Conditions

Understanding Panic Disorder: Causes, Symptoms, and Treatment

Panic disorder affects millions, causing sudden, intense fear and anxiety. Discover what defines this condition, the symptoms, causes, and effective treatments. Learn how to navigate life with panic disorder and support loved ones dealing with this mental health challenge.

therapist sean abraham By Sean Abraham, LCSW

Updated on May 24, 2024

x icon linked-in icon facebook icon instagram icon


More than 57 million adults in the United States live with a mental health condition. Forty million suffer from anxiety disorders, the most common among all mental health illnesses. Furthermore, estimates show that panic disorder accounts for the highest number of medical visits among all anxiety disorders.

Here, we’ll explore what panic disorder is, the symptoms, what causes it, and what treatment options are to make life with a panic disorder easier.

What Is Panic Disorder?

Panic disorder is a mental illness that typically starts in early adulthood. Women are more likely than men to develop this disorder, while children and teens can also develop symptoms. While many people are familiar with panic attacks, panic disorders are more complex.

Defining Panic Disorder

Panic disorder (PD) is an anxiety disorder where one regularly experiences sudden feelings of intense fear, worry, anxiety, stress, loss of control, and panic. Multiple studies concur that psychiatrists and primary care physicians encounter four subtypes of panic disorder:

  1. Cardiovascular subtype is characterized by the dramatic onset of various cardiac symptoms that symptomatize panic attacks. Chest tightness and/or discomfort, palpitations, fluttering of the heart, increased heart rate, and a pounding heart suggest PD so long as the presence of heart conditions and cardiac malfunction is ruled out.
  2. Respiratory subtype presents with acute and short-lived hyperventilation symptoms such as shortness of breath and a choking sensation.
  3. Gastrointestinal subtype involves episodic symptoms concentrated in the gastrointestinal tract. Those include constipation, nausea, stomach bloating, abdominal pain, diarrhea, and vomiting.
  4. Vestibular subtype presents common PD symptoms, including lightheadedness, faintness, dizziness, or unsteadiness.

The Difference Between Panic Disorder and Panic Attacks

The National Institute of Mental Health defines a panic attack as the abrupt heightening of fear or discomfort that peaks within minutes. According to the American Psychiatric Association, panic attacks are the core symptom of panic disorder, but they can represent other medical conditions such as anxiety attacks or substance use disorder. Therefore, experiencing a panic attack doesn’t automatically mean that one will develop PD.

Only a licensed therapist can diagnose PD after careful examination and evaluation of symptoms. According to DSM-5 criteria for panic disorder, a PD case is determined when a person experiences recurrent panic attacks followed by one month or more of either (1) intense worry/concern over more attacks or (2) significant behavior changes to avoid triggers.

It’s also important to differentiate PD from agoraphobia and generalized anxiety disorder (GAD). Agoraphobia is the fear of finding oneself in situations they cannot escape. Agoraphobia patients can panic or have panic-like symptoms, but they don’t have PD. GAD is an anxiety disorder with clear triggers and symptoms arising from familiar factors, excessive thoughts that create irrational fears or worry.

Symptoms of Panic Disorder

How can you know whether you or a loved one suffers from PD? Below, we’ll cover common physical and psychological symptoms. If you have concerns for a friend or family member, encourage them to reach out to their doctor for a formal diagnosis and personalized treatment plan.

Physical Symptoms of Panic Disorder

Psychological Symptoms of Panic Disorder

Periodic overwhelming fear and anxiety (with no known reason) are common indicators of panic disorder. People may also experience feelings of disassociation, alienation from or even unfamiliarity with their surroundings. These feelings can occur alongside depersonalization (feeling detached from oneself).

Another common psychological symptom is avoidance of places where panic attacks have occurred. Additionally, the fear of dying or ‘going crazy’ is also common among those diagnosed with panic disorder.

According to the Anxiety and Depression Association of America, many people don’t realize that PD is highly responsive to treatment. Understanding PD symptoms can help one to take the right steps in seeking help early and starting the journey to recovery.

Causes and Risk Factors for Panic Disorder

Like with most anxiety disorders, there is no specific cause of panic disorder. However, findings from different psychiatric studies have shown that certain biological and environmental risk factors are associated with its prevalence.

Biological Factors and Panic Disorder

Biological risk factors of PD fall into three categories: neurochemical, metabolic, and genetic.

Neurochemical

Some PD symptoms occur when there is a neurochemical imbalance of neurotransmitters such as serotonin, norepinephrine, dopamine, and GABA in the brain. Antidepressants and anxiolytic medications can counter the effects of such inequalities. Also, reproductive hormones have been found to influence the frequency and intensity of spontaneous panic attacks. Ongoing studies continue to investigate the clinical relevance of high hormone levels to PD.

Metabolic

Metabolic theories suggest that PD sufferers are more reactive to particular anxiety-inducing conditions or substances. For example, caffeinated and alcoholic drinks or nicotine products can all induce panic-like symptoms. Thus, a PD patient who uses these substances has a higher risk of a panic attack.

Genetic

The prevalence of PD is higher among families with a history of PD, according to genetic and hereditary studies. This means there’s a remote chance of inheriting panic disorder from a relative. However, no research has suggested that major genes are involved in the development of PD.

Environmental Factors and Panic Disorder

The environment in which one grew up or currently lives and works can influence the development of PD. Experiences such as sexual/physical abuse, trauma, and significant loss during childhood or adulthood contribute to a PD diagnosis. Parental negativity and lack of parental warmth have been found to elevate the risk for adult panic disorder.

Among children suffering from the disorder, broader factors such as peer relationships, stressful events, and the school environment influence the development of PD.

It’s important to note that the interaction of biological, environmental, and other risk factors compound the risk of PD development. A qualified mental health professional can help to understand the interplay of PD risk factors for an individual and assist in managing this complex mental health condition.

Diagnosis and Treatment of Panic Disorder

Proper diagnosis and treatment of PD aim to reduce the frequency of panic attacks and ease the severity of other symptoms. Mental Health America statistics show that appropriate treatment of panic disorder can reduce or prevent panic attacks in 70 to 90% of people with the disease. However, ADAA statistics show that only 36.9% of those suffering from anxiety disorders receive treatment. See the disconnect? PD is highly treatable, yet most people suffering from it aren’t receiving treatment.

Diagnosing Panic Disorder

Panic disorder is diagnosed in people who experience spontaneous panic attacks and are faced with constant fear of a recurring attack. Medical or mental health providers can diagnose PD based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DSM-5 is a general guideline for diagnosing different mental health conditions.

When preparing for an appointment with your doctor, it’s helpful to document important information you don’t want to forget. Particularly, keep details of other health conditions, hereditary diseases from family history, all medications you’re currently taking, how long you’ve experienced anxiety symptoms, major stressors in life, things you avoid, and things that make you anxious. This information will be crucial in determining your diagnosis.

During a PD diagnosis appointment, you should expect questions, tests, and exams by the healthcare provider, as they attempt to understand your symptoms. Panic disorder is diagnosed by exclusion, which means your PCP or GP will first need to rule out any other medical conditions that may cause symptoms similar to PD.

Treatment Options for Panic Disorder

Speaking with a healthcare provider about your panic disorder symptoms is the best way to know the right treatment for you. A doctor/therapist can prescribe medication, psychological therapy, or both based on a thorough analysis of your symptoms.

Medications Used to Treat Panic Disorder

Common medications for treating PD include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), beta-blockers, and benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin).

For patients with substance use disorder alongside PD, doctors may recommend using gabapentin and antidepressants such as mirtazapine to treat the symptoms. Also, it may be necessary to put some patients under inpatient monitoring if the risk of suicide is determined.

A NIMH article, ‘Panic Disorder: When Fear Overwhelms’, points out that many patients try more than one medication before finding the one that works best for them.

Cognitive Behavioral Therapy (CBT) for Panic Disorder

Cognitive behavioral therapy, a type of psychotherapy, is one of the most common techniques for treating panic disorder. CBT teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. There are many ways to use CBT for PD treatment. The choice between available treatment methods depends on a variety of factors, including the patient’s preference, time availability, financial considerations, and clinical considerations (such as medication side effects).

John’Neiska Williams, an LPC with Grow Therapy, notes that, “treatment of panic disorder relies heavily on exposure therapy, which is a type of CBT therapy. Exposure therapies that have been successful include techniques such as In Vivo and imaginal exposure, situational exposure, and interoceptive exposure.”

Mindfulness Based Stress Reduction can also assist with PD, as it can help to physically and emotionally relax someone who is presently overwhelmed and panicking.

Living with Panic Disorder

Having the right information on how to cope with panic attacks can help with recovery so you can live anxiety-free. Discover strategies to help (1) cope with panic attacks and other PD symptoms and (2) make PD treatment more effective and enjoy improved quality of life.

Coping with Panic Attacks

A panic attack can happen to anyone at any time. There’s a wide array of techniques for coping with panic attacks, including:

  1. Consult a therapist. Working with a therapist is a reliable way to help prevent future panic attacks.
  2. Diaphragmatic breathing is among the most effective relaxation techniques for the body when under a panic attack.
  3. Distraction techniques help to focus attention away from the physical symptoms one is experiencing.
  4. Keep a log of your panic attacks so you can try to understand what triggers the episodes and learn to better control situations that are likely to result in a panic attack.
  5. Talk to people about your panic attacks. It’s helpful to have a trusted person who can help talk you down when a panic attack starts.

Following a diagnosis, a medical professional will compose a remedial plan that’s specific to the individual, which may include a variety of the strategies listed, among others.

Strategies for Managing Panic Disorder

First, taking medication as prescribed is the key to effectively treating panic attacks and preventing further attacks.

Secondly, have the right information on panic attacks. Some of the things PD sufferers worry about are misconceptions and myths. ADAA debunks some of the myths associated with anxiety disorders, including PD. To mention a few:

The American Psychology Association notes that a panic attack can be frightening but it’s not dangerous. It may feel “crazy” and “out of control,” yet no real harm is going to occur. The APA further states that PD, if untreated, can lead to developing other conditions, including phobias, substance use disorder, and even life-threatening conditions such as suicidal ideations.

Finally, have a trusted support system. Joining a support group and attending group therapy can help alienate feelings of loneliness. Your therapist can help you find the right panic disorder support group.

Support for Individuals with Panic Disorder

Having the right information about panic is useful, and then making sure you know how to recognize a panic attack. Learn how to act when someone is experiencing an attack. According to experts’ advice, it’s important to stay calm, give the affected person some space, and do something to help them cope with the symptoms of the attack.

If you, a family member, or close friend is experiencing PD symptoms, there are various ways to find help and support. As already discussed, support groups are a great way to stay connected to other individuals going through similar conditions. In addition, you can find more information about community resources for anxiety disorders from the NAMI website.

Another way to support an affected person is to help them follow up with their prescribed medications. In fact, NAMI states that a therapist can occasionally enlist a loved one to take a role in the medication process of their family member.

Most crucially, knowing how to communicate with a PD sufferer is a key support aspect. Speak kindly and honestly when making offers of help so the person knows that you care. Also, understand that recovery takes time. Be patient with your loved one even as you help them push for progress.

When to Seek Help for Panic Disorder

It’s best to get medical help for PD as soon as possible to increase chances of full recovery. But how can one know that it’s time to seek help?

Recognizing When Panic Disorder is Disrupting Your Life

A single occurrence of panic is nothing to worry about. It’s normal to experience panic when in dangerous or stressful situations. However, panic attacks occurring repeatedly and without any real cause can disrupt one’s day-to-day life.

Here are ways to know when panic disorder is disrupting your life:

These symptoms can be painful and disruptive. You may feel isolated or alone in your experience. But, you’re not. Many people are struggling with similar symptoms, and help is available.

Finding a Mental Health Professional for Panic Disorder Treatment

No matter how long you have suffered, you don’t have to face your symptoms alone. You can find a supportive mental health professional to help you manage symptoms and move toward recovery. Reaching out for help is the first step.

Grow Therapy is an invaluable resource for finding help for a panic disorder. Browse our marketplace of therapists to get connected with one who can help.

Frequently Asked Questions

About the author
therapist sean abraham Sean Abraham, LCSW

Sean Abraham is a licensed clinical social worker who works with those who have struggled with substance use, depression, anxiety, loss, communication problems, student life, as well as other mental health concerns.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

x icon linked-in icon facebook icon instagram icon