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Panic disorder

Panic attacks; Anxiety attacks; Fear attacks; Anxiety disorder - panic attacks

 

Panic disorder is a type of anxiety disorder in which you have repeated attacks of intense fear that something bad will happen.

Causes

 

The cause is unknown. Genes may play a role. Other family members may have the disorder. But panic disorder often occurs when there is no family history.

Panic disorder is twice as common in women as it is in men. Symptoms often begin before age 25, but may occur in the mid-30s. Children can also have panic disorder, but it is often not diagnosed until they are older.

 

Symptoms

 

A panic attack begins suddenly, and most often peaks within 10 to 20 minutes. Some symptoms continue for an hour or more. A panic attack may be mistaken for a heart attack.

A person with panic disorder often lives in fear of another attack, and may be afraid to be alone or far from medical help.

People with panic disorder have at least 4 of the following symptoms during an attack:

  • Chest pain or discomfort
  • Dizziness or feeling faint
  • Fear of dying
  • Fear of losing control or impending doom
  • Feeling of choking
  • Feelings of detachment
  • Feelings of unreality
  • Nausea or upset stomach
  • Numbness or tingling in the hands, feet, or face
  • Palpitations, fast heart rate, or pounding heart
  • Sensation of shortness of breath or smothering
  • Sweating, chills, or hot flashes
  • Trembling or shaking

Panic attacks may change behavior and function at home, school, or work. People with the disorder often worry about the effects of their panic attacks.

People with panic disorder may abuse alcohol or other drugs. They may feel sad or depressed.

Panic attacks cannot be predicted. At least in the early stages of the disorder, there is no trigger that starts the attack. Recalling a past attack may trigger panic attacks.

 

Exams and Tests

 

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

The health care provider will perform a physical exam and a mental health assessment.

Blood tests will be done. Other medical disorders must be ruled out before panic disorder can be diagnosed. Disorders related to substance use will be considered because symptoms can resemble panic attacks.

 

Treatment

 

The goal of treatment is to help you function well during everyday life. Using both medicines and talk therapy works best.

Certain medicines, usually used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them without talking with your provider.

Medicines called sedatives or hypnotics may also be prescribed.

  • These medicines should only be taken under a doctor's direction.
  • Your doctor will prescribe a limited amount of these drugs. They should not to be used everyday.
  • They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.
  • If you are prescribed a sedative, do not drink alcohol while on this medicine.

Talk therapy (cognitive-behavioral therapy, or CBT) helps you understand your behaviors and how to change them. During therapy you will learn how to:

  • Understand and control distorted views of life stressors, such as other people's behavior or life events.
  • Recognize and replace thoughts that cause panic and decrease the sense of helplessness.
  • Manage stress and relax when symptoms occur.
  • Imagine the things that cause the anxiety, starting with the least fearful. Practice in real-life situations to help you overcome your fears.

The following may also help reduce the number or severity of panic attacks:

  • Not drinking alcohol
  • Eating at regular times
  • Getting plenty of exercise
  • Getting enough sleep
  • Reducing or avoiding caffeine, certain cold medicines, and stimulants

 

Support Groups

 

You can ease the stress of having panic disorder by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

Resources for more information include:

Anxiety and Depression Association of America: www.adaa.org

National Institute of Mental Health: www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml 

 

Outlook (Prognosis)

 

Panic disorders may be long-lasting and hard to treat. Some people with this disorder may not be cured. But most persons get better when treated correctly.

People with panic disorder are more likely to:

  • Abuse alcohol or illegal drugs
  • Be unemployed or less productive at work
  • Have difficult personal relationships, including marriage problems
  • Become isolated by limiting where they go or who they are around

 

When to Contact a Medical Professional

 

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

Call 911 or see your provider right away if you develop suicidal thoughts.

 

Prevention

 

If you get panic attacks, avoid the following:

  • Alcohol
  • Stimulants such as caffeine and cocaine

These substances may trigger or worsen the symptoms.

 

 

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Calkins AW, Bui E, Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 32.

Kang CS, Harrison BP. Anxiety and panic disorders. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 197.

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            Review Date: 2/2/2016

            Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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