Panic disorder is a type of anxiety disorder. Individuals with panic disorder have sudden and repeated attacks of fear that last for several minutes or longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. Panic attacks can happen anytime, anywhere, and without warning. Panic disorder often begins in the late teens or early adulthood. More women than men have panic disorder and about 2-3% of Americans experience panic disorder in a given year. The median age at onset for panic disorder in the United States is 20-24 years. But not everyone who experiences panic attacks will develop panic disorder. Panic disorder can interfere with daily life, causing people to miss work, go to many doctor visits, and avoid situations where they fear they might experience a panic attack.

Panic Disorder Defined

Panic disorder refers to recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of a list of 13 physical and cognitive symptoms occur. The term recurrent literally means more than one unexpected panic attack. The term unexpected refers to a  panic attack for which there is no obvious cue or trigger at the time of occurrence-that is, the attack appears to occur from out of the blue, such as when the individual is relaxing or emerging from sleep (nocturnal panic attacks). The frequency and severity of panic attacks vary widely. In terms of frequency, there may be moderately frequent attacks (e.g., one per week) for moths at a time, or short bursts of more frequent attacks (e.g., daily) separated by weeks or months without any attacks or with less frequent attacks (e.g., two per month) over many years.

Different Types of Panic Disorders

There are not different types of panic disorders as listed in the Diagnostic and Statistical Manual of Mental Disorders.

Panic Disorder Causes

There is no known direct cause of panic disorders. Panic disorders can sometimes run in families but no one knows for sure why some family members have it while others don’t. Some researchers think that people with panic disorder misinterpret harmless bodily sensations as threats. Sometimes the cause can be because a person is under a lot of stress.

Panic Disorder Symptoms

To be diagnosed with general panic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:

  1. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

    1. Palpitations, pounding heart, or accelerate heart rate.
    2. Sweating.
    3. Trembling or shaking.
    4. Sensations of shortness of breath or smothering.
    5. Feelings of choking.
    6. Chest pain or discomfort.
    7. Nausea or abdominal distress.
    8. Feeling dizzy, unsteady, light-headed, or faint.
    9. Chills or hear sensations.
    10.  Paresthesias (numbness or tingling sensations).
    11.  Derealization (feelings of unreality) or depersonalization (being detached from oneself).
    12.  Fear of losing control or “going crazy.”
    13.  Fear of dying.

Note: Culture- specific symptoms (e.g., tinnitus, next soreness, headache, uncomfortable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms. 

  1. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
  2. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
  3. A significant maladaptive change in behavior related to the attacks (e.g., behaviors de signed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situa tions).
  4. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorder). 
  5. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder, in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-obsessive-compulsive disorder; in response to reminders of traumatic events, as in post trauamtic stress disorder, or in response to separation from attachment figures, as in separation anxiety disorder.

 

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know has a panic disorder. People with panic disorder may struggle with completing daily tasks and may feel ashamed or discouraged. While preventing a loved one from developing a panic disorder disorder is not possible, providing support and being aware of how panic disorder impacts their life can be helpful. For more information on how to approach a loved one with a panic disorder visit: https://www.webmd.com/anxiety-panic/panic-attack-how-to-help

Types of Adjustment Disorder Treatment

Treating panic disorder usually includes the combination of medication and therapy. It is important to distinguish the best course of treatment individually. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70 to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.

 

Medication

The most common forms of medication used to treat panic disorders are antidepressants and anti-anxiety medication. More specifically, Selective Serotonin Reuptake Inhibitors (SSRI’s; e.g.., Paxil, Prozac, Zoloft), Benzodiazepines (e.g., Xanax, Lorazepam), and Selective Norepinephrine Reuptake Inhibitors (SNRI’s; e.g., Cymbalta, Effexor, Pristiq). These medications may have side effects and taking them can lead to tolerance, withdrawal symptoms, and dependence, so it is important that you consult with a physician before starting or stopping these medications. 

 

Psychotherapy

A type of psychotherapy called cognitive behavioral therapy (CBT) is a common form of treatment for panic disorder. CBT teaches individuals different ways of thinking, behaving, and reacting to the feelings that come on with a panic attack. The attacks can begin to disappear when an individuals learn to react differently to the physical sensations of anxiety and fear that occur during panic attacks. 

Differences Between Common Disorders

There are other disorders that may resemble general panic disorder, so it is important to differentiate the difference between common disorders that may get confused with this disorder.

 

  • Other specified anxiety disorder or unspecified anxiety disorder- Panic disorder should not be diagnosed if full-symptom (unexpected) panic attacks have never been experienced. In the case of only limited-symptom unexpected panic attacks, an other specified anxiety disorder or unspecified anxiety disorder diagnosis should be considered.
  • Anxiety disorder due to another medical condition- Panic disorder is not diagnosed if the panic attacks are judged to be a direct physiological consequence of another medical condition. 
  • Substance/medication-induced anxiety disorder- Panic disorder it not diagnosed if the panic attacks are judged to be a direct physiological consequent of a substance. 
  • Other mental disorders with panic attacks as an associated fear (e.g., other anxiety disorders and psychotic disorder)- Panic attacks that occur as a symptom of other anxiety disorders are expected (e.g., triggered by social situations in social anxiety disorder, by phobic objects or situations in specific phobia or agoraphobia, by worry in generalized anxiety disorder, by separation from home or attachment figures in separation anxiety disorder) and thus would not meet criteria for a paid disorder. 

 

Resources

American Psychiatric Association (2019). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

Anxiety and Depression Association of America. (2019). Retrieved from: https://adaa.org/understanding-anxiety/panic-disorder

 

MedlinePlus. (2019). Retrieved from: https://medlineplus.gov/panicdisorder.html

 

Mental Health America. (2019). Retrieved from: http://www.mentalhealthamerica.net/conditions/panic-disorder

 

National instate of Mental Health. (2019). Retrieved from: https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml#pub4

 

WebMD. (2019). How to Help Someone with Panic Disorder. Retrieved from: https://www.webmd.com/anxiety-panic/panic-attack-how-to-help#1