Written by Dr. Inez Van Roy on
December 26, 2021
Written by Dr. Inez Van Roy on:

Medically Reviewed by our Medical Affairs Team

Many people suffer from panic attacks every once in a while. They wake up in the middle of the night with hyperventilations. Some feel nauseous and feel like their heart is racing.

If you recognize this pattern, keep reading to know more about panic disorder. In this article, you can read about its causes, symptoms, diagnosis, and treatment options.

Panic Disorder and Panic Attacks

For some people, the occasional bout of anxiety is no big deal. For others, anxiety can be very intense and overwhelming. It feels like they are dying.

Panic disorder is a type of anxiety disorder that occurs when someone has recurrent panic attacks. If you’re wondering if you might have panic disorder, here are some signs to look out for.

A panic disorder is an extreme reaction to anxiety.

Anxiety is just a way for your body to protect itself from danger. Panic attacks are the physical preparation to fight or flight from danger. 

Panic disorders are categorized under the category “anxiety disorders”. It is an anxiety disorder with an extreme physical response as described below. If you want to know more about the symptoms, keep reading.

Symptoms

The symptoms of panic disorders are described in the psychiatric bible. The American Psychiatric Association defines all the symptoms of mental illnesses.

Below we will describe the diagnostic criteria as described in the newest version (DSM-5).

Someone with a panic disorder should have:

  • “Recurrent and unexpected panic attacks 
  • ≥1 attack has been followed by 1 month or more of 1 or both of the following
  • Persistent concern about additional attacks or their consequences
  • A significant maladaptive change in behavior related to the attacks”.

Let’s illustrate this with an example.

Anna is 21 years old and in college. One day, she went to her college classes. She couldn’t enter the class as she was feeling really unwell all of a sudden. 

She felt so hot and had to sit down. She started shaking. She felt like having an asthma attack. Anna thought “I don’t even have asthma, this doesn’t make sense”.

Her heart was pounding in her chest. She felt dizzy. When she calmed down, a deep fear came over her that this would happen again.

She would run to the doctor because she thought she was going to die. They couldn’t find anything wrong with her. Just thinking about that feeling made her gasp for air again.

Anna most likely is suffering from recurrent panic attacks and anxiety. Panic attacks are due to anxiety. The panic attacks are not due to substance use or abuse, or another medical condition.

If the panic attacks are due to another mental disorder, the person also can’t be diagnosed with panic disorder.

Symptoms of a Panic Attack

We are speaking a lot about panic attacks in the criteria of a panic disorder. But what are panic attacks? They are an abrupt surge of intense fear or discomfort. It reaches a peak within a couple of minutes.

After, it slows down again. Four or more of the following symptoms are active during a panic attack:

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

Does this sound relevant to your situation? We can surely recognize Anna in this description. She feels like she is dying and feels obvious panic attacks.

Anna is probably upset about this new or recurring event in her life. Keep on reading to know more about possible causes and treatment for panic disorder. 

What does agoraphobia have to do with panic disorder?

Agoraphobia is an extreme (and out of proportion) fear of being in open spaces. They might also fear going to the shops, theaters, and cinemas.

Other situations they fear are using public transportation or being in a crowded space. Some people with agoraphobia even fear going outside their homes. 

An illustration might make it easier to understand what agoraphobia entails. Tom has agoraphobia. When Tom goes shopping he has the feeling that people are looking at him.

He does not feel comfortable. Only thinking of standing in line makes him sweat. When he reaches the register he gets a feeling of deep discomfort. 

He hyperventilated and wanted to puke right there. He felt so embarrassed that he couldn’t go shopping anymore. He felt trapped. It felt like no help was coming. Tom can’t calm himself down anymore.

Agoraphobia used to be connected to panic disorders in the DSM-IV. It fell under the umbrella of panic disorders. The DSM-5 recognizes agoraphobia as an independent diagnosis. There is no need anymore to define panic disorders as occurring with or without agoraphobia. 

Causes of Panic Disorder

If you’ve ever experienced a panic attack, you know how frightening it can be. It’s normal to feel some anxiety.

If the attacks are frequent and interfere with your daily life, you may ask yourself about what causes this in the first place? That question is valid and many researchers ask the same thing. In short, we aren’t sure yet.

Causal models of panic disorders refer to a combination of genetics, psychology, and environment. 

Genetic theories believe that a highly sensitive anxiety response might be genetic. The sensitivity of your amygdala (and other brain areas) might be heritable. Your brain functionality might work a little differently.

Psychological models explain panic disorders differently. An anxiety response or a fight-or-flight reaction might be misinterpreted. This reaction is inherently positive, designed for survival. 

Your panic disorder might interpret it as if you were dying. This interpretation might make you hypervigilant to your physical symptoms. This ‘fear of fear” leads to more anxiety and stress. 

Another cause might be the sudden onset of a panic attack. It might be due to a traumatic event or the use and misuse of certain psychoactive substances like caffeine. This might start the anxiety cycle to spiral into panic disorder.

Risk Factors 

As explained above, the exact cause of panic disorders is difficult to provide. The below factors might increase the risk of developing a panic disorder or panic attacks.

Theories at this point believe that the etiology of panic disorders is multifactorial. 

  • Severe traumatic events during childhood, and unfavorable parental attitudes.
  • Family members with a history of panic disorder/ attacks or anxiety disorders
  • Unfavorable parenting style (maternal, and mostly paternal)
  • Severe (childhood) trauma, like sexual assault, an accident, separation of the parents.
  • Major life stress, like chronic illness or death of an attachment figure
  • Excessive caffeine or smoking
  • Childhood sexual or physical abuse
  • A big life change (e.g., having a baby or going through a divorce)

Complications

If your child has panic attacks (and possibly panic disorder) it is advised to seek help. Without help, it is likely the disorder will be carried through adulthood. If you are an adult, we also recommend seeking treatment as soon as possible. 

Panic disorder can disrupt your social life and your personal development. You might not be able to get in your car. Maybe you can’t handle work without a debilitating fear. It is clear that your quality of life will suffer from this experience. 

Panic disorders might also lead to other disorders. It is highly comorbid with depression, substance and alcohol abuse, and other anxiety disorders.

You might feel anxiety even in social situations or might start compulsions to manage your stress. Social phobia and obsessive-compulsive disorder can be related to panic disorder.

Post-traumatic disorder and generalized anxiety disorder could also be a complication of panic disorders.

Prevention of Anxiety Disorder

We are not entirely sure how to prevent panic disorders. 

Let’s consider a first panic attack as the official start of a panic disorder. In that case, it would be essential to use this point in time to prevent panic disorder (PD).

A study showed that a PD prevention workshop after a first attack had positive effects on these people. The workshop showed improvement in future anxiety attacks and avoidance of social situations.

Another way to prevent panic disorder is sticking to the treatment plan. While many people start avoiding situations in which they feel panic, it is recommended to follow the advice of your medical provider.

That advice might be exposure, therapy, and medication. It can also take a while until the medication works, your doctor will inform you more on this.

The Mayo Clinic believes that physical activity could also prevent panic disorder. Some research confirms this hypothesis.

Exercise is mostly known for its positive effects on our mood (or depression). It seems like people with an anxiety disorder could also profit from regular exercise.

Psycho-education on the physical signs they feel while exercising can help people to adapt. They might learn to interpret the racing heart, faster breathing, and sweating like a normal consequence of exercise or stress. It isn’t dangerous, it is a sign your body is doing exactly what it needs to.

Diagnosis of Anxiety Disorders

You might ask yourself “how is panic disorder diagnosed?”

Diagnosis of panic disorders can only be done by a registered (mental) health specialist. That might be a doctor, psychologist, or psychiatrist.

Your primary care provider will first need to exclude any other medical illness. They will most probably test your blood levels and heart. You will undergo a complete physical exam to exclude all other possible causes.

After a psychological assessment will take place. Your doctor might ask you about any thoughts, feelings, or recent events that might have caused this extreme anxiety. They might also ask about your family history, any life events, or any substance use.

Just as with other mental disorders, your mental health professional will use the DSM. They can find your symptoms in the diagnostic and statistical manual. The symptoms of panic disorder are described in this manual.

Treatment or Management

Family physicians recommend combining therapy and medications to treat panic disorder. 

Cognitive-behavioral therapy is a form of talk therapy that is highly recommended for mental health disorders. You can learn to reframe the panic attack and any other symptoms.

The most popular form of medication used with this mental illness is SSRIs. This is short for selective serotonin reuptake inhibitors. Other options are serotonin and norepinephrine reuptake inhibitors (SNRIs) or benzodiazepines if needed.

It is important to ask for medical advice as these can have side effects. Some of these could also interact with your current medication or your physical state. A doctor can evaluate whether these medications are recommended or not in your particular case.

How common are panic attacks?

Are you worried that you might be experiencing panic attacks? If so, you’re not alone. Panic attacks are actually quite common, affecting an estimated 2-3% of the population. 

When to Get Help

You should get help if symptoms of panic disorder have a negative influence on your daily life. You might notice that you are experiencing repeated panic attacks. Maybe you seek emergency medical care on a regular. In those cases, you might develop a panic disorder.

It is not necessary to live in intense worry and overwhelming fear daily. You can get help with your mental health so you handle negative emotions and prevent the next panic attack.

Concluding Thoughts

If you have recently gotten a panic attack, you can choose to get help. Panic disorder can be treated. 

If you feel alone or have other mental health symptoms, you can keep reading our blog. You can also join our online community. It is filled with people who want to make lifestyle changes to adapt to their mental health.  Let us know your story.

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