Panic disorder: symptoms, causes, treatment

Have you ever felt a sudden increase in your heart rate, trouble breathing, sweating, and overwhelming fear? These are common symptoms of a panic attack. Those symptoms would leave anyone feeling a little nervous about experiencing another unexpected panic attack. 

If you experience this feeling often and live in constant fear of another panic attack, you may have a panic disorder. Keep reading to learn more about the symptoms, causes, diagnosis, and treatment of panic disorder.

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Panic disorder and panic attacks are both common mental health conditions. An estimated one out of every 20 people will experience panic disorder at some point in their life (Kim, 2019). 

Panic disorder is a type of anxiety disorder that is characterized by:

• Experiencing recurring panic attacks

• Living in fear of experiencing another panic attack

A panic attack is an abrupt surge of intense fear or discomfort. The feeling typically eases within twenty minutes but can last for longer. Panic attacks may happen as frequently as several times a day to just once a year. Many people with panic disorder live in constant worry or fear about when the next panic attack will occur (Cackovic, 2020).  

Sometimes panic disorder is confused with another type of anxiety disorder called agoraphobia, which is an intense fear of situations and places that may cause embarrassment, helplessness, or panic (Kim, 2019). Unlike agoraphobia, panic disorder may or may not be associated with specific events or situations that trigger these feelings. The panic attacks in panic disorder usually occur without warning and may leave you feeling out of control. 

The good news is, while they can feel frightening, panic attacks are not dangerous, and there are treatments available. 

Panic disorder has two sets of symptoms. 

Panic attack symptoms

The first set includes the physical and emotional symptoms of a panic attack. The physical symptoms of a panic attack may consist of (Cackovic, 2020):

• Heart palpitations

• Increased heart rate or pounding heart

• Shortness of breath or trouble breathing

• Chest pressure or chest pain

• Sweating

• Trembling or shaking

• Dizziness or light-headedness

• Feeling unsteady or having trouble standing

• Fainting or passing out

• Chills or hot flashes

• Numbness or tingling

• Nausea or upset stomach

Some people confuse the physical symptoms of a panic attack with other medical emergencies, such as a heart attack. If you experience these symptoms, discuss them with your doctor or seek immediate medical attention, especially if you are unsure of the cause of your symptoms.

Common emotional or psychological symptoms of panic attacks include (Cackovic, 2020):

• Derealization—trouble recognizing what is real

• Depersonalization—feeling disconnected from yourself or your body

• Fear of losing control

• Fear of dying

There’s a theory that the symptoms of a panic attack may mimic the body’s normal response to danger. Your body has a response, called the “fight or flight" response, to prepare your body for life-threatening situations. A typical example that would activate this response is coming across a bear while in the woods.

During the fight or flight response, your body prepares you to run away from danger or defend yourself from the threat. It increases your heart rate and breathing, and releases energy from where it is stored in your body. 

Many of the same symptoms happen during a panic attack, even though there is sometimes no apparent cause of danger.

Symptoms outside a panic attack

When there isn’t an active panic attack, people with panic disorder often experience (Cackovic, 2020):

• Frequent worry or concern about having a panic attack

• Fear of panic attacks

• Avoiding situations that may trigger a panic attack

The exact cause of panic disorder is poorly understood. It’s believed that problems with the neurotransmitter serotonin likely play a role in triggering the part of the nervous system involved in fear (Cackovic, 2020). Here are some of the other risk factors for panic disorder:

• Stress

• Traumatic experiences

• Stressful childhood

• Genetics and family history

• Health conditions affecting brain function

The symptoms of panic disorder usually start in your late teens or early adulthood. Research had found that panic disorder commonly occurs along with other conditions like (Cackovic, 2020):

• Obsessive-compulsive disorder (OCD)

• Social anxiety

• Post-traumatic stress disorder (PTSD)

• Asthma

• Chronic obstructive pulmonary disorder (COPD)

• Irritable bowel syndrome (IBS)

• Hypertension (high blood pressure)

• Mitral valve prolapse

While not all panic attacks will have a clear trigger, there are some situations where they are more likely to occur.  Examples of common panic attack triggers include:

• Managing chronic illnesses or health conditions

• High-stress levels

• Alcohol use

• Financial or relationship problems

• Major life changes, like leaving for college, divorce, having your first child, etc.

The first time you experience panic attack symptoms, you may think you are having a heart attack. It’s common for people with panic disorder to look for answers for their physical symptoms rather than seeking help from a mental health professional. 

Your healthcare provider will likely run tests to assess your physical health first to look for a possible explanation for your symptoms. You may also be asked some questions about your daily stress levels and other mental health questions.

After ruling out other medical conditions, your healthcare provider will diagnose the panic attack. They may refer you to a mental health professional to help you create a treatment plan.

The Diagnostic and Statistical Manual of Mental Health Disorder (DSM-5) criteria for diagnosing panic disorder include the following (Cackovic, 2020):

• At least one panic attack (usually people experience more than one)

• One month or longer of persistent concern or fear of having more attacks

• Behavior changes to avoid situations that caused the panic attack

Panic disorder is only diagnosed when there are no other physical or psychological conditions explaining the symptoms. Having no clear trigger for the panic attack and the distinct physical symptoms are two of the most common signs of panic disorder (Cackovic, 2020).

There is no cure for panic disorder, but working with a mental health professional can help. They will help you find the best treatment plan to reduce your anxiety between panic attacks and potentially help reduce the number of panic attacks.

Treating panic disorder often includes a combination of psychotherapy and medications. 

Psychotherapy

Cognitive-behavioral therapy (CBT) helps you process negative emotions and teaches you coping strategies to help manage negative emotions and challenging triggers. You learn how to change your thoughts, feelings, and actions to understand your panic attacks better and manage your fear of having another panic attack (Cackovic, 2020). 

Medications

Common medications used to treat panic disorder include antidepressants like (Cackovic, 2020):

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Benzodiazepines

If left untreated, panic disorder may lead to other complications. Research shows people experiencing panic disorder are at higher risk for (Cackovic, 2020):

• Problems with work, school, or relationships

• Developing specific phobias and avoiding social situations

• Heart disease

• Gastrointestinal diseases

• Respiratory illnesses

• Alcohol or substance abuse

• Anxiety, depression, and other mental illnesses

• Thoughts of self-harm or suicide

If you or a loved one is struggling with thoughts of self-harm, don’t hesitate to call the National Suicide Prevention Hotline at 800-273-8255. This is a free service, available 24/7 to provide support and connect you to mental health resources in your area. 

Unfortunately, there is no known way to fully prevent panic disorder or panic attacks from occurring. Still, there are ways to help improve your situation, such as:

• Asking for help. It is difficult to ask for help, but working with a mental health professional can help you feel better sooner.

• Breathing training can help you control your breathing and promotes mental health (Ma, 2017).

• Practicing yoga helps both your physical and mental health. One study found that yoga helps to reduce anxiety and panic-related physical symptoms (Vorkapic, 2014). 

• Getting enough sleep. Poor sleep may make your mental health worse, so make time for adequate hours of sleep (Malik, 2014). 

If you’re struggling with panic disorder, taking care of yourself physically and mentally can help. Working with a mental health professional and following their medical advice can help you feel better sooner and reduce the effects of panic disorder. 

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 23, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.