Panic Disorder

What is panic disorder?

  • Panic disorder, or PD, is a type of anxiety disorder. It is a condition where you have sudden panic attacks that occur again and again. With PD, you worry when the attacks will come again. Your behavior may change and you may not want to go out with family and friends. You may think that you are losing your mind and even try to kill yourself.

  • Panic disorder usually happens together with at least one other mental condition. These conditions include depression (deep sadness), other anxiety disorders, post-traumatic stress disorder, alcohol abuse, and agoraphobia. Agoraphobia is the fear of being in a place or situation where the panic attack happened before. In PD with agoraphobia, you avoid doing things or being in places in case an attack occurs. You fear being places where it is hard to get away or find help during a panic attack. Panic disorder may come and go, and may last a long time. Treating panic disorder may help control your anxiety, and this may decrease your panic attacks.

What is a panic attack?

A panic attack is a period of strong fear or discomfort. You may feel as though something very bad is going to happen, but do not know what it is. It occurs suddenly and usually lasts about 10 minutes. A panic attack may occur anytime and without warning. A panic attack may occur very fast or happen slowly when in a feared situation. Besides fear, a panic attack comes with four or more of the following symptoms:

  • Chest pain or discomfort.

  • Chills or hot flushes.

  • Fear of dying.

  • Fear of losing control or going crazy.

  • Feeling dizzy, unsteady, light-headed, or faint.

  • Feeling of choking or having a lump in your throat.

  • Feeling short of breath, or having trouble breathing.
Other symptoms include:
  • Feeling aches and pains are worse then they are, such as thinking a headache is a brain tumor.

  • Feeling that you or the things around you are not real, or you are outside of your body.

  • Nausea (upset stomach) or abdominal (stomach) pain.

  • Numbness (loss of feeling) or a tingling feeling.

  • Pounding or fast heartbeat, or becoming suddenly aware of your heartbeat. You may also feel skipped or extra beats, or a flip-flop feeling in your chest.

  • Sweating.

  • Trembling or shaking.

What causes panic disorder?

No one knows for sure what causes PD. It may be from a problem in the brain that causes you to feel fear more easily. PD may occur when you think you are in danger. More worry and stress than usual over the past 12 months may also lead to PD. Other things that may increase your risk for PD, or make PD worse include the following:

  • Actions taken from parents who worry too much about their physical symptoms.

  • Having a close family member with PD.

  • Having a severe (very bad) illness or injury in the past, or having a friend or family member die.

  • Having medical problems such as asthma, lung disease, irritable bowel syndrome, heart problems, or thyroid disease. PD may make you to think your medical problem is worse than it is.

  • Having mental health problems such as depression or separation anxiety disorder during childhood.

  • Having been physically or sexually abused as a child.

  • Smoking, drug abuse, or alcohol abuse. If you abuse drugs or alcohol, you use them too much or too often. Alcohol is found in beer, wine, and other adult drinks.

What are the signs and symptoms of panic disorder?

  • Symptoms of panic disorder include the symptoms of a panic attack. Symptoms may be like those of a bad health condition. You may think that you are having a heart attack because of chest pain. Sudden tingling or numbness may make you think you are having a stroke. You may have a limited-symptom attack where you have less than four panic attack symptoms. How bad and how often you have panic attacks may not be the same for each attack. You may have mild to severe attacks. The attacks may not happen often, or they may happen a lot. Panic attacks may occur anywhere, anytime, and even while you are asleep.

  • In PD with agoraphobia, you may not want to be alone inside or outside your home. You may fear being in a crowd or standing in line. You may avoid being on a bridge or in an elevator. You may not want to travel in a vehicle or ride a plane. Your fears may keep you from doing things you enjoy. Sometimes, you may go to places you try to avoid, but you are very afraid. Being with someone you trust when you are afraid may help you feel safe.

How is panic disorder diagnosed?

  • Psychiatric assessment: Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. How you answer these questions can help caregivers decide on treatment. To help during treatment, caregivers will ask you about such things as how you feel about it and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.

  • Tests: Tests may be done to check for medical problems that may be causing your PD symptoms.

  • Discussion: Your caregiver will ask you how bad, how often, and in what situations your panic attacks occur. He may also want to know if other family members have PD or other mental health problems. He may need to learn how well you are doing in school or work, or with your daily activities. You have PD if you have all of the following:

    • At least two panic attacks that come again and again. They may occur all of a sudden, or for no reason.

    • At least one of the attacks is followed by at least one of the following for one or more months:

      • You worry again and again about having another panic attack.

      • You worry about what will happen during or after an attack. This includes worrying that you are losing control, having a heart attack, or going crazy.

      • You have made a change in how you act or your way of life because of the panic attacks.

    • The panic attacks are not from other problems. These problems include side effects of a medicine, drug or alcohol abuse, or a health problem.

    • The panic attacks are not caused by another mental health problem, such as social phobia, specific phobia, obsessive-compulsive disorder, post-traumatic stress disorder, or separation anxiety disorder. You may have PD with or without agoraphobia. Your caregiver will use a different guide to check if you have agoraphobia together with your PD.

How is panic disorder treated?

You may have one or more of the following:

  • Medicines:

    • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.

    • Anti-depressants: These medicines are given to decrease or stop the symptoms of depression. Other behavior problems may also be treated with anti-depressants.

    • Tranquilizers: These medicines may be given to help you stay calm and relaxed.

  • Therapies: You may have counseling (talk therapy) to treat PD. A family member or friend may also help in treating your PD. Any of the following therapies may be used:

    • Cognitive behavioral therapy: With a caregiver, you will learn to face the things that you fear slowly and carefully. You will also learn to control how you think and act when you are afraid.

    • Cognitive restructuring: Caregivers help you find out which thoughts make you nervous. These thoughts are then replaced with calming thoughts.

    • Exposure therapy: Exposure or desensitization therapy helps you face a feared object, person, or situation. Fantasy (not real) or real-life situations are used with this therapy. The goal of desensitization therapy is to help decrease your fear or anxiety.

    • Relaxation therapy: Stress may cause pain, lead to illness, and slow healing. Relaxation therapy teaches you how to feel less physical and emotional stress. Deep breathing, muscle relaxation, and music are some forms of relaxation therapy.

How can I help myself if I have panic disorder?

  • Keep a diary of your panic attacks: Bring your diary with you every time you see your caregiver. Write answers to the following in your diary:

    • Did anything help ease or stop the attack, such as trying to relax?

    • Did you try a new food, medicine, or herbal supplement?

    • How often do you have attacks? How long do they last?

    • What signs and symptoms did you have?

    • What were you doing when the panic attack started?

    • What were your thoughts and feelings during the attack?

    • Were you stressed or upset just before the attack?

  • Avoid foods and drinks that have caffeine: This may include coffee, tea, cola, energy drinks, and chocolate.

  • Do not drink too much alcohol: If you drink alcohol, talk to your caregiver about how much and how often you drink.

  • Exercise: Exercise can help you decrease stress and anxiety. Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising also makes your heart stronger, lowers blood pressure, and keeps you healthy.

  • Quit smoking: Smoking harms the heart, lungs, and the blood. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.

  • Manage your stress: Stress may slow healing and lead to illness. Learn ways to control stress, such as relaxation, deep breathing, and music. Talk to someone about things that upset you.

When should I call my caregiver?

Call your caregiver if:

  • You have new symptoms since you last saw your caregiver.

  • Your worry keeps you from doing tasks, such as work, or caring for yourself or your family.

  • You have problems that you think may be caused by the medicine you are taking.

  • Your symptoms such as chest pain or trouble breathing are getting worse.

  • You have questions or concerns about your illness, medicine, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You feel light-headed, too dizzy to stand up, or you faint.

  • You feel like killing yourself.

  • You have chest pain, tightness, or heaviness that spreads to your shoulders, arms, jaw, neck, or back.

Where can I find support and more information?

Having panic disorder is life-changing for you and your family. Accepting that you have PD may be hard. Talk to your caregivers, family, or friends about your feelings. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with PD. Join a support group with other people who have PD. Contact the following for more information:

  • Anxiety Disorders Association of America (ADAA)
    8730 Georgia Avenue, Suite 600
    Silver Spring , MD 20910
    Phone: 1- 240 - 485-1001
    Web Address:
  • National Institute of Mental Health (NIMH), Public Information & Communication Branch
    6001 Executive Boulevard, Room 8184, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address:

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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