Panic disorder

What is panic disorder?

Panic disorder is an anxiety disorder that occurs when you experience recurring, unexpected panic attacks. People with panic disorder can live in fear of having anxiety panic attacks.

While most people feel anxious, stressed or panicky at some point in their lives, if you have panic disorder, you may get these feelings regularly and at any time. Often, there is no obvious cause for your sudden, overwhelming panic.

What are the symptoms of panic disorders?

The main symptom of panic disorder is panic attacks that typically begin suddenly, with no warning.

Common panic attack symptoms include:

• Fast heartbeat (tachycardia)

• Rapid breathing (hyperventilating)

• Shortness of breath

• Feeling dizzy or lightheaded

• Feeling hot and sweaty

• Nausea

• Chest pain or tightness in the chest

• A choking feeling

• Dry mouth

• Needing to go to the toilet a lot

• Trembling or shaking

• Ringing in the ears

• Numbness, pins and needles or tingling feeling

• A feeling of dread

• Feeling like you’re dying

• A disconnected feeling as though you’re out if touch with reality

A panic attack can last for between five and 20 minutes, but in severe cases, panic disorder symptoms may last for more than an hour. Panic attacks are different for everyone, and symptoms often vary.

The number of panic attacks someone has depends on how severe their panic disorder is. You may have panic attacks once or twice a month, or you may have them several times a week.

Are panic attacks dangerous?

Panic attacks can be terrifying to experience, but they’re not dangerous and you can’t die from them. It’s unlikely you’ll have to go to hospital if you have a panic attack.

During a panic attack, you’re completely overwhelmed with fear and anxiety. This makes your body react as though it’s in danger. The body goes into ‘fight or flight’ mode, increasing your heart rate and making you breathe faster or hyperventilate. Rapid breathing can lower the carbon dioxide levels in your blood, making you feel dizzy and lightheaded. In some rare cases, a person having a panic attack may faint.

What are the causes of panic disorder?

The exact causes of panic disorder are not known. But these things may play a role:

• A traumatic event in childhood, like the death of a parent or sibling or sexual abuse

• Significant stress, like going through a divorce or being in a serious accident

• Having a family member with panic disorder

• Changes in the way certain parts of your brain works

Treating panic disorder

Panic disorder treatment aims to reduce the intensity and frequency of panic attacks. The main treatment options are psychological therapies and medicine, and your treatment depends on the severity of your symptoms.

Psychological therapies a doctor or psychologist may recommend are:

• Cognitive behavioural therapy (CBT): CBT for panic disorder helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It teaches you practical ways to deal with overwhelming problems by breaking them into smaller, manageable parts and helps improve your state of mind on a daily basis. You will probably receive between seven and 14 hours of treatment in total, provided as weekly sessions of one to two hours each. During your CBT, you should be regularly assessed to monitor how you’re doing.

• Guided self-help – a therapist will work with you to understand your problems and make positive changes in your life with the help of a workbook or computer course. It aims to give you helpful tools and techniques to continue to use after the course has finished. During the course you’ll be supported with face-to-face appointments or phone calls.

There are several types of medication that are effective at managing panic attack symptoms. These include:

• Selective serotonin reuptake inhibitors (SSRIs): SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks.

• Anti-epilepsy medicine: such as pregabalin or, if your anxiety is severe, clonazepam may be prescribed.

• Benzodiazepines: These sedatives are central nervous system depressants and are for short-term use only because they can be habit-forming.

If your symptoms do not improve after CBT and medication, the doctor may refer you to a mental health specialist such as a psychiatrist or clinical psychologist. The specialist will assess you and come up with an effective treatment plan to help you manage your symptoms.

In addition to the panic disorder treatments above, there are a number of lifestyle changes you can make to reduce your symptom, like:

• Maintaining a regular schedule

• Exercising on a regular basis

• Getting enough sleep

• Eating a healthy, balanced diet

• Avoiding the use of stimulants such as caffeine

• Avoiding alcohol or drugs

Read more on panic attacks and a psychologist’s tools to cope.