Anxiety disorders impact approximately 40 million adults in the United States annually. According to the latest data from the National Institutes of Health, around 4.7% of U.S. adults will experience panic disorder at some point in their lives. However, the good news is that it’s highly treatable.
If you believe that you or someone you care about is struggling with panic disorder, you are taking an important first step by seeking more information. Understanding the underlying causes, recognizing the symptoms, and knowing the treatment options available can empower you to manage the condition more effectively.
Key takeaways
- Panic disorder is characterized by recurring, unexpected panic attacks followed by ongoing worry or behavioral changes.
- Causes of panic disorder include genetic, neurochemical, hormonal, and metabolic factors.
- Risk factors for panic disorder include personal mental health history, chronic stress, and early-life trauma.
- Panic disorder symptoms include intense fear, physical distress, detachment, and hyperawareness of bodily sensations.
- Effective treatment for panic disorder includes cognitive-behavioral therapy, medications, and supportive lifestyle changes like exercise and stress management.
What is panic disorder?
Panic disorder (PD) is an anxiety disorder marked by recurrent and unexpected panic attacks (sudden episodes of intense fear, worry, stress, loss of control, and panic that peak within minutes). Many people wonder if experiencing a panic attack is the same thing as having a panic disorder. The answer is they’re different, although they share some similarities.
While panic attacks are central to panic disorder, they can also occur in many other conditions, including other anxiety disorders, depressive disorders, PTSD, and during substance use or withdrawal. People may also use the term ‘anxiety attack’ to describe intense anxiety, though this isn’t a clinical diagnosis or official term. According to the DSM-5, panic disorder is characterized by recurrent unexpected panic attacks, followed by at least one month of persistent worry about additional attacks or their consequences and/or a significant maladaptive change in behavior, such as avoiding work, school, or social situations.
It’s also important to differentiate PD from agoraphobia and generalized anxiety disorder (GAD). Agoraphobia involves marked fear or avoidance of situations where escape might be difficult if panic-like symptoms occur. In contrast, GAD is characterized by persistent, excessive worry across multiple areas of life, rather than sudden, intense panic episodes.
What are the causes of panic disorder?
Similar to other anxiety disorders, panic disorder most likely stems from a combination of factors rather than a single cause. Research suggests that both biological and environmental factors are associated with the development of panic disorder.
Biological factors
Biological factors play a significant role in the development of panic disorder. Genetically, panic disorder is more common in families with a history of the disorder. Research suggests that specific genes may influence panic disorder by affecting fear response, amygdala activation, and stress regulation.
Neurochemical factors
Dysregulation in neurotransmitter systems, including serotonin, norepinephrine, and GABA, is associated with increased anxiety sensitivity and vulnerability to panic symptoms. Hormonal fluctuations, particularly in estrogen and progesterone, can also influence the frequency and intensity of spontaneous panic attacks, which helps explain why panic disorder occurs more often in women than in men.
Metabolic factors
Metabolic theories propose that individuals with panic disorder have heightened sensitivity to certain anxiety-provoking conditions or substances. Some individuals with panic disorder show heightened sensitivity to certain substances. High-dose caffeine has been shown in experimental studies to provoke panic-like symptoms, whereas alcohol and nicotine have a more complex relationship with panic.
Rather than directly triggering attacks, these substances can shape the overall vulnerability to panic by increasing baseline arousal, interfering with the body’s ability to regulate stress, and contributing to withdrawal symptoms that mimic or intensify sensations associated with panic. Over time, this cycle can make panic symptoms feel more frequent or harder to manage, even if the substances themselves aren’t the direct cause of an attack.
What are the risk factors for panic disorders?
While anyone can develop panic disorder, certain factors increase the likelihood of its onset. Understanding these risk factors can help in the early identification and management of the condition.
Personal history of anxiety or other mental health conditions
Individuals with a history of anxiety disorders, depression, or other mental health issues are at an increased risk of developing panic disorder. Co-occurring mental health conditions can intensify the symptoms and complicate the treatment of panic disorder.
Stressful life events
Major life changes such as moving, job changes, relationship breakdowns, or loss can trigger panic attacks in anxiety-prone individuals due to elevated stress. Acute stressors like financial issues, demanding jobs, or trauma also heighten panic disorder vulnerability. Long-term stress without coping strategies worsens symptoms.
Childhood abuse, bullying, or neglect
Adverse childhood experiences, including various forms of abuse, neglect, and early family disruptions, are significantly associated with an increased risk of developing panic disorder in adulthood, according to a comprehensive systematic review and meta-analysis.
What are the common symptoms of panic disorder?
Other than panic attacks, what are some of the characteristic symptoms associated with panic disorder? According to the American Psychological Association, here are some of the most common symptoms of panic disorder:
Physical symptoms
- Palpitations or racing heart
- Difficulty breathing
- Feeling of choking
- Chest pain or discomfort
- Sweating
- Chills or trembling
- Weakness or dizziness
- Tingling sensations or numbness in the hands
- Stomach cramps or nausea
- Issues with memory and concentration
Emotional and psychological symptoms
- Intense anxiety and fear: Many people experience an overwhelming sense of impending doom or danger without any apparent or immediate threat. This intense anxiety can also bring about intrusive thoughts about when and where the next panic attack might occur.
- Loss of control: Many individuals describe feeling out of control during an attack, as though they are going crazy or losing their grip on reality. This can be particularly distressing and contribute to a cycle of fear about future attacks.
- Detachment from reality or self: Some people experience feelings of detachment, feeling disconnected from reality or their bodies, often described as an out-of-body experience.
- Hyperawareness of bodily sensations: As people become more anxious about panic attacks, they tend to become hyperaware of bodily sensations.
- Fear of dying: Individuals may experience an intense and acute fear of dying, coupled with an overwhelming sense of impending doom.
Despite how overwhelming these symptoms may seem, panic disorder is a condition that responds well to treatment. However, it’s important to remember that each person’s journey with panic disorder is unique, as symptoms and causes differ from person to person. Identifying these common symptoms is often the first step in effectively understanding and managing the condition.
How is panic disorder diagnosed by healthcare professionals?
Diagnosing panic disorder requires a comprehensive evaluation by a healthcare professional, typically a psychologist, psychiatrist, or master’s-level clinician who specializes in mental health disorders. The diagnostic process generally includes the following steps:
1. Clinical assessment
The process starts with a clinical assessment where the provider collects details on mental health history, panic attack frequency and intensity, and triggers, if any, helping to understand their context and impact on daily life.
2. Diagnostic criteria
Healthcare professionals use the DSM-5 criteria to determine if an individual meets the requirements for a PD diagnosis.
3. Rule out other conditions
Panic attack symptoms can resemble those of other medical conditions, like heart attacks, respiratory problems, or thyroid issues. To rule these out, healthcare providers may conduct physical exams and tests, ensuring that symptoms are due to panic disorder and not other medical conditions. For example, chest pain, shortness of breath, or palpitations can occur in both panic attacks and cardiac issues, making an accurate diagnosis essential.
4. Assessment of other factors
Professionals will also assess other factors that may contribute to or exacerbate panic attacks. This includes evaluating your family history, current stress levels, recent life changes, any traumatic experiences, and substance abuse, including caffeine intake. By understanding more about you, your environment, and your lifestyle, your therapist can then create a more tailored treatment plan that suits your needs.
What is the best treatment for panic disorder?
There isn’t a one-size-fits-all approach to treating panic disorder, as it often requires a tailored strategy to meet the unique needs of each individual. However, several effective treatments are commonly used to manage and alleviate the symptoms of panic disorder.
Cognitive-behavioral therapy (CBT) for panic disorder
Cognitive behavioral therapy (CBT) is a widely used psychotherapy for treating panic disorder. It helps individuals reinterpret panic attacks and develop effective anxiety coping strategies. CBT offers various approaches tailored to each individual, based on factors such as personal preference, available time, financial constraints, and clinical aspects, including severity and intensity of symptoms, age of the client, and desire for group, family, or individual therapy.
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 in treating panic disorder 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.
Medications
Common medications for panic disorder (PD) include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). Beta-blockers may be used to help with physical symptoms like a racing heartbeat. Benzodiazepines can provide short-term relief for severe panic symptoms, but they’re typically used cautiously due to the risk of dependence.
Lifestyle changes
Alongside therapy and medication, lifestyle changes can effectively manage panic disorder, enhancing overall well-being and reducing panic attack frequency and intensity. It’s important to note that the lifestyle changes below do not serve as a substitute for treatment.
- Regular exercise: Engaging in regular physical activity can release endorphins and significantly reduce stress levels. Activities such as walking, jogging, yoga, or swimming can help manage anxiety symptoms and improve mood.
- Mindful eating: A balanced diet plays a crucial role in maintaining mental health. Consuming whole foods rich in omega-3 fatty acids has been found to moderately decrease anxiety symptoms. Additionally, avoiding caffeine, alcohol, and sugar can help reduce the likelihood of triggering panic attacks.
- Sleep quality: Establishing a consistent sleep schedule and creating a restful environment can improve sleep quality. Prioritizing sleep can reduce stress and enhance mental clarity, which is beneficial in managing panic disorder.
- Stress management techniques: Adopting relaxation techniques such as deep breathing exercises, progressive muscle relaxation, mindfulness exercises, or meditation can help calm the mind. Regular practice of these techniques can improve resilience against stress and anxiety.
- Support system: Having supportive relationships can make a meaningful difference in managing panic symptoms. Studies show that higher levels of perceived social support, especially from a partner, are linked to lower symptom severity. It’s not just having people around you, but the quality of the support that matters.
Speaking with a therapist about your panic disorder symptoms is the best way to know the proper treatment for you. They can provide personalized guidance to support your journey.
How to find a therapist for panic disorder
Consulting your family doctor or primary healthcare provider is a convenient method to find a therapist for panic disorder. They can recommend qualified mental health professionals, such as a clinical psychologist, psychiatrist, or licensed counselor who specializes in anxiety disorders.
Additionally, local mental health clinics offer support and trained specialists for effective treatment. If you’re unsure where to start, Grow Therapy is here to help. Our platform is designed to simplify the therapy process by matching you with professionals who best suit your unique preferences and needs.