What Is Panic Disorder?

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.

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 pain
• Dizziness
• Feelings of extreme terror that occur suddenly without warning
• Numbness in the hands and feet
• Pounding heart
• Rapid breathing
• Sweating
• Trembling
• Weakness

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 condition
• Another mental disorder, including social phobia or another specific phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety 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.

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.

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 therapy involves 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)

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:

• Alcohol
• Caffeine
• Monosodium 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 breathing
• Mindfulness meditation
• Progressive muscle relaxation
• Visualization
• Yoga

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.