Panic Disorder

What is panic disorder?

A panic attack is a sudden, intense rush of fear that sets off strong physical symptoms, like a pounding heart, shortness of breath, and sweating, even when there is no real danger. Panic disorder is an anxiety disorder marked by repeated, unexpected panic attacks, along with at least a month of worrying about the next one or changing your routine to avoid it.

A single panic attack does not mean you have panic disorder, and many people have one at some point without it becoming ongoing. The condition also differs from an anxiety attack, which tends to build gradually in response to a stressor, while panic attacks usually strike suddenly and without a clear trigger.

Panic attacks are common. Up to 11% of people in the U.S. have one each year, while about 2% to 3% have panic disorder. Women are diagnosed about twice as often as men.

What are the symptoms of panic disorder?

A panic attack comes on suddenly, peaks within about 10 minutes, and usually passes within 5 to 20 minutes. During one, the mind and body react as if in danger even when there is no real threat. Symptoms tend to show up in two overlapping ways.

Physical symptoms are the body's fight-or-flight response kicking in.

• A racing heart or chest pain
• Shortness of breath or hyperventilating
• Trembling, sweating, or chills
• Nausea, or tingling and numbness in your fingers or toes

Emotional and cognitive symptoms are the intense fear and disorientation that come with it.

• A sudden wave of intense terror or dread
• A choking or smothering sensation
• Fear of losing control or of dying
• Feeling detached from yourself or your surroundings

Because the physical symptoms can mimic a heart attack, many people first fear something is medically wrong. Repeated attacks, and the worry about when the next one will strike, are what point toward panic disorder.

Who is at increased risk for panic disorder?

Experts do not fully know why some people develop panic attacks or panic disorder, though the brain's fear circuitry and stress chemistry appear to be involved. Differences in the amygdala and in chemicals like GABA, cortisol, and serotonin may play a part. Knowing the common risk factors can help you make sense of your own experience, even though having them does not mean you will develop the condition.

Biological factors

• A family history; a first-degree relative with panic disorder raises your risk by about 40%
• Differences in the brain's fear circuitry, including the amygdala
• Chemical imbalances involving GABA, cortisol, and serotonin

Life and environmental factors

• Having another mental health condition, such as anxiety or depression
• Adverse or traumatic experiences in childhood
• High stress, or heavy caffeine, alcohol, or nicotine use

Panic disorder often begins in the late teens or early adulthood. Because the causes are still being studied, these factors describe risk rather than certainty.

How is panic disorder treated?

Panic disorder responds very well to treatment, and most people improve with therapy, medication, or both. Therapy is often the foundation, and a provider will tailor the plan to how often attacks happen and how much they affect you.

Cognitive behavioral therapy (CBT) is the most effective therapy for panic. It helps you identify what sets off attacks and change the thoughts and reactions that fuel them, so the attacks tend to become less frequent over time.

Exposure therapy gradually and safely reintroduces the situations or bodily sensations you have come to fear. Paired with relaxation and breathing skills, it helps your body learn that those triggers are not actually dangerous.

Medication can make attacks less frequent or less severe. Doctors often prescribe antidepressants such as SSRIs or SNRIs, and sometimes anti-anxiety medications for short-term use, since some carry a risk of dependence.

Everyday habits can lower how often attacks happen. Cutting back on caffeine, alcohol, and nicotine, exercising regularly, and managing stress all help calm an overactive stress response.

Treatment length varies from person to person, and many people see attacks ease within a few months of starting care.

When should you seek help?

It is a good idea to see a professional if panic attacks keep happening, if you are spending a lot of time dreading the next one, or if you are starting to avoid places or situations out of fear. Panic disorder responds very well to care, and most people who get help improve, so there is no need to wait until it takes over your routine.

Because panic symptoms can mimic a heart attack, seek emergency care for chest pain, trouble breathing, or fainting if you are not sure what is happening. If you ever have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline, or call 911. Panic attacks are frightening but not dangerous in themselves, and with support they can ease. Whenever you feel ready, help will be there for you.