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.
What Is Panic Disorder?
Panic disorder is described as “a fear of fear” because people with the condition develop a deep fear 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.
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 their 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
- 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 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 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.
Panic Attacks & Fight or Flight
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.1 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.
Panic Attacks vs Anxiety Attacks
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 both terms and use them interchangeably.
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.
Signs of 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
Symptoms of Panic Disorder
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.
According to the DSM-5, the symptoms for Panic Disorder are: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 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.
Risk Factors for Developing 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.5 Certain childhood experiences also increase the risk of developing panic disorder, including having parents who were overly strict, unaffectionate or critical.5 Experiencing trauma at any age is also believed to increase a person’s risk.5,6
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 The use of alcohol, drugs and even caffeine also increases the risk of developing panic disorder.6 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 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.
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.
How to Get Help for a Child
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.
Is Treatment for Panic Disorder Covered by Insurance?
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.
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 or 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 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:3,6,7,9,10
- One third of people will have a panic attack at some point in their lives
- 4.7% of US adults will develop panic disorder in their lifetime
- In a given year, 2.7% of adults in the US will suffer from panic disorder
- 90% of people diagnosed with panic disorder mistake their symptoms for a medical emergency
- Panic disorder is the cause of 18-25% of all ER visits for chest pain and costs the healthcare system more than any other mental illness
- Women are twice as likely as men to develop panic disorder
- Panic disorder and depression are closely linked, co-occurring 50% of the time
- People with panic disorder and depression are seven 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
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.
