What is Panic Disorder?

Feelings of intense fear – and physical manifestations of that fear – are very common if someone is facing immediate danger or a perceived threat. In panic disorder, however, a person experiences recurrent unexpected panic attacks (abrupt surges of intense fear or discomfort accompanied by physical and cognitive symptoms) even when they are not in any danger.

Panic disorder causes a person to be persistently concerned or worried about having more panic attacks or causes them to change behavior because of the panic attacks. Panic attacks – which typically reach a peak within minutes – may occur in response to a known feared object or situation, or they may seem to appear out of the blue.

Symptoms

For panic disorder diagnosis, a person must have experienced recurrent, unexpected panic attacks and one month or more of persistent worry about additional panic attacks or a significant change in behavior related to the attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and can occur from a calm or anxious state, and includes at least four of the symptoms listed below. Common panic attack symptoms are listed below.

Panic Attack Symptoms

• Palpitations, pounding heart or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying

Panic Disorder Symptoms

• Persistent concern or worry about additional panic attacks or their consequences (like losing control or having a heart attack)
• A significant change in behavior related to the attacks (like avoiding unfamiliar situations)

In panic disorder, these symptoms are not attributable to the effects of drugs, alcohol, medication or another medical condition and are not better explained by another mental disorder.

Causes

The causes of panic attacks and panic disorder are unknown. Genetics, major stress (like the death or illness of a loved one), a negative temperament or increased sensitivity to stress, and functional changes in the brain are all thought to play a part.

Risk Factors

Risk factors that could contribute to panic disorder include:

Traumatic history: Traumatic events like physical abuse, sexual assault or a serious accident may precipitate panic disorder.

Major life changes: Having a baby, getting a divorce, losing a job and other major changes may trigger panic attacks.

Habits: Smoking or excessive caffeine intake may contribute to panic disorder.

Diagnosis

A panic disorder diagnosis requires thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for panic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

The panic disorder criteria are:

• Frequent panic attacks over long periods of time
• At least one panic attack followed by a month of intense worry about future attacks or other forms of psychological discomfort
• The panic attacks are not rooted in another medical or psychiatric condition, or in behavioral issues such as drug or alcohol abuse.

Panic Disorder Diagnosis

Diagnostic tests for panic disorder include:

Physical examination: Your provider will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem, medication side effects or unhealthy behaviors (like drug use). To rule out medical conditions, he or she may order:

• Blood tests to check for thyroid and other conditions
• An electrocardiogram (ECG or EKG) to rule out a heart condition

Psychiatric evaluation: Your behavioral health provider will ask you questions about your symptoms, stressful situations in your life, fears or concerns, relationship problems and other issues to confirm a diagnosis and rule out other psychiatric conditions.

Panic Attack Diagnosis

An individual panic attack is diagnosed similarly to panic disorder, but without reference to the DSM-5 criteria noted above.