Panic Disorder

Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason.

Everyone experiences feelings of anxiety and panic at certain times during their lifetime. It’s a natural response to stressful or dangerous situations.

However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time.

Anxiety

Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear. There are several conditions that can cause severe anxiety including

• phobias – an extreme or irrational fear of an object, place, situation, feeling or animal
• generalised anxiety disorder (GAD) – a long-term condition that causes excessive anxiety and worry relating to a variety of situations
• post-traumatic stress disorder – a condition with psychological and physical symptoms caused by distressing or frightening events

Panic attacks

A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms.

You may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also have physical symptoms such as:

• nausea
• sweating
• trembling
• a sensation that your heart is beating irregularly (palpitations)

The number of panic attacks you have will depend on how severe your condition is. Some people may have one or two attacks each month, while others may have several attacks a week.

Read more about the symptoms of panic disorder.

Panic attacks can be very frightening and intense, but they’re not dangerous. An attack won’t cause you any physical harm, and it’s unlikely that you’ll be admitted to hospital if you’ve had a panic attack.

What causes panic disorder?

As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.

However, it’s thought the condition is probably linked to a combination of physical and psychological factors.

Read about the possible causes of panic disorder.

It’s important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example:

• mitral valve prolapse
• postural orthostatic tachycardic syndrome (POTS)
• anaemia
• paroxysmal atrial tachycardia – episodes of rapid and regular heartbeats that begin and end abruptly
• thyrotoxicosis – where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating, tremor and anxiety
• poorly controlled diabetes
• adrenal tumours – growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys)
• carcinoid syndrome – a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones)
• Zollinger-Ellison syndrome – causes overproduction of insulin and low blood sugar (hypoglycaemia)

Diagnosing panic disorder

See your GP if you have symptoms of anxiety or panic disorder (see above).

You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks.

Read more about how panic disorder is diagnosed.

Treating panic disorder

The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Symptoms

The symptoms of a panic attack can be very frightening and distressing.

Symptoms tend to occur suddenly, without warning and often for no apparent reason.

As well as overwhelming feelings of anxiety, a panic attack can also cause a variety of other symptoms, including:

• a sensation that your heart is beating irregularly (palpitations)
• sweating
• trembling
• hot flushes
• chills
• shortness of breath 
• a choking sensation
• chest pain
• nausea
• dizziness
• feeling faint
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears 
• a feeling of dread or a fear of dying
• a churning stomach
• a tingling sensation in your fingers
• shivering
• shaking

The physical symptoms of a panic attack are unpleasant, and they can also be accompanied by thoughts of fear and terror.

For this reason, people with panic disorder start to fear the next attack, which creates a cycle of living in ‘fear of fear’ and adds to the sense of panic.

Sometimes, the symptoms of a panic attack can be so intense they can make you feel like you’re having a heart attack.

However, it’s important to be aware that symptoms such as a racing heartbeat and shortness of breath won’t result in you having a heart attack. Although panic attacks can often be frightening, they don’t cause any physical harm. People who have had panic disorder for some time usually learn to recognise this ‘heart attack sensation’ and become more aware of how to control their symptoms.

Most panic attacks last for five to 20 minutes. Some attacks have been reported to have lasted up to an hour. However, it’s likely that in these cases one attack occurred straight after another or high levels of anxiety were felt after the first attack.

Recurrent panic attacks

People with panic disorder have panic attacks on a recurring basis. Some people have attacks once or twice a month, while others have them several times a week.

People with panic disorder also tend to have ongoing and constant feelings of worry and anxiety. The panic attacks associated with panic disorder can be very unpredictable.

If you have panic disorder, you may also feel anxious about when your next attack will be.

Depersonalisation

During a panic attack your symptoms can be so intense and out of your control that you can feel detached from the situation, your body and your surroundings. It can almost feel as if you’re an observer, making the situation seem very unreal.

This sense of detachment is known as depersonalisation. Being detached from the situation doesn’t provide any relief or make a panic attack less frightening. Instead, it often makes the experience more confusing and disorientating.

Causes

As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.

It’s thought that panic disorder is probably caused by a combination of physical and psychological factors. Some of these factors are outlined below.

Traumatic life experiences

A trauma, such as bereavement, can sometimes trigger feelings of panic and anxiety. These feelings may be obvious soon after the event or they may be triggered unexpectedly years later.

Genetics

Having a close family member with panic disorder is thought to increase a person’s risk of developing it. However, the precise nature of the risk isn’t known.

Neurotransmitters

Neurotransmitters are chemicals that occur naturally in the brain. It’s thought that an imbalance of these chemicals may increase your risk of developing conditions such as panic disorder.

Increased sensitivity to carbon dioxide

Some experts believe that panic disorder is linked to an increased sensitivity to carbon dioxide. Breathing in air with high carbon dioxide levels can bring on panic attacks, and breathing techniques can help to relieve or stop panic attacks.

Catastrophic thinking

Another theory is that people who experience panic attacks tend to focus on minor physical symptoms and interpret them in a catastrophic way. This triggers a nervous system response that causes the panic attack.

treatment

The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.