disorder, but one non-CBT therapy option for panic disorder is called panic-focused psychodynamic psychotherapy. It encourages clients to confront and examine the significance of their panic symptoms.¹¹

Medication

Medication is sometimes recommended as a part of treatment for panic disorders, and increases the likelihood of recovery. Research suggests that CBT therapy with medication results in the best outcomes.³ Medications commonly used to treat panic disorder include anti-anxiety medications and antidepressants.⁷

How to Get Help for Panic Disorder

Because therapy has proven to be so effective in treating anxiety disorders, the best first step towards getting help is often to start finding a therapist. Many people begin their search by using an online therapist directory that allows them to narrow their search to therapists who work with specific populations or who have certain specialties. Those who are anxious or unable to get to a therapist’s office might wish to consider online therapy options.

If you’re ready to begin online therapy, Talkspace is an excellent choice for those with insurance. If you do not have insurance, there are several online therapy options to choose from, with one of the most accessible options being BetterHelp.

If you’re ready to begin online CBT for Panic Disorders, Online-Therapy.com is an excellent choice for those without insurance. If you have insurance, there are several online therapy options that take insurance.

In some cases, people with panic disorder also benefit from combining therapy with medication, which could be prescribed by a doctor, psychiatrist, or other prescribing professional, including online psychiatrists.

Alternative Medicine

Alternative and complementary approaches to anxiety and panic may be helpful for some as they manage panic symptoms. Some helpful alternative medicine treatments for panic include:¹²

• Relaxation techniques
• Meditation
• Yoga
• Acupuncture

Most of these options can be integrated with other therapies and medication to create a holistic treatment approach.

Can Panic Disorder Be Prevented?

Panic attacks tend to be random and unexpected rushes of symptoms, so prevention can be challenging. However, as time and experience grows, people may better understand their symptoms and triggers. They may not stop all of their attacks, but they could greatly reduce the frequency, intensity, and duration of the symptoms.

7 Ways to Cope With Panic Disorder

The symptoms of panic disorder cause a lot of distress for people, and keep them from being able to live full, productive, and happy lives. Treatment can substantially reduce, or even eliminate, the symptoms of this disorder but certain lifestyle changes and grounding techniques for panic attacks can also be important aspects of recovery.

Here are seven healthy coping mechanisms that can help people manage symptoms of anxiety and panic disorder:⁸

1. Educate Yourself About Panic Disorder & Anxiety

Panic disorder can be a frightening and overwhelming condition. Information and education can go a long way to demystify the condition and build a sense of control and power.

2. Communicate Your Needs to Your Treatment Team & Loved Ones

There may not be a clear way to stop all panic attacks, but by communicating your situation, experiences, and feelings to the important people in your life, you can help the treatment process. Finding new, effective ways to express yourself can aid in your recovery and boost your relationships.

3. Develop a Meditation Routine

Research continues to emerge on the health and mental health benefits associated with meditation for panic attacks. Dedicating even a few minutes a day to unhooking your thoughts and being present is particularly helpful in reducing stress and anxiety. Apps like Headspace and Calm make this easier than ever, offering free guided meditations on your smartphone, including some that are five minutes or less.

Some people find that practices like yoga or tai chi are easier for them to engage in because they get your body involved. These practices also incorporate mindfulness and can be just as beneficial in reducing stress and anxiety. Yoga apps can be a great way to get started with your practice.

4. Maintain an Active Lifestyle

Exercise and physical activity help to regulate hormones and other chemicals associated with mood, stress and energy levels. Physically active people report lower levels of anxiety, and many people report that exercise is key in managing their symptoms. All forms of physical activity are beneficial, but those who exercise outside get an added mood boost. Physical and mental health are also closely linked, so benefits to one translate into benefits to both.

5. Limit Stimulants Like Caffeine & Nicotine

Caffeine and nicotine are two of the most common stimulants used by Americans, and both can mimic some of the physiological changes associated with anxiety and panic disorders. Limiting or cutting out caffeine and nicotine helps some people with anxiety and panic disorder reduce overall levels of anxiety.

If you are unsure whether these are affecting your symptoms, try cutting down or stopping for a few days and keep track of any changes in your symptoms. If your symptoms keep you up at night, implementing a cutoff time in the late afternoon could be helpful.

6. Cut Out Drugs & Alcohol

There is a known link between panic disorder and the use of alcohol and other illicit substances. People who have panic symptoms might turn to these substances to self-medicate when they are stressed or anxious. With regular use, these substances tend to become less effective over time, leading people to take more and ultimately ending in dependence.

Even prescribed medications can become problematic if they are misused or overused. Resist the urge to take these chemical “shortcuts” during times when you are anxious, instead finding healthier outlets and ways to cope.

7. Engage in Social & Recreational Activities

Making good use of your free time is also important in helping you manage symptoms of panic disorder. People with panic disorder often describe that avoidant behavior begins with activities that are optional, like activities or outings with friends. Avoidance decreases short term anxiety but tends to make panic disorder worse in the long run, so don’t cancel plans if you are feeling anxious. Pushing yourself to get out, see people, and do these activities anyway works similar to exposure therapy, keeping your symptoms from taking over your routine.

Panic Disorder Tests & Self-Assessment Tools

Panic disorder, like all mental health conditions, can only be diagnosed by a licensed health or mental health professional. Psychologists, and licensed counselors or social workers are all able to diagnose panic disorder, as are doctors, psychiatrists, and other licensed professionals. Because many different factors are considered when making a diagnosis, symptoms alone do not always indicate a disorder.

Knowing the symptoms, however, can help a person determine whether they need to set up an appointment with a professional who can provide a formal assessment. Symptoms can be identified by using the Anxiety and Depression Association of America (ADAA) screening tool for panic disorder.

Final Thoughts on Panic Disorder

Panic disorder is debilitating for many people, keeping them from being able to function and follow their normal routine. People suffering from panic disorder often feel hopeless about their symptoms, but research shows that therapy (sometimes in addition to medication) is highly effective at treating panic disorder. With treatment, people with panic disorder are usually able to greatly reduce or even resolve their symptoms, which greatly improves their quality of life.