What Is Panic Disorder: Everything You Need To Know

What is panic disorder?

Panic disorder refers to recurrent, unexpected panic attacks (e.g., heart palpitations, sweating, shaking) followed by at least one month of constant concern about having another panic attack.

Anxiety disorders, including panic disorders, are the most prevalent mental health problems in the United States, impacting 40 million individuals each year. However, only 36% of people get the necessary therapy for anxiety problems. People with anxiety are six times more likely to be hospitalized or see a doctor for a mental health condition.

Around six million individuals are diagnosed with panic disorder every year, and women are more than twice as likely as males to suffer from panic disorders. An estimated 4.7% of individuals in the United States have panic disorder at some point in their life.

Many people can experience panic attacks, but only in rare instances, such as during times of stress or sickness. Others can experience moments of panic characterized by high levels of stress or anxiety. They usually suffer frequent and sudden panic episodes, as well as persistent worries of having more attacks.

When you feel threatened, your body prepares for "fight or flight." Your heart rate rises and blood rushes to the arm and leg muscles, producing shaking or trembling. For those experiencing a panic attack, these feelings occur even when there is no direct or perceived threat.

At the peak of a panic attack, you may experience the sensation that your surroundings have become unreal or disconnected. You may be concerned about dying, suffering a heart attack, or feeling helpless.

Panic disorder may significantly impact your everyday life, forcing you to miss work, make many health appointments, and avoid situations where you think you may have a panic attack. Agoraphobia (a type of anxiety disorder in which you fear and avoid places that make you feel trapped or helpless) can sometimes co-occur with panic disorder, causing a heightened impact.

Many people are unaware that their condition is real and very treatable. Some people are reluctant or ashamed to talk about their symptoms for fear of being branded as a hypochondriac. Instead, they suffer in silence, isolating themselves from friends, family, doctors, and anyone who may provide any form of support.

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Symptoms

People who have never experienced a panic attack may be curious about how it feels. Imagine feeling your heart thumping hard and rapidly for no apparent reason, your body sweating, and your hands shaking. You feel like something is physically wrong with your body, and the worry compels you to overthink, and you begin to worry about dying. That is how a panic attack feels.

Many people with panic disorder express feeling as if they are having a stroke or about to die. They exhibit any or all of the following symptoms:

  • Increased awareness for potential dangers and physical symptoms

  • Anxiety and illogical thoughts

  • An intense sense of foreboding, danger, or dread

  • Fear of losing control, going insane, or dying

  • Feeling dizzy and lightheaded

  • Tingling sensations and chills, especially in the arms and hands

  • Sweating, trembling or shaking

  • Increased heart rate

  • A tightening sensation in the chest

  • Breathing problems, such as shortness of breath

  • Nausea or stomach pain

  • Muscle tension

  • Mouth dryness

  • Unreality and alienation from one's surroundings.

During a panic attack, a person may also feel an intense fear of losing control, going insane, or dying. It is quite unusual for a person to experience all of these symptoms at the same time. The appearance of at least four symptoms, on the other hand, strongly suggests that you may have panic disorder.

Life with panic disorder is difficult. The condition is irregular, giving the impression that one's physical and mental well-being is rapidly deteriorating. People with panic disorder are usually so troubled by their illness that they withdraw from much of their lives and avoid potential panic triggers. Because triggers frequently include stimuli outside of the home, avoiding these situations diminishes exposure to others and societal engagement.

Some people with panic disorder are unable to leave their homes for groceries or other necessities, and many more are unable to work due to the disorder. Panic disorder frequently influences sleep habits, the gastrointestinal system, and the body's immune system.

Often, the mere fear of having a panic attack is enough to trigger the symptoms. This is the underlying cause of agoraphobia. Agoraphobia makes it hard for you to leave the house because of fear of having a panic attack in public or not having an easy way out once the symptoms begin.

Causes

Panic disorder, like other mental health issues, appears to be caused by a mix of biological and psychological elements, as well as difficult life experiences, such as:

  • Age: Panic disorder usually appears between the ages of eighteen and thirty-five.

  • Gender: According to the National Institute of Mental Health, women are more than twice as likely as males to suffer from panic disorder.

  • Genetics: If you have a close relative with panic disorder, you are significantly more likely to develop the disease yourself. However, up to half or more of persons with panic disorder do not have a close relative who suffers from the illness.

  • Trauma: Being the victim of a traumatic incident, such as physical or sexual abuse, might increase your risk of developing panic disorder.

  • Significant life changes: Going through a life change or a tragic life event, such as losing a loved one or a job, may cause panic attacks.

Panic attacks can strike quickly and without warning at first, but over time, specific events can trigger the attacks.

According to some studies, panic attacks are caused by your body's normal fight or flight response to threats. For instance, if you are endangered or attacked, your body will respond automatically. As your body prepares for a life-threatening circumstance, your heart rate and breathing will increase. In a panic attack, many of the same reflexes occur.

How is panic disorder diagnosed?

According to the DSM-5, a person must have repeated and often unexpected panic attacks to be diagnosed with panic disorder. Also, at least one attack must be followed by the fear of having further attacks for at least one month.

Your health care physician will evaluate if you have panic attacks, panic disorder, or another illness with symptoms similar to panic attacks, such as heart or thyroid problems.

To help carry out a diagnosis, you may experience the following:

  • Therapy: Many panic disorder patients seek therapy at an emergency department since a panic episode frequently feels like a heart attack.

  • Blood tests: to evaluate your thyroid and other potential problems, as well as cardiac testing like an electrocardiogram (ECG or EKG).

  • A psychological assessment: to discuss your symptoms, worries, stressful events, interpersonal issues, scenarios you may avoid, and family history.

  • A panic disorder test¹: is used to determine if particular symptoms result from panic disorder or a medical illness, such as a heart attack.

Criteria for a panic disorder diagnosis

Medical or mental health professionals can diagnose panic disorder. Panic disorder does not affect everyone who suffers panic episodes. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifies the following criteria for a diagnosis of panic disorder:

  • You experience sudden panic episodes regularly.

  • At least one of your episodes was followed by a month or longer of continuing fear of having another attack.

  • Your panic attacks aren't the result of drug or alcohol abuse, a physical issue, or another mental health problem like social phobia or obsessive-compulsive disorder (OCD). 

If panic attacks are not addressed, they can worsen and progress to panic disorder or phobias.

  1. Panic Disorder Test | Medline Plus

Treatments

Common treatments for panic disorder are recognizing stressors, analyzing the effect of symptoms, and focusing on altering one's interaction with the disease through cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

The objective of therapy is to help you resume regular, daily life functioning. It is preferable to use both medications and talk therapy for panic disorder.

Therapy

Talk therapy (CBT) can help you understand and manage panic episodes. In therapy, you will learn how to:

  • Understand and manage skewed perceptions of life stresses, including other people's conduct or life circumstances.

  • Recognize and replace panic-inducing ideas to reduce feelings of powerlessness.

  • When symptoms appear, manage tension and relax.

  • Consider the sources of your anxiety, beginning with the least concerning to the most anxiety-provoking.

  • Conquer your anxiety by practicing gradual exposure to real-life scenarios that typically trigger your anxiety.

Medication

Certain medications, which are often used to treat depression, may be highly beneficial for panic disorder. They operate by either avoiding or alleviating your symptoms and are to be taken daily.

Several medications have been shown to help treat panic attack symptoms, including:

Selective serotonin reuptake inhibitors (SSRIs)

SSRI antidepressants are often the first choice to treat panic attacks since they are generally safe and have a low risk of significant adverse effects.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

These medications belong to a different class of antidepressants. For example, the FDA has authorized Venlafaxine (Effexor XR), an SNRI, to treat panic disorder.

Benzodiazepines

These sedatives depress the central nervous system. Alprazolam is a benzodiazepine that the FDA has authorized to treat panic disorder and falls under the names of Xanax and clonazepam (Klonopin).

If one drug isn't working well for you, your doctor may suggest switching to another or combining several medications to increase efficacy. It is important to remember that it might take many weeks after beginning a drug to observe an improvement in symptoms.

All medications can have potential side effects, and some may be unsuitable for specific circumstances, such as pregnancy. Discuss potential side effects and dangers with your doctor.

Self-care

While professional therapy is recommended for panic attacks and panic disorder, the following self-care measures can help you manage symptoms:

Maintain your treatment plan

It might be tough to confront the sources of your anxiety, but treatment can help you feel like you're not captive in your own home or trapped without options.

Participate in a support group

Joining a support group for those suffering from panic attacks or anxiety disorders might help you connect with others dealing with similar issues.

Avoid certain substances

Caffeine, alcohol, smoking, and recreational drugs should all be avoided. All of these factors can precipitate or aggravate panic attacks.

Manage stress

Use stress-reduction and relaxation strategies. Yoga, deep breathing, and progressive muscle relaxation, which involves tensing one muscle at a time and then totally releasing the tension until every muscle in the body is relaxed, may also be beneficial.

Exercise more

Get some more exercise into your day. Aerobic exercise may help to improve your mood.

Practice good sleep hygiene

Get enough sleep. Getting sufficient, restful sleep can help you avoid feeling tired during the day.

During a panic attack

Employ the following methods during a panic attack:

  • Determine the sources of your stress and take action to change them. You may not be able to change everything, but taking small, continuous steps to minimize your stress every day can help.

  • Be honest with your friends, family, and coworkers. How can they help you in general, or how can they help you during an attack?

  • Accept your feelings. You know that these feelings will pass and that you will be okay once the attack is over.

  • Awareness. Observe your moods and thoughts without criticizing or responding to them. Concentrate on what is actual and now, rather than what you are anticipating or imagining may happen.

Prevention

There is no foolproof technique to prevent panic attacks or panic disorder. Get care for panic attacks as soon as possible to prevent them from worsening or becoming more regular. Maintain your treatment plan to avoid relapses or worsening of panic attack symptoms. Engage in frequent physical activity, which may help to reduce anxiety.

It is critical to address panic attacks as soon as possible as it can help to avoid additional issues associated with panic disorder. Depression, other anxiety disorders, and drug use are examples of these issues.

Remember that while home remedies might help alleviate panic attacks, they are not a substitute for professional treatment. Panic attacks may necessitate counseling or prescription medication. It is therefore vital that you discuss your concerns with your doctor.

Doctors & specialists

To treat panic disorder, you and your doctor must be able to collaborate as a team. Several doctors and experts may be able to assist you in managing your anxiety. Your primary care physician is an excellent place to start.

Primary care physician (PCP)

The first step is to consult with your PCP. Your PCP can assist you in determining if your anxiety is the result of an outside influence or a probable reaction to something physically wrong with your health. If your doctor determines that you do not have a medical problem, you may be referred to a psychologist or psychiatrist.

Psychologist

Psychologists specialize in the treatment of anxiety disorders through counseling or talk therapy. A psychologist can assist you in determining the root of your anxiety. This understanding alone may be all you need to start to feel better again. They can also assist you in making behavioral adjustments or alter your thinking and belief patterns, which can significantly reduce your anxiety. A psychologist's treatment will most likely be combined with continuous care from your primary doctor. Anxiety disorders are frequently treated with a combination of psychotherapy and medication.

Psychiatrist

A psychiatrist is a medical doctor who has received specialized training in diagnosing and treating mental disorders. A psychiatrist can treat your panic disorder by engaging you in a discussion, evaluating your symptoms and background history, and prescribing medication. While some psychiatrists provide psychotherapy, most do not. This is one important distinction between a psychologist and a psychiatrist. Psychiatrists can write prescriptions, while in most states, psychologists cannot prescribe. There are several medications available to treat anxiety, ranging from antidepressants to sedatives. Many of these medicines are quite potent, and not every prescription or dosage is appropriate for every individual.

Psychiatric nurse practitioner

Psychiatric nurse practitioners provide primary mental health care for patients seeking treatment for various mental health problems. Psychiatric nurse practitioners can diagnose and treat patients suffering from mental health disorders and can prescribe medications. As fewer medical students choose careers in psychiatry, psychiatric nurse practitioners take on more and more patients seeking psychiatric care.

Nutritionists

Nutritionists may be a valuable resource in overcoming anxiety. Nutritionists, who are specially trained to help you establish a balanced eating plan that works particularly for you, cannot cure your anxiety condition on their own. However, when used in combination with a physician, they can have a significant influence. Nutritionists are especially useful if you or someone you care about has an eating disorder.

Clinical trials for panic disorder

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Sleep and Emotional Memory in Peripubertal Anxiety
FL (US)
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Positive Affect Treatment for Anhedonia, Depression, and Anxiety
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Trial With the Treatment of Sertraline in Youth With Generalized, Separation and/or Social Anxiety Disorders.
NY, OH (US)