Panic disorder involves recurrent panic attacks that come on suddenly and usually last for several minutes. In severe cases, panic attack symptoms can last more than an hour. The disorder usually develops in early adulthood or slightly earlier and occurs about twice as often in women as in men. Most people suffer at least one or two panic attacks in their lifetime, but those with the disorder experience these attacks much more frequently.
Experts have described panic disorder as a “fear or fear.” People with the disorder tend to worry about disasters and about losing control. They also often misinterpret bodily sensations as signals of danger. As a result, upon sensing things like dizziness, chest pain, or shortness of breath, someone with panic disorder may become hypervigilant, exacerbating the bodily sensation, further enhancing their hypervigilance. The anxiety that accompanies this type of experience often sets off a panic attack.
In addition to the suffering that comes from panic attacks themselves, patients with panic disorder are also often limited in their activities because of the psychological burden of anticipating panic attacks. It is common for those with panic disorder to avoid situations in which they think a panic attack may occur, as the dread associated with imagining a panic attack is a major feature of the disorder.
It is common for people experiencing their first panic attack to perceive it as a heart attack.
The symptoms of panic disorder include:
- Recurrent and sudden panic attacks that involve an overwhelming sense of fear, anxiety, or doom and are often accompanied by physical symptoms like sweating, shortness of breath, dizziness, chest pain, numbness, or nausea.
- Feelings of being out of control and fretting over when a panic attack may occur.
- Avoidance of scenarios in which panic attacks have previously occurred.
- Irrational fears of death.
It is not clear how or why panic disorder develops, but research has helped to clarify some of the factors that may increase one’s risk for the disorder. These factors include
- Family history. If other people in your family have panic disorder, you are more likely to have the disorder as well. The link between family history and panic disorder is not completely clear, but it likely involves both genetic and environmental elements.
- Stress. Panic attacks have been observed in people who are undergoing a major life transition or who are exposed to significant stress, such as the loss of a loved one. Though it is not completely understood how stress may lead to panic disorder, high levels of stress increase the risk for developing the disorder.
- Substance abuse. Panic disorder may follow drug or alcohol abuse or withdrawal, as well as excessive caffeine intake.
From a biological perspective, studies in neuroscience and psychology have shown that certain parts of the brain are implicated in panic disorder. A part of the brain called the amygdala has been deemed a critical player in panic disorder. The amygdala processes emotional information, including fear. It, along with other parts of the brain, such as areas known as the hippocampus and prefrontal cortex, make up a fear circuit – or fear network – that is active during panic attacks. Areas of the brain involved in processing sensory information have also been suggested to be part of this fear network, which would help to explain how bodily sensations lead to panic attacks.
Panic disorder is chronic and cannot be cured. However, there are several options that people with the disorder can pursue to reduce their symptoms and hopefully live more comfortably with their condition.
Healthcare providers usually treat panic disorder with psychotherapy, medication, or a combination of the two.
Cognitive behavioral therapy (CBT) is a first-line treatment for panic disorders. This type of psychotherapy focuses on appealing to the patient’s cognitive abilities to change the way they think and react to feelings that have historically led to their panic attacks. By learning to think and behave differently in response to physical sensations and fear, you can disrupt the brain activity that leads to panic attacks, thereby preventing the attacks.
There are several different drugs that can be used to combat panic disorder and to prevent the attacks that characterize it. These drugs include:
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin- norepinephrine reuptake inhibitors (SNRIs). Fluoxetine (also known as Prozac), paroxetine (also known as Paxil or Seroxat), and sertraline (also known as Zoloft) are examples of SSRIs, and venlafaxine (also known as Effexor) is an example of an SNRI. These drugs work by enhancing the activity of the chemical serotonin within the brain. These higher levels of serotonin activity are associated with a reduction of symptoms of anxiety.
- Beta-blockers. Beta blockers can help to reduce the physical symptoms of panic disorder and are often used to prevent panic attacks in situations where panic attacks are anticipated. These drugs are prescribed for panic disorder less frequently than SSRIs and SNRIs.
- Benzodiazepines. These drugs can stop a panic attack quickly once it starts, but they are powerful sedatives that can lead to dependence and so are used sparingly to combat issues related to panic disorder.
- Monoamine oxidase inhibitors (MAOIs). These drugs tend to be kept as a last resort for both anxiety and depression because they are associated with serious adverse side effects.
In addition to the medical interventions to fight panic disorder, there are lifestyle changes that are often recommended for those who experience regular panic attacks. These changes include: eating well, minimizing caffeine and alcohol, exercising, getting more sleep, and maintaining a normal routine.
Takeaway & Final Thoughts
Recurrent and sudden panic attacks are indicative of panic disorder. Though the cause of panic disorder is not well understood, there are several ways to combat the symptoms. These strategies include lifestyle changes, therapy, and medications. These approaches may on their own or in combination help people with panic disorder to reduce their anxiety and enjoy a higher quality of life.