What Is Panic Disorder?

Chest pains, anxiety, dizziness—are these symptoms of a panic attack or something else? Learn what panic disorder is and how it’s treated.

Sanaz Majd, MD,
May 7, 2015
Episode #093

What is Panic Disorder?

The top two questions I get asked about by my Quick and Dirty Tips listeners are chest pain and anxiety. And today’s topic is one that includes both – panic disorder.

What Is a Panic Attack?

Having a panic attack is different from a panic disorder. A panic attack occurs suddenly and typically reaches its peak within 10 minutes before subsiding. The incident includes an intense feeling of fear or anxiety, along with at least 4 of the following symptoms: 

  • Sweating

  • Chest pain

  • Palpitations

  • Shortness of breath

  • Dizziness

  • Tingling

  • Trembling/shaking

  • Nausea/abdominal discomfort

  • Chills/hot flashes

  • Fear of dying

Panic disorder, on the other hand, is diagnosed when panic attacks are recurrent and unpredictable. Because they seem to occur out of nowhere, patients often fear having another one. This fear must technically be present for at least one month for a diagnosis of panic disorder.

And in panic disorder, this fear is so great that it starts to change the way people behave in order to prevent the panic episodes from happening. For instance, those with panic disorder may refuse to leave their homes for fear of having an attack in public places or crowds. They may refuse to take the bus or attend work meetings for fear of having one there. This is referred to as “agoraphobia,” or fear of the outside. Also, because the symptoms are so distressing, patients often have great fear that they are suffering from a heart attack and are seen in the ER multiple times. In fact, panic attacks and anxiety are some of the most common causes of chest pain.

Who Gets Panic Disorder?

About 5% of the population suffers from panic disorder, although studies show that up to one third of us have experienced a panic attack. It tends to be twice as common in women, and can begin as early as adolescence. Panic disorder tends to occur in those with a family history of anxiety, but environmental factors also contribute to its development. For instance, people experiencing stressful life events or who have endured childhood trauma can develop panic disorder, especially if they have a genetic tendency towards it.

What Can Mimic Panic Disorder?

Before you jump to conclusions, it’s important to rule out other causes of similar symptoms. When discussing your symptoms with your doctor, you will likely have a blood test to rule out for hyperthyroidism in addition to a possible electrocardiogram and/or heart monitor if you experience heart symptoms such as heart palpitations or chest pain.

Cocaine, amphetamines, and excessive caffeine use can also trigger panic attacks and/or exacerbate them. Therefore, if you do use these substances, it’s important to stop and share this information with your doctor as well.

How is Panic Disorder Treated?

First line of treatment is a group of medications referred to as the “Selective Serotonin Reuptake Inhibitors” (or SSRIs), which tend to work very well to prevent future panic attacks by regulating the brain chemicals that are often imbalanced in those with panic disorder. These drugs can take 2-6 weeks to start working, but tend to work well for most people. 

Some doctors prescribe a benzodiazepine, such as alprazolam, to take as needed for the first few weeks until the SSRI kicks in. However, benzodiazepines are highly addictive and have significant side effects. They should not be taken long term, and are not the treatment of choice for panic disorder.

It’s also important to get enough sleep every day, to exercise, and to avoid caffeine in order to minimize symptoms.

Also, many patients with panic disorder self-medicate with alcohol, substance abuse, or prescription drugs. These may temporarily alleviate symptoms, but will ultimately only make the situation worse. So if you suffer from panic disorder, get the help you need from your primary care doctor or a psychiatrist who can prescribe you the right treatment, which can include medication, talk therapy, or both. What you don’t want to do is to trade one disorder for another by creating an addiction on top of your panic. 

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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

Young Woman in Panic image from Shutterstock