Panic Disorder What Is Panic Disorder? ByKendra CherryKendra CherryFacebookTwitterKendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.Learn about our editorial processUpdated on January 29, 2021Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Margaret Seide, MDMedically reviewed byMargaret Seide, MDLinkedInMargaret Seide, MS, MD, is a board-certified psychiatrist who specializes in the treatment of depression, addiction, and eating disorders. Learn about our Medical Review BoardJamie Grill / Getty Images Table of Contents View All Table of ContentsWhat Is Panic Disorder?SymptomsDiagnosisCausesTypesTreatmentCoping What Is Panic Disorder? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic disorder is a type of anxiety disorder that is characterized by intense, recurrent, and unexpected panic attacks. Fear and anxiety can be normal reactions to specific situations and stressful events. Panic disorder differs from this normal fear and anxiety because it is often extreme, and may seem to strike out of the blue. A person with panic disorder may experience symptoms such as severe feelings of terror, rapid breathing, and rapid heart rate. People with panic disorder may experience these attacks unexpectedly and for no apparent reason, but they can also be preceded by some sort of triggering event or situation. The National Institute of Mental Health (NIMH) reports that approximately 2.7% of the adult U.S. population experiences panic disorder each year. Approximately 44.8% of these individuals experience cases of panic disorder that are classified as "severe." Symptoms According to the Anxiety and Depression Association of American, nearly six million American adults experience the symptoms of panic disorder during any given year. While panic disorder can strike at any point in life, symptoms most often begin during late adolescence or early adulthood and affect twice as many women as men. Many people living with panic disorder describe feeling as though they are having a heart attack or on the verge of dying, and experience some or all of the following symptoms: Chest painDizzinessFeelings of extreme terror that occur suddenly without warningNumbness in the hands and feetPounding heartRapid breathingSweatingTremblingWeaknessPanic disorder can lead to serious disruptions in daily functioning and make it difficult to cope with normal, everyday situations that may trigger feelings of intense panic and anxiety.The Symptoms of Panic Disorder Diagnosis To be diagnosed with a panic disorder, a person must experience recurrent and often unexpected panic attacks, according to the DSM-5. In addition, at least one attack needs to be followed by one month or more of the person fearing that they'll have more attacks. Your healthcare provider will also need to rule out other potential causes of your symptoms, including: The direct physiological effects of a substance (such as drug use or a medication) or a general medical conditionAnother mental disorder, including social phobia or another specific phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety disorderDSM-5 Criteria for Diagnosing Panic Disorder Avoidance Behaviors and Panic Disorder Because panic disorder often leads to a person avoiding certain situations or objects, it can also lead to the development of phobias. For example, a person living with panic disorder might stop leaving home in order to prevent having an attack or losing control in public. In time, this person might develop agoraphobia, a marked fear of being in a variety of situations outside of the home in which escape might be difficult or help might not be available if debilitating symptoms develop. While previous versions of the DSM categorized panic disorder as occurring with or without agoraphobia, the newest edition of the diagnostic manual lists the two as distinct and separate disorders. Causes Although the exact causes of panic disorder are not clearly understood, many mental health experts believe that a combination of environmental, biological, and psychological factors play a role: Age:Panic disorder typically develops between the ages of 18 and 35.Gender:According to the National Institute of Mental Health, women have more than twice the risk of panic disorder than men.Genetics: If you have a close biological family member with panic disorder, you are much more likely to develop the condition. Although up to half or more of people with panic disorder do not have close relatives with the condition.Trauma: Experiencing a traumatic event, such as being the victim of physical or sexual abuse, can increase risk of panic disorder as well.Life transitions: Going through a life transition or difficult life event, including the death of a loved one, divorce, marriage, having a child, or losing a job may increase also risk.What Are Risk Factors for Panic Disorder? Types of Panic Attacks There are two main types of panic attacks: unexpected and expected. People with panic disorder most commonly experience unexpected panic attacks, but some do experience both types. Unexpected panic attacks occur suddenly without any external or internal cues. In other words, they seem to happen "out of the blue" when you feel relaxed.Expected panic attacks occur when someone is exposed to a situation for which they carry fear. For example, having a panic attack during take-off on a plane.An Overview of the Types of Panic Attacks Treatment Panic disorder, like other anxiety disorders, is often treated with psychotherapy, medication (antidepressants or anti-anxiety drugs), or a combination of both. Psychotherapy Psychotherapy for panic disorder can include several different approaches, including: Cognitive behavioral therapy (CBT) can help people with panic disorder learn new ways of thinking and reacting to anxiety-provoking situations. As part of the CBT process, therapists help clients identify and challenge negative or unhelpful patterns of thinking and replace these thoughts with more realistic and helpful ways of thinking.Exposure therapyinvolves progressively exposing people with panic disorder to the object and situations that trigger a fear response while teaching and practicing new relaxation strategies.Panic-focused psychodynamic psychotherapy (PFPP) aims to uncover underlying conflicts and experiences that may have influenced the person’s development of panic and anxiety. Medication Medications for panic disorder fall into one of two categories: antidepressants and anti-anxiety drugs. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants used for panic disorder, including: Paxil (paroxetine)Prozac (fluoxetine)Celexa (citalopram)Zoloft (sertraline)Benzodiazepines are a commonly prescribed class of anti-anxiety medication that can help reduce the severity of panic attacks acutely, including: Ativan (lorazepam)Klonopin (clonazepam)Valium (diazepam)Xanax (alprazolam)Top Treatments for Panic Disorder Coping In addition to medication and psychotherapy, there are some lifestyle habits that have been found to help people better cope with the symptoms of panic disorder. Get Moving Not only can regular exercise help reduce stress, anxiety, and tightness throughout the body, but it's been found to lessen the frequency of panic attacks as well. Prioritize Sleep Sleep disturbances and panic disorder can be a vicious cycle. People with panic disorder often have trouble sleeping and the resulting sleep deprivation can result in greater panic disorder symptoms. In addition to doing your best to practice good sleep hygiene, it's important to tell your health care provider if you believe you have developed a sleep disturbance and/or are experiencing more frequent panic attacks. Watch Your Diet While there's no magic diet to cure your panic disorder, there are certain foods and substances that might increase your anxiety or trigger a panic attack, including: AlcoholCaffeineMonosodium glutamate (MSG)Refined sugar Keep a Journal In addition to tracking your triggers, a panic attack journal can be used to record your symptoms (physical and emotional) as well as any coping strategies that helped you cope with those symptoms. Practice Relaxation Relaxation techniques can help you slow down your thoughts, ease stress and anxiety, and counteract many of the cognitive and physical symptoms of panic disorder. Here are a few relaxation techniques you can try on your own or with the help of a mental health professional: Deep breathingMindfulness meditationProgressive muscle relaxationVisualizationYoga Seek Help For many people, the stigma associated with panic disorder can prevent them from seeking support and treatment. However, getting a proper diagnosis and treatment and having a solid support system of friends and family can help you manage your symptoms and feel your best. If your loved one has a panic disorder, do your best to remain supportive and encourage them to seek treatment, whether psychotherapy, medication, self-help, or a combination of these options. If you or a loved one are struggling with panic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.For more mental health resources, see our National Helpline Database.How to Cope With Panic Disorder 11 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.Anxiety and Depression Association of America. Facts & Statistics.Anxiety and Depression Association of America. Panic Disorder Symptoms.National Institute of Mental Health. Panic Disorder.Telman LGE, van Steensel FJA, Maric M, Bögels SM. What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders. Eur Child Adolesc Psychiatry. 2018;27(5):615-624. doi:10.1007/s00787-017-1076-xNational Institutes of Health. Understanding Anxiety Disorders: When Panic, Fear, and Worries Overwhelm.Milrod B, Chambless DL, Gallop R, et al. Psychotherapies for panic disorder: A tale of two sites. J Clin Psychiatry. 2016;77(7):927-935. doi:10.4088/jcp.14m095pQuagliato LA, Cosci F, Shader RI, et al. Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. J Psychopharmacol. 2019;33(11):1340-1351. doi:10.1177/0269881119859372Lattari E, Budde H, Paes F, et al. Effects of aerobic exercise on anxiety symptoms and cortical activity in patients with panic disorder: A pilot study. Clin Pract Epidemiol Ment Health. 2018;14:11-25. doi:10.2174/1745017901814010011Anwar Y. Tired and apprehensive: Anxiety amplifies the impact of sleep loss on aversive brain anticipation. The Journal of Neuroscience. 2013;33(26):10607-10615. doi:10.1523/JNEUROSCI.5578-12.2013Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169-83. doi:10.1037/a0018555 Additional ReadingAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.Anxiety and Depression Association of America. Facts & Statistics.Kessler R, Chiu W, Demler O, Walters E. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005; 62(6):617–627.By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. 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