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Panic Disorder: Signs, Symptoms & Treatments

Published: April 6, 2022 Updated: May 12, 2022
Published: 04/06/2022 Updated: 05/12/2022
Headshot of Hailey Shafir, LPCS, LCAS, CCS
Written by:

Hailey Shafir

LPCS, LCAS, CCS
Headshot of Benjamin Troy, MD
Reviewed by:

Benjamin Troy

MD
  • What Is Panic Disorder?Definition
  • What Is a Panic Attack?Panic Attacks
  • Panic Disorder SymptomsSymptoms
  • What Causes Panic Disorder?Causes
  • How Is Panic Disorder Diagnosed?Diagnosis
  • Panic Disorder TreatmentTreatment
  • How to Get Help for Panic DisorderGet Help
  • Can It Be Prevented?Prevention
  • Ways to Cope With Panic Disorder5 Tips
  • Panic Disorder Tests & Self-Assessment ToolsTests
  • Final Thoughts on Panic DisorderConclusion
  • Additional ResourcesResources
  • Panic Disorder InfographicsInfographics
Headshot of Hailey Shafir, LPCS, LCAS, CCS
Written by:

Hailey Shafir

LPCS, LCAS, CCS
Headshot of Benjamin Troy, MD
Reviewed by:

Benjamin Troy

MD

Panic disorder is an anxiety disorder characterized by frequent panic attacks and a persistent fear of future panic attacks. Panic attacks are intense symptoms of anxiety like a racing heart and shortness of breath that come on suddenly and last for several minutes. People with panic disorder often change their routines to avoid people, places and situations that may cause a panic attack.

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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 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?

Anxiety disorders are fairly common overall, but panic disorder affects a small group of people. 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.
People with other kinds of anxiety disorders can experience occasional panic attacks, but people with panic disorder tend to experience them more frequently.

Essentially, panic is a word used to describe extremely high levels of anxiety. 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 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 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 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 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

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 mental health issues, particularly anxiety disorders, 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

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.

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.

Medication

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 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 for panic disorder is often to find 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 can also use these filters to find providers who offer online therapy sessions.

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.

Can It Be Prevented?

Panic attacks, by nature, tend to be random and unexpected rushes of symptoms. Prevention is 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.

5 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 can also be important aspects of recovery.

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

1. 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 and Calm make this easier than ever, offering free guided meditations on your smartphone, including some that are 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.

2. 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.

3. 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.

4. 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.

5. 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.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for referrals by the companies mentioned below.

BetterHelp Online Therapy – BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Talkspace Online Therapy – Online therapy is convenient with Talkspace. Get therapy for as little as $69 per week, or potentially much less if you have insurance from Cigna, Optum, or UHR. Try Talkspace

Choosing Therapy’s Directory – Find an experienced therapist who is committed to your wellbeing. You can search for a therapist by specialty, availability, insurance, and affordability. Therapist profiles and introductory videos provide insight into the therapist’s personality so you find the right fit. Find a therapist today.

Online Psychiatry & Medication – Answer a few questions and Talkspace will match you with an online prescriber and get schedule a video psychiatry session. Your online psychiatry prescriber will personalize your treatment, which may include psychiatric medication and follow-ups. Get started for $249 or see if your insurance is one of many Talkspace accepts. Learn More

Mindfulness & Meditation App – Headspace is an easy way to incorporate mindfulness and meditation into your routine. See for yourself how a few minutes each day can impact your stress levels, mood, and sleep. A monthly subscription for Headspace is only $12.99 per month and comes with a 7-day free trial. Try Headspace

Choosing Therapy partners with leading mental health companies and is compensated for referrals by BetterHelp, Talkspace, and Headspace

For Further Reading

  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov

Panic Disorder Infographics

What Is Panic Disorder? What Is a Panic Attack? How to Cope With Panic Disorder

10 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Olatunij, B. O., Cisler, J. M. & Deacon, B. J.. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. The Psychiatric Clinics of North America, 33(3), 557-577.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

  • Choy, Y. (2008). Treatment Planning for Panic Disorder. Psychiatric Times, 25 (2). Retrieved from https://www.psychiatrictimes.com/articles/treatment-planning-panic-disorder.

  • Elia, J.  (2019). Panic Disorder in Children and Adolescents. Merck Manual. Retrieved from https://www.merckmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/panic-disorder-in-children-and-adolescents

  • Bandelow, B., Spath, C., Tichauer, G. A., Broocks, A., Hajak, G. & Ruther, E. (2002). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Comprehensive Psychiatry, 43 (4), 269-278. https://doi.org/10.1053/comp.2002.33492

  • Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. https://doi.org/10.1136/bmj.332.7547.951

  • National Institute on Mental Health. (2020). Panic Disorder: When Fear Overwhelms. Retrieved from https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml.

  • Sarris, J., Moylan, S., Camfield, D. A., Pase, M. P., Mischoulon, D., Berk, M., Jacka, F. N., & Schweitzer, I. (2012). Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence. Evidence-based complementary and alternative medicine : eCAM, 2012, 809653. https://doi.org/10.1155/2012/809653

  • Lynch, P., & Galbraith, K. M. (2003). Panic in the emergency room. The Canadian Journal of Psychiatry, 48(6), 361-366.

  • Huffman, J. C., Pollack, M. H., & Stern, T. A. (2002). Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Primary care companion to the Journal of clinical psychiatry, 4(2), 54–62. https://doi.org/10.4088/pcc.v04n0203

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: June 11, 2020
    Original Author: Hailey Shafir
    Original Reviewer: Benjamin Troy

  • Updated: January 28, 2021
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for Readability; Added “What Is Panic Disorder?” “If I’ve Had a Panic Attack, Do I Have Panic Disorder?” and “Panic Attacks vs Anxiety Attacks.”

  • Updated: April 6, 2022
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for readability and clarity; Added and reviewed relevant resources. Added “How Common Is It?”, “Complications & Long-Term Effects”, and “Can It Be Prevented?” New material written by Eric Patterson, LPC and reviewed by Dena Westphalen, PharmD.

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Headshot of Hailey Shafir, LPCS, LCAS, CCS
Written by:

Hailey Shafir

LPCS, LCAS, CCS
Headshot of Benjamin Troy, MD
Reviewed by:

Benjamin Troy

MD
  • What Is Panic Disorder?Definition
  • What Is a Panic Attack?Panic Attacks
  • Panic Disorder SymptomsSymptoms
  • What Causes Panic Disorder?Causes
  • How Is Panic Disorder Diagnosed?Diagnosis
  • Panic Disorder TreatmentTreatment
  • How to Get Help for Panic DisorderGet Help
  • Can It Be Prevented?Prevention
  • Ways to Cope With Panic Disorder5 Tips
  • Panic Disorder Tests & Self-Assessment ToolsTests
  • Final Thoughts on Panic DisorderConclusion
  • Additional ResourcesResources
  • Panic Disorder InfographicsInfographics
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