Panic Disorder

Panic disorder is an anxiety disorder characterized by recurrent unexpected panic attacks and the individual's response to those attacks. A panic attack is a surge of intense fear and discomfort that usually peaks within ten minutes, but can last as long as several hours.

Panic Attack Symptoms

Panic attacks are associated with the following physiological and cognitive symptoms.

  • Heart palpitations
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Numbness or tingling sensations
  • Feelings of unreality or being detached from oneself
  • Fear of losing control or “going crazy”
  • Fear of dying

Individuals with panic disorder also become persistently worried about having future attacks (e.g. having a heart attack, “going crazy”) or change their behavior significantly to avoid having panic attacks (e.g. avoidance of unfamiliar situations). Like other mental disorders, these symptoms can cause a significant amount of distress and impairment in daily life.

Panic Attack or Heart Attack?

Part of panic disorder is worrying about the consequences of the panic attacks. Many people mistake panic attacks for heart attacks due to their similarities. A cardiac chest pain (as experienced in heart attacks) is typically brought on by movement or exertion while a panic attack is not usually associated with exercise. People with cardiac chest pain can also become winded from any amount of exercise whereas those with panic disorder are unaffected by exercise. Cardiac chest pains are also associated with older ages and a history of more numerous medical conditions when compared to panic disorder.

Panic Attacks versus Panic Disorder

It is important to note that the mere presence of panic attacks is not sufficient to meet criteria for diagnosing panic disorder. A panic attack is an anxiety reaction that can occur in other anxiety disorders or anxiety-provoking situations for people without anxiety disorders.

Panic disorder infrequently occurs in absence of other mental disorders. People with panic disorder often have other anxiety disorders, major depression, bipolar disorder, and mild alcohol use disorder. Reported lifetime rates of co-occurrence between major depression and panic disorder range from 10 to 65 percent. Panic disorder also frequently co-occurs with other medical conditions, such as dizziness, cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease, and irritable bowel syndrome.

How Common Is Panic Disorder?

The one-year prevalence for panic disorder is 2 to 3 percent in the United States and European countries. Asian, African, and Latin American countries have lower prevalence rates, ranging from 0.1 to 0.8 percent. Females are twice as likely to be affected than males, and the gender difference is observed as early as adolescence. The median age of onset for panic disorder in the United States is 20-24 years. A small percentage of cases first occur in childhood or later adulthood.

What Causes Panic Disorder?

The exact causes of panic disorder are unknown. Certain genes may confer vulnerability to panic disorder, though the exact genes and mechanisms are unknown. Children of parents with anxiety, depressive, and bipolar disorders have higher rates of panic disorder. Brain models of panic disorder emphasize the brain structures involved in anxiety and fear.

Ethnic and Cultural Differences

In the United States, Latinos, African Americans, Caribbean blacks, and Asian Americans report lower rates of panic disorder than non-Latino whites. Native Americans report the highest rates. Asian, African, and Latin American countries also report lower rates of panic disorder than the United States and European countries. These disparities can be partially explained by different cultures’ treatment of fears and attribution of panic attacks. Examples of culture-specific characterizations associated with panic attacks include trúng gió (“hit by the wind”) in Vietnamese culture, ataque de nervios (“attack of nerves”) among Latin Americans, and khyâl (“soul loss”) among Cambodians.

Treatment of Panic Disorder

Both medication and psychotherapy can effectively treat panic disorder. Medications typically prescribed are anti-anxiety medications and antidepressants. A combination of medication and psychotherapy is found to be most effective.