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

Panic attacks

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. Panic disorder may occur in children, but it is often not diagnosed until they are older.

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.

Panic attacks can include anxiety about being in a setting where an escape may be difficult such as being in a crowd or traveling in a car or bus. This type of panic disorder is called agoraphobia.

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 four of the following symptoms during an attack:

• Chest pain or discomfort
• Dizziness or faintness
• 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.

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 abuse will be considered because symptoms can resemble panic attacks.

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

Types of medicines used to treat panic disorder:

• Antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for panic disorder.
• Sedatives are medicines that relax you. These may be used for a short time. There is a risk of becoming dependent on these medicines.
• Antiseizure medicines are sometimes used in severe cases.

Your symptoms should slowly get better over a few weeks. Do not stop taking your medicine or change the amount you are taking (dosage) without talking with your health care provider.

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

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

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

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

If you get panic attacks, avoid the following:

• Alcohol
• Stimulants such as caffeine and cocaine

These substances may trigger or worsen the symptoms.

Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69:621-632.

Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: Panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 32.

Pollack MH, Kinrys G, Delong H, Vasconcelos e Sá D, Simon NM. The pharmacotherapy of anxiety disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 41.

Stein MB, Goin MK, Pollack MH, Roy-Byrne P, Sareen J, Simon NM, et al. Practice guideline for the treatment of patients with panic disorder. Arlington, VA: American Psychiatric Association, 2009.