What Is Panic Disorder? Symptoms, Causes & Treatment

Panic disorder is a type of anxiety disorder in which a person experiences recurrent, unexpected panic attacks and develops persistent fear or concern about having another attack or about its consequences.

A panic attack itself is not necessarily a disorder. Panic attacks can occur in several anxiety disorders, depression, trauma-related disorders, and some medical conditions. Panic disorder is diagnosed when recurrent unexpected attacks are followed by significant ongoing concern, behavioural changes, or both.

Also read - Generalised Anxiety Disorder (GAD)

What is a panic attack?

A panic attack is a sudden episode of intense fear or extreme discomfort that usually reaches its peak within minutes.

It may occur without warning and without any obvious danger. Sometimes a person may be sitting quietly, travelling, shopping, sleeping, or doing ordinary daily activities when an attack begins.

During an attack, the person may experience:

• Rapid or pounding heartbeat
• Shortness of breath or a feeling of suffocation
• Chest pain or discomfort
• Dizziness or light-headedness
• Trembling or shaking
• Sweating
• Choking sensation
• Nausea or abdominal discomfort
• Feeling hot or cold
• Numbness or tingling
• Feeling unreal or detached from oneself
• Fear of losing control
• Fear of going crazy
• Fear of dying

The symptoms can be extremely frightening. A person may genuinely feel that something is seriously wrong with the body.

Why does a panic attack feel so dangerous?

The body's alarm system becomes suddenly activated.

The brain detects—or sometimes mistakenly interprets—a threat and activates the fight-or-flight response. Stress hormones such as adrenaline increase heart rate, breathing and alertness.

These physical changes are normally useful when there is real danger. During a panic attack, however, the alarm response may occur without an appropriate external threat.

The physical sensations themselves can then create more fear:

Palpitations → "Something is wrong with my heart" → more fear → stronger adrenaline response → more palpitations.

This can create a rapidly escalating cycle of panic.

Panic disorder is more than having panic attacks

A person may have one or occasional panic attacks without having panic disorder.

In panic disorder, the attacks are typically recurrent and unexpected, and the person develops persistent concern about:

• Having another attack
• Losing control
• Dying
• Having a serious medical problem
• Embarrassing oneself in public
• Being unable to obtain help

The person may also begin to change their behaviour to avoid another attack.

For example, they may stop travelling alone, avoid crowded places, avoid shopping malls, refuse to use public transport, or repeatedly seek reassurance about their health.

Agoraphobia

Panic disorder can occur with or without agoraphobia.

Agoraphobia involves marked fear or anxiety about situations from which escape might be difficult or help might not be available if panic-like symptoms or other incapacitating symptoms occur.

Examples include:

• Public transportation
• Open spaces
• Enclosed places
• Crowded places
• Standing in a queue
• Being outside the home alone

A person may gradually restrict their activities because of this fear.

What causes panic disorder?

There is no single cause.

Several factors may contribute, including:

Biological factors

• Genetic vulnerability
• Increased sensitivity of the brain's fear and alarm systems
• Alterations in systems involving neurotransmitters and stress responses

Psychological factors

• Increased attention to bodily sensations
• Catastrophic interpretation of normal physical sensations
• Persistent fear of losing control or becoming seriously ill

Environmental factors

• Severe or prolonged stress
• Traumatic experiences
• Major life changes
• Sleep deprivation and other physical or psychological stresses

Some people develop panic disorder without any obvious precipitating event.

What happens in the brain?

Panic involves the brain's threat-detection and autonomic nervous systems.

Structures and networks involving the amygdala, brainstem, hypothalamus and other interconnected regions participate in detecting danger and producing the body's alarm response.

In panic disorder, these systems may become excessively sensitive to perceived threat or to internal bodily sensations.

It is important to understand that this does not mean that the person's symptoms are imaginary. The physical symptoms are real, even though the alarm response may be occurring in the absence of actual danger.

Panic disorder and the heart

Because panic attacks can cause chest pain, rapid heartbeat, breathlessness and sweating, many people initially believe they are having a heart attack.

These symptoms can overlap with medical illnesses. Therefore, a new or unexplained episode of severe chest pain, fainting, significant breathing difficulty, or other concerning symptoms should not automatically be assumed to be a panic attack.

A doctor may need to rule out medical conditions before making a psychiatric diagnosis.

How is panic disorder diagnosed?

Diagnosis is based mainly on:

1. The nature and frequency of panic attacks
2. Whether the attacks are unexpected
3. Persistent concern about further attacks or their consequences
4. Avoidance or changes in behaviour because of the attacks
5. The duration and impact of symptoms
6. Whether another psychiatric or medical condition better explains the symptoms

A doctor may also ask about medications, caffeine, alcohol, recreational drugs and other substances because some can produce panic-like symptoms.

Treatment

Panic disorder is highly treatable.

The main treatments include:

1. Cognitive Behavioural Therapy (CBT)

CBT is one of the best-established psychological treatments for panic disorder.

It helps the person:

• Understand the panic cycle
• Identify catastrophic thoughts
• Reinterpret bodily sensations more realistically
• Reduce avoidance
• Gradually face feared situations
• Develop strategies for managing anxiety

A specific technique called interoceptive exposure may sometimes be used. Under professional guidance, the person learns that certain harmless bodily sensations associated with panic can be tolerated without catastrophe.

2. Medicines

Antidepressant medicines, particularly SSRIs and SNRIs, are commonly used for panic disorder.

They can reduce the frequency and severity of panic attacks and the ongoing anxiety associated with them.

Other medicines may sometimes be used in selected circumstances. Benzodiazepines can reduce acute anxiety rapidly but require particular caution because of tolerance, dependence and withdrawal problems. They are therefore not usually the preferred long-term treatment.

Medication should be prescribed and monitored by a qualified doctor.

Lifestyle measures

Lifestyle changes can support treatment:

• Maintain regular sleep
• Exercise regularly
• Reduce excessive caffeine
• Avoid recreational drugs
• Limit alcohol
• Practise relaxation or breathing exercises
• Maintain regular meals
• Continue normal activities as far as possible rather than progressively avoiding situations

These measures can help, but they should not be considered a substitute for professional treatment when panic disorder is significantly affecting life.

Can panic disorder be cured?

Many people with panic disorder improve greatly with appropriate treatment, and some become completely free of panic attacks.

Others may have occasional symptoms but learn to manage them effectively.

Early treatment is particularly useful because repeated panic attacks can lead to increasing avoidance and restriction of everyday activities.

An important message for patients and families

A panic attack can feel extremely dangerous, but the experience of panic itself does not mean that a person is "going mad" or losing control.

The symptoms are real physical and psychological manifestations of an activated alarm system.

With appropriate assessment and treatment, panic disorder can be managed successfully, and people can return to normal work, education, relationships and social activities.