Panic disorder is a condition characterized by recurring and unexpected panic attacks. It affects around 2-3% of Americans each year. Panic attacks themselves can be extremely distressing and debilitating. But when they occur repeatedly and at any time, they can result in a persistent state of fearfulness and anxiety. This is what constitutes panic disorder.
What is a panic attack?
A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes. The feelings occur out of the blue, without any apparent trigger or cause. Panic attacks can be highly debilitating, often coming with uncomfortable physical symptoms like a pounding heart, dizziness, sweating, trembling, and more.
During a panic attack, people often think they are going crazy, having a heart attack, or are about to die. It’s an intensely frightening experience. Panic attacks typically reach their peak within 10 minutes or less, then gradually subside. But the terror and distress of a panic attack can leave a lasting imprint.
Panic disorder symptoms
To receive a diagnosis of panic disorder, a person must experience:
- Recurrent, unexpected panic attacks
- At least one month of persistent concern about having another attack or anxiety around the consequences
- Avoidant or maladaptive behaviors related to the attacks (like excessive avoidance of certain places or situations)
On top of meeting these criteria, the panic attacks cannot be attributable to another medical or mental health condition. Examples of other conditions that may involve panic attacks include some phobias, PTSD, hyperthyroidism, heart disease, or withdrawal from certain drugs.
Common symptoms of panic disorder
In addition to panic attacks themselves, common symptoms of panic disorder include:
- Anticipatory anxiety – Worrying about when the next attack will happen
- Phobic avoidance – Deliberately avoiding places, situations, objects, or activities due to feeling unsafe and vulnerable to panic attacks
- Distress over health – Frequent doctor’s visits and checking body for signs of illness
- Distress over mental health – Fear of losing control or going crazy
What happens during a panic attack?
Panic attacks involve an abrupt and intense surge of fear and discomfort that reaches a peak rapidly, within minutes. They often occur out of the blue, without any apparent trigger.
During a panic attack, people may experience a wide range of frightening physical and emotional symptoms, including:
Physical symptoms
- Pounding or racing heart
- Chest pain or tightness
- Lightheadedness or dizziness
- Nausea
- Trembling or shaking
- Choking sensation
- Hot flashes or chills
- Numbness or tingling
- Shortness of breath
Emotional symptoms
- Feelings of doom
- Fear of losing control or going crazy
- Fear of death
- Detachment from reality or self
It’s important to note that the specific symptoms can vary substantially from person to person. But in general, panic attacks involve an intense wave of fear accompanied by pronounced physical discomfort.
What triggers a panic attack?
For people with panic disorder, panic attacks seem to arise spontaneously, without any external trigger. However, there may be subtle internal cues that go unnoticed yet play a role in sparking attacks. Potential hidden triggers include:
- Subtle body sensations (like a slight dizzy feeling)
- Anxious thoughts or ruminations
- Stimulants like caffeine
- Emotional triggers (like stress, even if not consciously felt)
While panic attacks can seem random and inexplicable to the person experiencing them, they may be primed to happen by subtle internal factors like these. However, the focus of panic disorder treatment is not on identifying triggers, since they are often elusive.
How often do panic attacks occur?
To meet diagnostic criteria for panic disorder, the individual must have recurrent, unexpected panic attacks. Panic attacks occur with varying frequency among people with panic disorder:
- 24% have less than one panic attack per month
- 34% have 1-3 panic attacks per month
- 42% have more than 4 panic attacks per month
On average, most people with panic disorder tend to have around one panic attack per week. However, there is substantial variation from person to person.
How long do panic attacks last?
A core feature of a panic attack is its rapid timeframe. Symptoms typically crescendo within minutes and peak at around 10 minutes or less. Resolution of symptoms usually begins within 20-30 minutes, but residual effects like shakiness and anxiety may persist for hours afterward.
Overall, most panic attacks resolve within 20-30 minutes. However, the experience can leave a powerful mental imprint that lasts well beyond the attack itself.
What’s it like to live with panic disorder?
Living with panic disorder can be extremely challenging. In addition to experiencing recurrent panic attacks, many aspects of a person’s life are often affected:
Work
- Missing work due to panic attacks or anxiety
- Reduced productivity
- Struggling with meetings or public speaking
- Difficulty concentrating due to hypervigilance or anxiety
Social life
- Canceling plans with friends
- Withdrawing from social activities
- Isolating self due to embarrassment or phobic avoidance
Daily activities
- Avoiding driving, public transportation, enclosed spaces, etc.
- Relying on others for help with errands
- Difficulty leaving home
Mental health
- Feeling anxious and apprehensive a lot of the time
- Fear of having a panic attack
- Worrying about possible causes of panic attacks
- Feelings of hopelessness, depression, or suicidal thoughts
Physical health
- Avoiding exercise due to elevated heart rate
- Poor sleep
- Muscle tension
- Headaches
- Gastrointestinal issues
As this illustrates, panic disorder often involves pervasive anxiety and phobic avoidance that can substantially reduce quality of life. However, the right treatment can help dramatically reduce symptoms and improve daily function.
How is panic disorder treated?
The most effective treatments for panic disorder are psychological therapies like cognitive behavioral therapy (CBT) and medications. Combination treatment with both therapy and medications tends to give the best results. Some key components of panic disorder treatment include:
- Cognitive restructuring – Learning to challenge fearful thoughts and beliefs related to panic
- Exposure therapy – Gradually facing feared situations in a safe, controlled way
- Relaxation skills – Techniques to induce relaxation and reduce anxiety
- Medications – Anti-anxiety meds and antidepressants can help reduce symptoms
- Mindfulness – Developing greater present moment awareness
With comprehensive treatment, around 70-90% of people with panic disorder can achieve significant symptom relief and improved quality of life.
What’s the difference between panic attacks and anxiety attacks?
“Anxiety attack” is not an official clinical term. It typically refers to experiences of sudden, intense anxiety but not necessarily full-blown panic attacks. Key differences include:
| Panic Attacks | Anxiety Attacks |
|---|---|
| Discrete episodes of intense fear that peak rapidly (often within 10 minutes) | Episodes of intense anxiety that may last longer and not culminate in an obvious peak |
| Prominent physical symptoms like heart palpitations, chest pain, dizziness | More focus on thoughts and worries, less on physical sensations |
| Sense of immediate danger or urge to escape | Unsettled feeling but not necessarily need to flee |
So while anxiety attacks share some features with panic attacks, they tend to be less abrupt, peak less rapidly, and are characterized more by a sense of extreme anxiety than acute panic.
Can panic attacks cause you to pass out?
Yes, some panic attacks may cause temporary loss of consciousness due to excessive hyperventilation. However, this is relatively uncommon. Passing out can occur because rapid breathing blows off too much carbon dioxide from the bloodstream. This can cause dizziness from lack of oxygen supply to the brain.
If passing out occurs during a panic attack, coming to shortly after is common. Remaining unconscious for more than a minute or so is rare. Those with health conditions like heart disease or seizures are more prone to longer losses of consciousness.
Conclusion
Panic disorder is a serious condition characterized by debilitating, recurring panic attacks and ongoing anticipatory anxiety related to the attacks. It can profoundly disrupt many aspects of life, including work, social activities, relationships, and physical health.
However, through evidence-based treatment methods like CBT, exposure therapy, and medications, most people with panic disorder can achieve full remission or significant improvement. While panic disorder is highly treatable, getting appropriate help is important for both reducing symptoms and improving quality of life.