Panic (PA-nik) is a sudden surge of overwhelming fear that causes both psychological (sy-ko-LAH-je-kal) and physical symptoms. Panic disorder is a condition where repeated attacks of panic occur often and without warning causing fear and worry about future attacks.
Karla was riding her bicycle to school when a speeding car ran a stop sign. The driver slammed on the brakes, but the car kept skidding toward Karla with a sickening squeal. Karla saw the car bearing down on her. She felt her heart racing. She broke into a sweat, and could not catch her breath. Everything seemed to be moving in slow motion. For a moment before the car finally came to a stop, Karla thought she was going to die.
Karla was feeling panic, a sudden surge of overwhelming terror that causes both psychological symptoms, such as feeling that things are unreal or that death is approaching, and physical symptoms, such as a racing heart, sweating, trembling, shortness of breath, chest pain, upset stomach, and dizziness. These feelings are the body's natural response to danger or stress, and in Karla's situation, they were perfectly appropriate. She was in real danger.
For some people, however, these same psychological feelings and physical symptoms seem to arise from nowhere without warning when no danger is present. They can occur in seemingly harmless situations, such as while taking a quiet walk or sitting in class. These panic attacks are bursts of intense fear or discomfort that happen for no obvious reason. Many people have one or two panic attacks and then the problem disappears, often when they are no longer under major stress. Panic attacks become panic disorder when fear of a panic attack and frequency of attacks interferes with daily life.
Panic disorder is a mental health disorder. It is classified in the DSM-5 * as a type of anxiety disorder in which people have panic attacks that occur often and usually without warning. In panic disorder the attacks are so unpleasant that people with the disorder live in dread of the next one and alter their behavior in an attempt to prevent an attack. People may develop phobias, intense, unrealistic fears of certain objects or situations, that are linked to past panic attacks. For example, a boy who has had several panic attacks during basketball practice might develop a phobia of the gym and make an effort to avoid it by quitting the basketball team. Panic attacks become a mental health disorder when they interfere with daily life.
Scientists don't know exactly what causes panic disorder, but there are likely several factors that play a role in its development. As of 2016, researchers believed that one factor is an imbalance among various brain chemicals and/or a decreased response to the receptors that respond to these chemicals. Genetics (juh-NEH-tiks) also appears to play a role, since panic disorder and other anxiety disorders tend to run in families. Also, research has shown that identical twins are more likely to both have panic disorder than fraternal (non-identical) twins. Other research suggests that some people are especially sensitive to internal responses to real or imagined danger. They theorize that these people may overreact to normal body changes, giving rise to frequent false alarms. Some scientists speculate that the faulty learning may be the result of repeated stress. Once people have learned to react this way, a stressful event may trigger a full-blown panic attack.
Panic disorder starts with panic attacks that appear to be triggered for no explainable reason. The individual is simply struck suddenly by intense feelings of fear and vulnerability, a desire to escape, or a feeling of losing control. These symptoms usually last several seconds, but they may go on for several minutes or longer. Confused by the unexpected rush of feelings, these individuals may worry that they are going crazy or suffering from a serious disease. Even when the most intense symptoms of panic have stopped, anxiety and nervousness may linger.
Symptoms of a panic attack may include:
Initial panic attacks may occur when people are under great stress, such as when they have too many demands on them for a long period; are seriously ill; or when they have just lost a loved one through moving away, divorce, or death. A panic attack may also follow surgery or a serious accident. In addition, overuse of caffeine or abuse of cocaine and certain other drugs may trigger panic attacks. Whatever the situation, though, first panic attacks usually take people completely by surprise, which is one reason they are so frightening and so clearly remembered.
Some people have a single panic attack or occasional attacks, but they never have a problem serious enough to affect their daily life. For others, however, panic attacks can continue and cause much misery. People with panic disorder have attacks so often that they start to live in constant fear of the next one. This “fear of fear” can become so intense and last so long that it greatly interferes with people's lives. To be diagnosed with panic disorder, the individual must:
People with panic disorder may also complain of headaches, insomnia, cold hands, diarrhea, and fatigue. People who have panic disorder often have other mental health disorders and tend to abuse alcohol at a higher rate than the general population. The suicide rate of people with panic disorder is also higher than in the general population, although other mental health disorders present in addition to panic disorder may contribute to this outcome.
Early treatment helps keep panic disorder from reaching the stage where people experience severe problems in everyday life. With a combination of behavioral therapy and medication, about 85 percent of people with panic disorder experience substantially reduced symptoms within six months. Before treatment starts, a medical checkup can determine if there are other possible causes for the person's physical symptoms.
In another technique, the therapist may have the patient intentionally bring on some of the sensations of a panic attack. For example, exercising to raise the heart rate. Then the therapist can teach him or her how to cope better with these physical sensations. For example, instead of thinking, “I am having a heart attack,” a person may be taught to think, “It is only my heart beating fast. I can handle it.” People are taught to understand the thought processes behind their panicky feelings and the way the body physically reacts to stress. Then the therapist can help individuals find specific ways to respond better when they feel the symptoms of a panic attack.
Certain sedative medications can prevent or lessen the severity of panic attacks. Medication is often used along with cognitive-behavioral therapy to treat severe panic disorder. When people find that their panic attacks are less frequent or less severe, they may worry less about future attacks, and they may be able to face situations they have been avoiding. The specific medications prescribed depend on the person's age, general health, and response to the medication.
See also Anxiety and Anxiety Disorders: Overview • Fears and Phobias
Lambert, R. “Lifestyle Behaviours Add to the Armoury of Treatment Options for Panic Disorder: An Evidence-Based Reasoning.” International Journal of Environmental Research and Public Health (June 18, 2015) 12 no. 6: 7017-43.
Tompkins, Michael A. Anxiety and Avoidance: A Universal Treatment for Anxiety, Panic, and Fear. Oakland CA: New Harbinger pub., 2013.
Mayo Clinic Staff. “Panic Attacks and Panic Disorder.” Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/panic-attacks/basics/definition/CON-20020825 (accessed March 28, 2016).
MedlinePlus. “Panic Disorder.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/panicdisorder.html (accessed March 28, 2016).
American Psychiatric Association. 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901. Toll-free: 888-357-7924. Telephone: 703-907-7300. Website: http://www.psych.org (accessed March 28, 2016).
National Institute of Mental Health. 6001 Executive Blvd., Room 6200, MSC 9663, Bethesda, MD 20892-9662. Toll-free: 866-615-6464. Website: http://www.nimh.nih.gov (accessed March 22, 2016).
* DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, published by the American Psychiatric Association. This book is used by physicians in the United States to classify and diagnosis mental conditions.