Table of Contents

Panic Disorder & Panic Attacks

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Clinically Reviewed by: Dr. Robin Campbell, LMFT, PHD

Panic Disorder

Panic attacks are sudden and unexpected episodes of overwhelming anxiety that can strike without warning. These sudden attacks are often characterized by intense worry and a host of distressing physical symptoms, such as a racing heart, sweating, choking, and nausea. When these repeated panic attacks occur, individuals may develop panic disorder, a serious mental health condition marked by constant fear of the next panic attack. People who develop panic disorder may feel like their fear overwhelms them, making everyday life challenging. Although these episodes can feel life-threatening, research suggests they are not associated with any real danger. Understanding how panic disorder is diagnosed and treated can provide relief and help those experiencing symptoms regain control over their lives.

What is Panic Disorder?

Panic disorder is a type of anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These episodes are referred to as panic attacks and are often not predictable, adding to the distress they cause.

Key features and symptoms of panic disorder include:

  • Frequent Panic Attacks: Sudden and recurrent panic attacks that are not necessarily triggered by specific situations and are often unpredictable.
  • Persistent Concern: Ongoing worry about the possibility of more panic attacks, which can lead to significant anxiety about their implications.
  • Behavioral Changes: Avoidance of activities or situations that the person fears might trigger an attack. In severe cases, this can lead to agoraphobia, where individuals avoid a range of situations and may become housebound.

 

What is a Panic Attack?

A panic attack is a sudden and intense wave of fear or discomfort that peaks within minutes and includes a variety of physical and emotional symptoms. These symptoms can include a racing or pounding heartbeat, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills or hot flashes, numbness or tingling sensations, feelings of unreality or detachment from oneself, fear of losing control, fear of dying, and a sense of impending doom.

Panic attacks can occur unexpectedly or can be triggered by specific situations, and they are often mistaken for heart attacks or other serious physical illnesses. They are a central feature of panic disorder, but they can also occur in the context of other anxiety disorders or independently without a broader anxiety disorder.

 

What are Panic Attack Symptoms?

The symptoms of a panic attack can be intensely distressful and alarming. They typically come on suddenly and reach their peak within minutes. Here are the common symptoms:

  1. Physical Symptoms:
    • Palpitations, pounding heart, or accelerated heart rate: This is often one of the first signs.
    • Sweating: Increased sweating is common.
    • Trembling or shaking: This can range from slight trembling to more severe shaking.
    • Sensations of shortness of breath or smothering: Individuals may feel like they can’t breathe or are being suffocated.
    • Feelings of choking: This is a terrifying sensation that may accompany an attack.
    • Chest pain or discomfort: This can mimic the symptoms of a heart attack.
    • Nausea or abdominal distress: This may include stomach cramps or an upset stomach.
    • Dizziness, unsteady feelings, lightheadedness, or faintness: These may lead to a feeling of being detached from reality.
    • Chills or heat sensations: Sudden waves of chills or hot flashes can occur.
  2. Emotional Symptoms:
    • Fear of losing control or “going crazy”: This fear can exacerbate the panic.
    • Fear of dying: During a panic attack, the fear of imminent death is common and very real to the sufferer.
    • Feeling detached from reality or oneself (depersonalization or derealization): People might feel like they’re observing themselves from outside their body or that the world doesn’t feel real.
  3. Other Symptoms:
    • Numbness or tingling sensations (paresthesia): These can occur in various parts of the body.
    • A sense of impending doom: This overwhelming fear can feel like the danger is immediate and catastrophic.

 

Types of Panic Related Symptoms

Panic attack symptoms can be broadly categorized into physical, emotional, and cognitive types, each reflecting different aspects of the experience. Unexpected panic attacks are characterized by sudden waves of fear or discomfort with no clear danger or trigger present, and they can occur at any time, significantly affecting the individual’s quality of life. Here’s a breakdown of these categories:

Physical Symptoms:

  • Heart palpitations or accelerated heart rate: Feeling like the heart is beating too fast or irregularly.
  • Sweating: Excessive perspiration often without physical exertion.
  • Trembling or shaking: Involuntary muscle tremors.
  • Shortness of breath or smothering sensations: Difficulty breathing normally.
  • Feelings of choking: Sensation of being unable to swallow or breathe.
  • Chest pain or discomfort: Often mistaken for heart-related conditions.
  • Nausea or abdominal distress: Including stomach pain or cramps.
  • Dizziness, lightheadedness, or faintness: A sense of instability or unsteadiness.
  • Chills or hot flashes: Sudden waves of feeling very cold or very hot.

 

Emotional Symptoms:

  • Intense fear of dying: Irrational fear that death is imminent.
  • Fear of losing control or “going crazy”: Fears of behaving erratically or not being able to manage oneself.
  • A sense of impending doom: Feeling that something terrible is about to happen.

 

Cognitive Symptoms:

  • Depersonalization: Feeling detached from oneself, as if watching oneself from outside.
  • Derealization: Feeling disconnected from reality, as if the world is not real.
  • Difficulty concentrating: Inability to focus or think clearly due to overwhelming fear or anxiety.

 

What are the Causes of Unexpected Panic Attack Symptoms?

Panic attack symptoms arise from a complex interplay of biological, psychological, and environmental factors. Here’s an overview of the main causes:

  1. Biological Factors:
    • Genetics: A family history of anxiety disorders or panic attacks can increase the risk.
    • Neurological factors: Dysregulation in brain areas that control the fear response, such as the amygdala, may contribute to heightened anxiety.
    • Physical health conditions: Issues like thyroid problems, heart disease, and respiratory disorders can trigger symptoms similar to panic attacks.
    • Substance use: Caffeine, alcohol, and drugs (including withdrawal from them) can precipitate more panic attacks in some individuals.
  2. Psychological Factors:
    • Stress: Significant life stressors, such as the death of a loved one, job loss, or major life transitions, can trigger panic attacks.
    • Trauma: Past traumatic events, especially if unresolved, can lead to a heightened state of anxiety.
    • Personality traits: Certain personality types, such as those with a predisposition to negative emotions or perfectionism, are more susceptible to anxiety disorders.
    • Mental health disorders: Conditions like depression, other anxiety disorders, and PTSD can also include panic attacks as a symptom.
  3. Environmental Factors:
    • Learned behaviors: Exposure to a family member or significant other who exhibits anxiety can teach similar behaviors and reactions.
    • Life circumstances: Stressful or unsafe environments can contribute to the development of anxiety and panic.
  4. Triggers:
    • Specific situations: Some people experience symptoms of a panic attack in response to specific triggers like enclosed spaces, large crowds, or situations where escape might be difficult.
    • Physical sensations: Awareness of certain bodily sensations (like a rapid heartbeat or shortness of breath) can escalate into a panic attack for those particularly sensitive to bodily changes.

 

What are the Signs of a Panic Attack?

The signs often involve a sudden onset of intense fear or discomfort accompanied by several physical and emotional symptoms, including:

  1. Physical Signs:
    • Accelerated heart rate or palpitations.
    • Sweating.
    • Trembling or shaking.
    • Shortness of breath or a feeling of being smothered.
    • Chest pain or discomfort.
    • Nausea or abdominal distress.
    • Dizziness, lightheadedness, or faintness.
    • Chills or hot flashes.
  2. Emotional Signs:
    • Overwhelming fear of loss of control or impending doom.
    • Fear of dying.

 

These symptoms typically peak within minutes, creating a severe and disabling bout of anxiety.

 

Prevalence of Panic Attack Symptoms

Panic attack symptoms are quite common, with studies suggesting that about 11% of people experience an attack each year. However, the prevalence of panic disorder, where panic attacks are frequent and distressing, is lower, affecting about 2-3% of adults annually. These rates can vary by population and may be influenced by factors such as age, gender, and stress levels. Women are more likely than men to experience panic attacks and panic disorder. The onset of panic disorder is most common in late adolescence and early adulthood.

 

How are Panic Attack Symptoms Diagnosed?

Panic attack symptoms are diagnosed through a combination of methods:

  1. Medical Interview: A healthcare provider conducts a thorough interview to gather information about the symptoms, their frequency, duration, and the context in which they occur.
  2. Physical Examination: To rule out physical health issues that could mimic or contribute to panic attack symptoms, such as cardiovascular or thyroid problems.
  3. Psychological Assessment: A mental health professional may use specific psychological evaluations to assess for panic disorder and other anxiety-related conditions, based on the criteria outlined in the Diagnostic and Statistical Master of Mental Disorders (DSM-5).
  4. Exclusion of Other Conditions: It’s crucial to differentiate panic attacks from other possible conditions like heart disease or other anxiety disorders.

 

Is Panic Disorder Hereditary?

Yes, panic disorder has a hereditary component, meaning it can run in families. Research indicates that genetics can play a significant role in the development of panic disorder, though it’s not the sole factor. Studies of twins and families suggest that people who have first-degree relatives with panic disorder are more likely to develop the condition themselves.

However, the genetic predisposition interacts with environmental factors—such as stress, traumatic events, and learned behaviors—to influence the likelihood of developing panic disorder. Therefore, having a family history of panic disorder increases risk but does not guarantee that an individual will experience the disorder. It’s a complex interplay of genes and environment that determines the onset of panic disorder.

 

Can Panic Attack Symptoms Be Prevented?

Preventing attack symptoms entirely may not always be possible, especially for individuals with a predisposition to anxiety disorders. However, there are strategies that can help reduce their frequency and severity:

  1. Stress Management: Learning and practicing stress management techniques such as deep breathing exercises, mindfulness meditation, and progressive muscle relaxation can help mitigate anxiety levels.
  2. Healthy Lifestyle Choices: Regular physical activity, adequate sleep, a balanced diet, and avoiding excessive caffeine and alcohol can contribute to overall mental health and reduce triggers for panic attacks.
  3. Therapy: Cognitive-behavioral therapy (CBT) is particularly effective for panic disorder. It helps individuals recognize and change thought patterns and behaviors that trigger panic attacks.
  4. Medication: In some cases, medications such as antidepressants and anti-anxiety drugs are prescribed to help manage symptoms.
  5. Education: Understanding panic attacks and recognizing the signs of an impending attack can reduce fear and enable more effective coping strategies.
  6. Avoidance of Triggers: If specific situations are known to trigger attacks, preparing for or avoiding these situations can help.

 

Is Panic Disorder Curable?

Panic disorder is not typically considered curable, but it is highly treatable. With appropriate treatment, such as cognitive-behavioral therapy (CBT) and medications, many people can manage their symptoms effectively and achieve significant, long-lasting relief. Lifestyle changes and stress management techniques also play a crucial role in reducing the frequency and severity of panic attacks. While some individuals may continue to experience occasional symptoms, they can often be managed successfully with ongoing strategies and support.

 

What are the Effects and Risk Factors?

Effects of Panic Attack Symptoms:

  • Physical Health Issues: Chronic anxiety and stress can lead to conditions like high blood pressure and heart problems.
  • Mental Health Problems: Increased risk of developing other anxiety disorders, depression, and substance abuse.
  • Impaired Daily Functioning: Difficulty performing everyday tasks, maintaining relationships, and holding jobs due to fear of future attacks.
  • Social Isolation: Avoidance of social situations to prevent panic attacks can lead to loneliness and isolation.

 

Risk Factors for Panic Attack Symptoms:

  • Genetics: Family history of panic attacks or other anxiety disorders.
  • Stress: Major life stressors, such as the death of a loved one, divorce, or job loss.
  • Temperament: More prone to negative emotions and sensitivity to stress.
  • Trauma: Experiencing a traumatic event, particularly during childhood.
  • Substance Use: Excessive caffeine, alcohol, and drug use or withdrawal.

 

How Do You Help a Loved One with Panic Disorder?

Helping a loved one with panic disorder involves providing support, understanding, and encouragement. Here are some key steps:

  1. Educate Yourself: Learn about panic disorder to better understand what your loved one is experiencing.
  2. Be Supportive: Listen without judgment and offer reassurance during panic attacks.
  3. Encourage Treatment: Support them in seeking professional help, such as therapy or medication.
  4. Promote Healthy Habits: Encourage regular exercise, a healthy diet, and stress-reduction techniques.
  5. Be Patient: Recovery can take time, so be patient and understanding of their progress and setbacks.
  6. Create a Calm Environment: Help create a supportive and stress-free environment at home.

 

Treatment Options

  1. Cognitive-Behavioral Therapy (CBT): A highly effective therapy that helps identify and change negative thought patterns and behaviors.
  2. Medication:
  • Antidepressants: Such as SSRIs (e.g., sertraline, fluoxetine) and SNRIs (e.g., venlafaxine).
  • Benzodiazepines: For short-term relief (e.g., alprazolam, clonazepam).
  1. Lifestyle Changes: Regular exercise, a well balanced diet, adequate sleep, and avoiding caffeine and alcohol.
  2. Stress Management Techniques: Mindfulness, meditation, deep breathing exercises, and relaxation techniques.
  3. Support Groups: Joining a support group to share experiences and strategies with others facing similar challenges.

 

These treatments can be used individually or in combination to effectively manage and reduce symptoms of panic disorder and panic attacks. Treatment is highly effective in helping individuals recognize that the symptoms of panic disorders are not life-threatening, and in teaching coping skills and relaxation techniques to reduce the intensity and duration of panic attacks.

 

Common Medications for Panic Attack Symptoms

Common medications for symptoms include:

  1. Selective Serotonin Reuptake Inhibitors (SSRIs):
    • Sertraline (Zoloft): Starting dose 25-50 mg daily, typical range 50-200 mg daily.
    • Fluoxetine (Prozac): Starting dose 10-20 mg daily, typical range 20-60 mg daily.
    • Paroxetine (Paxil): Starting dose 10-20 mg daily, typical range 20-60 mg daily.
  2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):
    • Venlafaxine (Effexor XR): Starting dose 37.5 mg daily, typical range 75-225 mg daily.
  3. Benzodiazepines (for short-term or acute use):
    • Alprazolam (Xanax): 0.25-0.5 mg taken 2-3 times daily as needed, up to a maximum of 4 mg daily.
    • Clonazepam (Klonopin): 0.25-0.5 mg taken twice daily, typical range 1-2 mg daily.

 

Does Insurance Cover Panic Disorder Treatment?

Yes, most health insurance plans cover treatment for panic disorder, including therapy and medications. Coverage details can vary based on medical history etc, so it’s important to check with your insurance provider to understand specifics about copayments, deductibles, and any limitations on mental health services.

 

Common Insurance Plans for Mental Health Treatment

Common insurance plans that typically offer mental health treatment coverage include:

  1. Employer-Sponsored Health Plans: Many employers offer health insurance plans that include mental health benefits.
  2. Medicaid: Provides mental health coverage for eligible low-income individuals and families.
  3. Medicare: Offers mental health services, including therapy and medication, for individuals 65 and older and some younger people with disabilities.
  4. ACA Marketplace Plans: Health insurance plans available through the Affordable Care Act (ACA) marketplaces must cover mental health services as essential health benefits.
  5. Private Insurance Plans: Individual plans purchased directly from insurance companies often include mental health coverage.
  6. TRICARE: Provides mental health services for military personnel, retirees, and their dependents.

 

Coverage and benefits can vary, so it’s important to review the specific details of each plan.

 

Conclusion

Living with panic disorder means dealing with the persistent fear of when the next panic attack will strike, which can lead to overwhelming anxiety and significant disruptions in daily life. However, panic disorder can be effectively treated with a combination of talk therapy, such as cognitive-behavioral therapy (CBT) and exposure therapy, and medications, including anti-anxiety medicines. By addressing the intense worry and teaching individuals how to overcome fears, these treatments can significantly improve the quality of life for people with panic disorder. If you or someone you know is experiencing symptoms, it’s important to seek medical education and professional help. The National Institute of Mental Health and other organizations offer resources and support to help individuals understand their condition and explore effective treatment options. Through ongoing research and clinical trials, new treatments continue to emerge, providing hope for those affected by this challenging condition.

 

Seeking Treatment? We Can Help!

At New Hope Healthcare, as an in-network provider we work with most insurance plans, such as:

 

If you or a loved one are struggling with mental health challenges or substance abuse, reach out to New Hope Healthcare today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-799-0806

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Frequently Asked Questions

If you experience one, try to stay calm and remind yourself that the symptoms, while distressing, are not life-threatening. Practice deep breathing, focus on a single object, and use relaxation techniques to help manage the attack. Seeking emergency medical care is important if you are unsure whether it is a panic attack or another medical issue.
Yes, lifestyle changes can help. Regular exercise, a balanced diet, adequate sleep, and stress management techniques like mindfulness and meditation can reduce anxiety levels. Avoiding caffeine, alcohol, and drugs, which can trigger or worsen panic attacks, is also beneficial.
Yes, panic disorder often coexists with other mental health conditions such as depression, generalized anxiety disorder, and substance abuse disorders. Treating these co-occurring conditions is crucial for overall recovery and managing panic disorder effectively.
While panic disorder may not be completely curable, it is highly treatable. With appropriate treatment, many people with panic disorder can achieve significant symptom relief and lead fulfilling lives. Ongoing therapy, medication, and lifestyle adjustments can help manage the disorder and reduce the frequency and intensity of panic attacks. Early intervention and consistent treatment are key to achieving the best outcomes.
Panic disorder is diagnosed through a combination of a detailed medical history, physical examination, and psychological evaluation. Healthcare providers look for a pattern of recurrent panic attacks and persistent concern about having additional attacks. They also assess whether these symptoms cause significant distress or impairment in the individual’s daily life and rule out other possible causes.

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