Health Encyclopedia

Panic disorder

Definition

Panic disorder is an anxiety disorder that causes repeated, unexpected attacks of intense fear. These attacks may last from minutes to hours.

Alternative Names

Panic attacks

Causes, incidence, and risk factors

The exact cause of a panic disorder is unknown. Genetics may play a role in this disorder. Studies suggest that if one identical twin has panic disorder, 40% of the time, the other twin will also develop the condition. However, panic disorder also often occurs in family members who are not blood relatives.

Panic disorder occurs twice as often in women as in men. A person with panic disorder often lives in fear of another attack and may be afraid to be alone or to be far from medical help.

Symptoms usually begin before the age 25. Although panic disorder may occur in children, it is often not diagnosed until you are older. Persons with this condition often have medical tests and exams for symptoms related to heart attack or other conditions before a diagnosis of panic disorder is made.

Symptoms

With panic disorder, at least 4 of the following symptoms suddenly occur within 10 minutes. Attacks may be followed by at least 1 month of persistent fear of having another attack.

Sensation of shortness of breath
Dizziness or faintness
Palpitations or pounding heart
Trembling or shaking
Sweating, chills, or hot flashes
Feeling of choking
Nausea or upset stomach
Numbness or tingling
Chest pain or discomfort
Fear of dying
Fear of losing control
Feelings of unreality
Feelings of detachment

There are often extreme changes in behavior at home, school, work, or with family. People with the disorder often worry about the significance of their panic attacks. They may think they are "going crazy" or having a heart attack.

Signs and tests

A health care provider will perform a physical examination, including blood tests and a psychiatric evaluation. Underlying medical disorders must be ruled out before the diagnosis of panic disorder can be made.

Disorders related to substance abuse should also be considered, because some can mimic panic attacks. Substance abuse may result when individuals with panic attacks try to cope with fear by using alcohol or illegal drugs.

Cardiovascular, endocrine, respiratory, and neurologic disorders may be suspected, and can be present at the same time as panic disorders. Specific diagnostic tests will vary between individuals and will be based on the symptoms.

Many people with panic disorder first seek treatment in the emergency room, because the panic attack feels like a heart attack.

Treatment

Anti-anxiety medications, antidepressants, and cognitive behavioral therapy (working with a therapist) have been successfully used to treat panic disorders. The medications act on the central nervous system to reduce the occurrence of anxiety and associated symptoms.

A commonly-used class of anti-anxiety medications is benzodiazepines, including aprolazam (Xanax). However, this class of medications is associated with dependence and addiction. Ideally, these drugs are used only on a temporary basis.

Drugs from a class of antidepressant called SSRIs (selective serotonin reuptake inhibitors) are the most commonly used medications for panic disorder. If these do not help, longer-term use of benzodiazepines may be considered.

Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive restructuring (learning to recognize and replace panic-inducing thoughts). Psychological counseling and therapy techniques may be helpful in addition to medications.

Regular exercise, adequate sleep, and regularly scheduled meals may help reduce the frequency of the attacks. Caffeine and other stimulants should be reduced or eliminated.

Expectations (prognosis)

The disorder may be long-lasting and difficult to treat. Although some people with this disorder may not be cured with treatment, most can expect rapid improvement with drug and behavioral therapies.

Complications

Possible complications of this condition include avoiding situations or places that might bring on an attack, and an increased likelihood for other anxiety and mood disorders.

Dependence on anti-anxiety medications is a possible complication of treatment. Dependence involves needing a medication to be able to function and to avoid withdrawal symptoms. It is not the same as addiction, which involves the uncontrolled use of a substance despite negative results. Dependence and addiction often occur together, but dependence itself is not always a problem.

Calling your health care provider

Call for an appointment with your health care provider if panic attacks are interfering with work, relationships, or self-esteem.

Prevention

Avoid stimulants such as caffeine and cocaine and avoid alcohol use if you are prone to panic attacks. These substances may induce or worsen the symptoms.

Review Date:7/25/2006
Reviewed By:Paul Ballas, D.O., Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.