Panic attacks are intense symptoms of anxiety that come on suddenly and generally last several minutes. Some people who experience panic attacks go on to develop panic disorder, a condition characterized by an intense fear of having another panic attack. Panic disorder leads to avoidant behavior which disrupts a person’s ability to follow their normal routine.
Types of Panic Disorder
There are no distinct types of panic disorder, but the symptoms of panic disorder are often confused with other conditions. The primary symptom of panic disorder is having one or more panic attacks.
Panic is a word used to describe extremely high levels of anxiety, and panic attacks describe episodes lasting several minutes that include four or more of the following symptoms:1
- Heart palpitations or racing heart
- Shortness of breath
- Feeling choked
- Tightness or pain in the chest
- Nausea or stomach upset
- Shaking or trembling
- Dizziness or unsteadiness
- Feeling disconnected from yourself
- Feeling disconnected from your surroundings
- Fear of dying
- Fear of losing control or going crazy
- Numbness or tingling
- Feeling hot or cold
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 or other specific phobias
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 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.
Out of all of the disorders listed above, the one most closely resembling panic disorder is agoraphobia. Agoraphobia is the fear of being in certain public places that could be hard to escape from or get help if needed. People with agoraphobia often fear places where they have had panic attacks in the past which leads to avoidant behavior. Prior to 2010, agoraphobia was considered to be a subtype of panic disorder, but it is now considered a separate diagnosis.1
In some cases, a person can have a panic attack even without having a mental health condition. This could happen when a person is under extreme stress or experiencing a lot of anxiety. In certain situations where there is an actual threat, panic symptoms are normal and possibly even helpful. The physiological changes that occur during a panic attack are actually part of a built-in alarm system all humans have, which is also called the “fight or flight” response.
The “fight or flight” response begins when the brain senses danger, which cues the release of specific chemicals and stress hormones that provide energy meant to help a person overpower or outrun a predator. Anxiety disorders are understood to be the result of an overactive fight or flight response that is being triggered by false alarms.6 When these hormones and chemicals are released but not needed, it results in the uncomfortable experience of anxiety. Panic attacks occur on the higher end of the anxiety scale, when the intensity of symptoms reaches a peak.
Some people who experience panic attacks will become so disturbed by them that they develop intense anxiety about the possibility of another attack, leading to panic disorder. Panic disorder is described as “a fear of fear” because panic attacks become the primary source of anxiety. This leads a person to avoid certain situations they believe might trigger a panic attack or to avoid situations where having a panic attack would be problematic or embarrassing. While avoidance works to decrease anxiety in the moment, it reinforces the “false alarms,” increasing anxiety in the long run.6
An anxiety attack is a non-medical term sometimes used to describe a panic attack. Some have used the term to describe an episode slightly different or less intense than a panic attack, but this difference isn’t one recognized in the health or mental health profession. Generally, most professionals are familiar with the term and assume it is being used to describe a panic attack. From a clinical standpoint, symptoms that are less extreme than panic but still bothersome would probably be attributed to another condition within the anxiety disorder category.
Signs of Panic Disorder
The most obvious sign of panic disorder is the experience of having one or more panic attacks. For those with existing mental health disorders, the onset of panic disorder may correlate with an overall worsening of their symptoms, resulting in more anxiety and more frequent panic attacks.
The second hallmark sign of panic disorder is avoidance. A person might begin skipping parts of their normal routine or activities when they are feeling anxious. As panic disorder progresses, a person will typically begin avoiding more situations, activities, and parts of their routine due to their fear of having a panic attack.
Because of the physical nature of panic symptoms, people may not know that their symptoms are related to anxiety. Instead they may confuse their symptoms for a heart attack or other serious medical problem, even after getting diagnosed with panic disorder. 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
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 stomachache. Other times, children, teens, or even adults might appear irritable and on-edge instead of anxious or scared, making it more difficult to detect the underlying issue.4
Symptoms of Panic Disorder
All mental health disorders are diagnosed using a standardized set of criteria drawn from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (or DSM-5). Published by the American Psychiatric Association, the DSM-5 outlines specific guidelines for licensed health and mental health professionals to diagnose mental health conditions.
According to the DSM-5,1 the symptoms for Panic Disorder are:
- The experience of recurrent unexpected panic attacks (panic attack symptoms listed above in “types of panic disorder” section), where at least one of these attacks has been followed by 1 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 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.
Causes and Triggers of Panic Disorder
No one cause explains why some people develop panic disorder, although certain factors make it more likely to occur. Some of these risk factors are genetic. People who have a family history of mental health issues, particularly anxiety disorders, are at higher risk for the condition.2 Certain childhood experiences also increase the risk of developing panic disorder, including having parents who were overly strict, unaffectionate or critical.2 Experiencing trauma at any age is also believed to increase a person’s risk.2,8
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 either co-occur and having one makes it much more likely the other will develop.8 The use of alcohol, drugs and even caffeine also increases the risk of developing panic disorder.8 There are individuals with panic disorder who will have attacks without an obvious trigger immediately preceding that attack.
Not everyone who has panic attacks will develop panic disorder. This might be partially due to differences in how a person interprets and responds to panic attacks. 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.
Treatments for Panic Disorder
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 not mean that they never experience another panic attack, but that they learn better methods of coping and can keep them from interfering with their daily lives.
Some of the more common treatments for panic disorder are:
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy, also called CBT, is a highly effective form of therapy. CBT is considered an evidence-based practice because decades of research shows it is effective in treating anxiety disorders,5,6 including panic disorder. CBT treatment is generally provided by a licensed therapist, psychologist, or social worker who has received training in this type of therapy.
CBT therapists focus on the link between thoughts, feelings and behaviors. They learn to become more aware of their own thoughts, feelings, and behaviors, even tracking these during times when they have symptoms. Throughout treatment, clients learn skills to interrupt unhelpful thought and behavior patterns which feed into their anxiety, replacing them with more helpful responses. Sessions usually last about an hour and are offered once or twice a week for several weeks until there is a reduction in symptoms.
Exposure therapy is a specific type of CBT that is used to treat anxiety-related avoidance. Exposure therapy is an especially effective treatment for panic disorder because it helps to reverse avoidant behaviors and build a person’s confidence in their ability to manage their symptoms.
Exposure therapy is highly effective in treating panic disorder but treatment requires clients to be willing to face feared situations.6 The goal of exposure therapy is to help the client resume the normal responsibilities, routines and activities they previously avoided because of anxiety.
Exposure therapy is usually provided in office settings with a therapist, social worker, or psychologist in individual therapy appointments lasting about an hour. The length of treatment varies, but many clients see improvements quickly, some in as few as 2-4 sessions. Therapy will begin with exposures that provoke mild anxiety, working up to those which usually cause a lot of anxiety. Clients in exposure therapy may experience an initial increase in their anxiety but those who complete treatment usually report significant improvements.6
Psychiatric 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 antidepressants and anti-anxiety medications.5
Antidepressants include medications which work on brain receptors that are involved in both depression and anxiety. The most common type of antidepressant prescribed for panic disorder is an SSRI, which is a type of medication that works on serotonin receptors in the brain.3
The most commonly prescribed anti-anxiety medications are benzodiazepines, which work to slow down certain nervous system responses. While these medications are highly effective in reducing anxiety, they are only recommended for short term use. This is because of their addictive potential, their sedating effects, and because they do not help people learn how to manage anxiety without the medication. They are most safely used when attacks are infrequent or occur only in predictable settings.
More recently, medications called betablockers (used to treat high blood pressure) have been used to treat anxiety and panic disorders, and these carry lower risks for adverse effects or addiction.
How to Get Help for Panic Disorder
Scheduling an individual therapy appointment can be a good starting point for treating panic disorder. The first appointment is reserved for an assessment which will confirm your diagnosis and inform recommendations for further treatment. Determining treatment is a collaborative process that you should be actively involved in.
There are many different therapy types and styles and finding one that is a good match for you is important. Therapists may also have recommendations about psychiatrists and other prescribing professionals, which can be difficult to find on your own, particularly in more rural parts of the country.
Not all counselors specialize in working with kids and teens. If you are seeking treatment for a child under the age of 18, you should confirm beforehand that the provider is willing to work with your child. It might be possible to get specialized recommendations from your child’s pediatrician. You could also use an online directory which allows you to narrow your search based on location, areas of specialty, and ages and insurances accepted. Those who are anxious or unable to get to a therapist’s office can also use these filters to find providers who offer telehealth sessions.
Outpatient therapy is covered under most health insurance plans, although plans vary in how much they reimburse versus how much you will need to pay out of pocket. If you want to use your health insurance, call the number on the back of the insurance card or use their online portal to conduct a search. Once you have a list of in-network providers, you will need to call around to see who has openings. Many counselors also offer free phone or in-person consultations to help potential new clients determine whether their skills and experience are a good match.
Panic Disorder Statistics
Research has provided more insight about panic disorder, who is more likely to develop it, and what experiences are common in people with the disorder:3,5,8
- 4.7% of US adults will develop panic disorder in their lifetime
- 2.3% of US teens between the ages of 13-18 will develop panic disorder
- Women are twice as likely as men to develop panic disorder
- 1/3 of people with depression also have panic disorder
- Half of the people with depression will develop panic disorder in their lifetime
- Half of the people with panic disorder will develop depression in their lifetime
- People with panic disorder and depression are 7 times more likely to struggle with suicidal thoughts
- Panic disorder is associated with lower quality of life and 30-50% of people with this disorder report moderate or severe impairments in their ability to function
- In health care settings, 20% or less of people with the disorder receive adequate treatment
Living and Coping 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 can also be important aspects of recovery.
Some of the lifestyle changes that can help people manage symptoms of anxiety and panic disorder are:7
Develop a Meditation Routine
Research continues to emerge on the health and mental health benefits associated with meditation and mindfulness practices. Dedicating even a few minutes a day to unhooking from your thoughts and being present is particularly helpful in reducing stress and anxiety. Apps like Headspace make this easier than ever, offering free guided meditations on your smart phone, including some that are only 5 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.
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.
Cut Out Stimulants
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.
Cut Out Drugs and 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.
Social and 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, Quizzes, and Self-diagnosis 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 using the previous “Symptoms” section of this article or by using one of the free screening tools listed below:
- Anxiety and Depression Association of American (ADAA) screening tool for panic disorder
- The GAD-7 screening offered on SAMHSA’s website which helps identify symptoms of Generalized Anxiety Disorder
More Resources on Panic Disorder
Those who are interested in learning more about panic disorder can visit the following sites: