Panic disorder

Fear is a very useful emotion. It triggers our 'fight or flight' reaction, which allows us to react well to certain kinds of stressful situations. All people normally experience fear and anxiety in new or challenging situations.

However, people sometimes experience sensations of fear without any apparent reason. A sudden, unexpected wave of intense fear and discomfort is known as a 'panic attack'. Panic attacks can appear quickly, peak within about 10 minutes and last about 30 minutes on average [1] [2] . They can happen at any time, including during sleep.

Having a panic attack does not mean you have panic disorder. Panic attacks are relatively common; 3-5% of all people will experience a panic attack in their lifetime [3] . However, if you experience repeated panic attacks and you often worry about having another, you may have panic disorder. Panic disorder is diagnosed when panic attacks happen regularly, cause you worry and disrupt your daily life.

Panic disorder is a real medical condition. People who have it are not 'faking', nor are they able to 'calm down' at will. The disorder can cause serious disruption to a person's life, but it can be treated with psychotherapy and medication.

Psychotherapy

A therapeutic treatment, also known as talking therapy, used to treat different types of mental health issues ranging from shyness or depression to anxiety attacks.

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5 edition.). Washington, D.C: American Psychiatric Publishing.

2. Bandelow, B., Domschke, K. & Baldwin, D. (2013). Panic Disorder and Agoraphobia. Oxford Psychiatry Library.

3. Clinical handbook of psychological disorders : a step-by-step treatment manual / edited by David H. Barlow (5th ed.). New York: The Guilford Press.

What is panic disorder?

Panic disorder is when you experience repeated panic attacks that [1] :

  • Cause you to worry about them or about other people noticing them, and;
  • Cause you to change your behaviour in the hope of avoiding the attacks, or of avoiding other people noticing them.

People with panic disorder are often concerned that the symptoms they are experiencing indicate a physical problem such as heart attack or stroke. Therefore, many people with panic disorder seek medical treatment more often than usual and are frequent visitors to their doctors' clinics and to hospital emergency rooms.

Even when people are confident about their symptoms being the result of a panic attack, they may worry that their symptoms may bring about physical illness - for example, that their fast heart rate might be causing harm.

If you commonly experience fear, discomfort and anxiety only in response to certain situations (such as public speaking, social interactions or the like) then you are probably not suffering from panic disorder; you might be suffering from another type of anxiety disorder, such as social anxiety disorder or generalised anxiety disorder. Consult your doctor to receive the appropriate treatment.

Social anxiety disorder

Excessive fear of social situations.

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5 edition.). Washington, D.C: American Psychiatric Publishing.

Causes

It is not known what exactly causes panic disorder. Panic attacks may be caused by problems in the circuitry of the brain that controls the physical response to stress [4] .

There is some genetic component to panic disorder, as it can run in families.

Genetic

Related to genes, the body's units of inheritance or origin.

4. Shin, L.M. & Liberzon, I. (2009). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology 35: 169–191.

Risk factors

Factors that can increase the risk of having panic disorder can include [5] :

  • Being female - women are about twice as likely as men to have panic disorder;
  • A stressful life event within the past year;
  • A temperament that is particularly sensitive and vulnerable to feelings of anxiety [2] ;
  • A history of abuse during childhood;
  • Another mental disorder (such as depression or bipolar disorder), and;
  • Consuming alcohol and certain drugs.

5. Katon, W.J. (2006). Panic Disorder. New England Journal of Medicine 354: 2360–2367.

2. Bandelow, B., Domschke, K. & Baldwin, D. (2013). Panic Disorder and Agoraphobia. Oxford Psychiatry Library.

Signs and symptoms

A panic attack is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM V) as experiencing four or more of the following symptoms suddenly and unexpectedly, without any apparent reason [1] :

  • A pounding heartbeat or a quick, 'racing' pulse;
  • Sweating;
  • Shaking or trembling;
  • Feeling short of breath;
  • Feeling as if you are choking, or gasping for air;
  • Chest pain;
  • Nausea or stomach-ache;
  • Feeling dizzy, faint or light-headed;
  • Numbness, tingling;
  • Feeling chills or heat sensations;
  • Feeling of unreality or 'dispersonalisation' - feeling as if you are not inside your own body;
  • Fear of  'going crazy' or losing control, and/or;
  • Fear of dying.

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5 edition.). Washington, D.C: American Psychiatric Publishing.

Methods for diagnosis

Diagnosing panic disorder is not easy, since there are many other medical conditions that can cause your symptoms. Your doctor will likely take your medical history and perform a physical examination.

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5 edition.). Washington, D.C: American Psychiatric Publishing.

Types of treatment

Panic disorder can be treated by medication as well as by psychotherapy ('talking therapy'). Both these methods have their advantages and disadvantages; they are equally effective, but are more effective when used together [5] .

Both types of treatments may not be immediately effective. It can take several weeks for the effects to be noticed.

Psychotherapy

Cognitive behaviour therapy is the recommended psychotherapy for treating panic disorder. It can help you prepare for panic attacks and manage them when they appear.

Psychotherapy, or 'talking therapy', can help with the management of panic disorder. 

Medication

Several types of medications can help treat panic disorder or help with panic attacks. These include:

  • Selective serotonin reuptake inhibitors (SSRIs) - currently the medications of choice for panic disorder;
  • Serotonin-neuroepinephrine reuptake inhibitors (SNRIs);
  • Tricyclic antidepressants;
  • Beta-blockers, and;
  • Monoamine oxidase inhibitors (MAO inhibitors).

The specific type and dose of medication that is recommended for each case varies, according to the individual's circumstances.

Breath control exercises

Panic attacks often bring about rapid breathing (hyperventilation), which in turn causes the panic symptoms to worsen. You can learn breathing techniques that can enable you to be more aware of your breathing during a panic attack and to control it better [2] . Note that breathing control is meant to help you manage and ease the symptoms; the method cannot treat the root cause of panic disorder.

Beta-blockers

Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particuarly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.

Cognitive behaviour therapy

A psychological or 'talking' therapy that focuses on changing unhelpful thoughts and behaviours that are causing a person distress.

Psychotherapy

A therapeutic treatment, also known as talking therapy, used to treat different types of mental health issues ranging from shyness or depression to anxiety attacks.

SSRIs

A type of antidepressant medication.

5. Katon, W.J. (2006). Panic Disorder. New England Journal of Medicine 354: 2360–2367.

2. Bandelow, B., Domschke, K. & Baldwin, D. (2013). Panic Disorder and Agoraphobia. Oxford Psychiatry Library.

Prognosis

Panic disorder is usually first experienced in adolescence or young adulthood. Although treatment does help many people, panic disorder can be a chronic condition, lasting many years. It rarely goes away if not treated [2] . Long-term treatment can help manage the disorder and reduce the frequency and severity of the attacks.

2. Bandelow, B., Domschke, K. & Baldwin, D. (2013). Panic Disorder and Agoraphobia. Oxford Psychiatry Library.