What is panic disorder?

Panic is something most of us are familiar with. The feeling of being overwhelmed by great terror and loss of the ability to think and behave logically usually results from a dangerous or frightening situation. Fortunately, it’s a rare event for most of us. But for people with panic disorder, this feeling of panic is triggered by non-dangerous events and may be a frequent part of their life.

Panic disorder is a type of anxiety disorder. It tends to be about 2-3 times more common among women than men, and symptoms usually begin in people in their 20s or 30s. The good news is that panic disorder can be treated.

Symptoms of panic attacks

Those affected by panic disorder experience feelings of panic known as panic attacks. These can occur out of the blue and for no apparent reason or be triggered by specific cues. The panic attacks are recurrent and often unpredictable.

Symptoms of a panic attack may include the following.

  • Intense and overwhelming fear or discomfort.
  • Nausea.
  • Feeling short of breath.
  • Choking sensations.
  • Chest pain or discomfort.
  • Dizziness or light-headedness.
  • Rapid ‘thumping’ heartbeat or palpitations.
  • Sweating.
  • Numbness or tingling sensations.
  • Tremor (shaking).
  • Fear of dying or losing control.

Some people also experience derealisation (a sense or feeling that you or the world around you is not real) or depersonalisation (feeling detached from yourself or your surroundings).

The symptoms of a panic attack usually peak within minutes and last less than 30 minutes. The frequency of the attacks can vary widely.

Panic disorder symptoms

Many people have had one or 2 panic attacks at some time in their lives, but people with panic disorder have repeated, unexpected attacks. Also, in people with panic disorder, panic attacks are accompanied by additional problems, including:

  • A persistent fear of having more panic attacks or worrying what the symptoms of panic attacks mean (such as losing control or thinking that the panic attacks are the result of an undiagnosed serious physical illness). Many people who experience panic attacks worry that their symptoms mean they are having a dangerous event such as a heart attack. These worries last at least a month in people with panic disorder.
  • A change in behaviour related to the panic attacks, usually aimed at trying to avoid further panic attacks (avoidance behaviour).

Agoraphobia (fear and avoidance of being in places from which escape might be difficult or in which help might not be available in the case of a panic attack) is common among people with panic disorder.

People with agoraphobia often avoid public transport, shopping centres and theatres. Some people avoid leaving their homes altogether. Agoraphobia is a major problem that can totally disrupt work and social life.

Causes

Panic disorder is thought to be caused by a combination of genetic (inherited) and environmental factors. People with a family history of anxiety disorders have a higher risk of developing panic disorder.

Risk factors

Experiencing ongoing stress or very stressful major negative life events may trigger the onset of symptoms.

You may be at increased risk of panic disorder if you have another anxiety disorder or problems such as depression, or if you have a substance-use problem.

Diagnosis and tests

If you are concerned that you may have panic disorder, see your GP (general practitioner). Your doctor will ask about your panic and anxiety symptoms and how long you’ve had them. They will want to know whether there are any triggers and whether you also have symptoms of agoraphobia.

Your doctor will also ask about any medicines or other substances you take (including alcohol and smoking). They may also perform a physical examination to check for any possible physical conditions that may be causing your symptoms.

The diagnosis of panic disorder is based on your history. There are no tests needed, other than those that may be ordered to rule out physical causes for your symptoms.

Your doctor may refer you to a psychologist (mental health professional specialising in conditions that can be treated with psychological therapies) or a psychiatrist (medical doctor specialising in mental health) for further assessment and treatment.

Treatment of panic disorder

There are several treatments available for panic disorder. The main aims of treatment are to:

  • reduce the severity and frequency of panic attacks;
  • reduce avoidance behaviour; and
  • improve quality of life.

Lifestyle adjustments, self-care and psychoeducation (learning about your condition) are often recommended as the initial treatments. If additional treatment is needed, psychological treatment, medicines or a combination of both may be recommended.

Self-care

You can help manage the symptoms of panic disorder with the following self-care measures.

  • Avoid caffeine and alcohol as much as possible, as they can trigger panic attacks or make them worse. You should also avoid smoking and illicit drugs for the same reasons.
  • Get enough sleep. Being sleep deprived can make symptoms worse.
  • Practice relaxation strategies to reduce stress and stay calm. Yoga, mindfulness, special breathing techniques (such as slow breathing) and progressive muscle relaxation are some of the methods that may help to reduce stress.
  • Eat healthily and get adequate amounts of physical activity. Some people with panic disorder stop exercising because they misinterpret the body’s normal response to exercise (increased heart rate, sweating, breathlessness) as panic symptoms. Understanding this and gradually returning to exercise helps in this situation.

Psychoeducation

Learning about the nature of your condition and how a panic attack can cause physical symptoms is an extremely important first step. Education also involves dispelling fears that people with panic disorder commonly have, such as that they are losing control, or that they will die as a result of the symptoms.

Understanding that the first goal of treatment is to manage anxiety successfully (rather than to remove all anxiety) is often helpful.

Psychological treatment

Cognitive behavioural therapy (CBT) is a type of psychological therapy that challenges unhelpful thinking patterns. It helps break the cycle of panic and avoidance that characterises panic disorder.

CBT for panic disorder involves being exposed to deliberately induced symptoms, together with techniques for controlling symptoms. This can help you stop avoiding places and situations due to fears of having a panic attack.

CBT can be face-to-face with a therapist. It’s also possible to have this type of therapy online as self-guided therapy or via computer programmes or smartphone apps. This is especially helpful for people living in rural and remote areas in Australia where access to trained therapists is limited.

Medicines

Antidepressant medicines such as SSRIs and SNRIs have been shown to be helpful in the treatment of panic disorder. Advice on self-care and education on the nature of panic disorder are usually given together with medicines.

Medicines can also be prescribed in combination with cognitive behavioural therapy, especially if either is not effective on its own, or symptoms are severe.

It can take time for medication to take effect and sometimes dose changes or changing to a different type of medicine is recommended. Side effects will depend on the medicine prescribed – your doctor should discuss possible side effects with you.

Sometimes another type of medicine (benzodiazepines) may be prescribed for a short period to control symptoms. These medicines can cause side effects and be addictive and are not suitable for everyone.

Support for people with panic disorder

There is support available in Australia for people with panic disorder. Online and in-person support groups allow people with panic disorder to share experiences and feel connected to others with the condition. Practical advice and understanding are often of great benefit, reducing feelings of isolation and confusion.

Last Reviewed: 15/10/2019

myDr



References

1. Royal Australian and New Zealand College of Psychiatrists. Clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. First published in the Australian and New Zealand Journal of Psychiatry 2018;52(12):1109-72. https://www.ranzcp.org/files/resources/college_statements/clinician/cpg/ranzcp-anxiety-clinical-practice-guidelines.aspx (accessed Sep 2019).
2. BMJ Best Practice. Panic disorders (updated Jan 2019; reviewed Aug 2019). https://bestpractice.bmj.com/topics/en-gb/121 (accessed Sep 2019).
3. Royal Australian and New Zealand College of Psychiatrists. Anxiety disorders - your guide (published April 2017). https://www.yourhealthinmind.org/getmedia/b9b7a719-5c48-4d8a-b7a8-c05a21a29aad/Anxiety-disorders-YHIM.pdf.aspx?ext=.pdf (accessed Sep 2019).
4. National Institute of Mental Health. Panic disorder: when fear overwhelms (revised 2016). https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml (accessed Oct 2019).