Panic Disorder

What Is Panic Disorder?

Panic disorder is characterized by recurrent unexpected panic attacks, or episodes of acute, overwhelming fear or discomfort, as well as resulting worry and/or changes in behavior due to these panic attacks. While panic attacks peak, or are at their worst, within minutes (typically within 10 minutes), the episodes can have a lasting impact on a person’s thoughts and behaviors. As seen in panic disorder, panic attacks can lead to increased worry about having additional attacks or fear of the consequences of these episodes (e.g., fear that the symptoms are indicators of dying or “going crazy”). Many individuals with panic disorder even begin to develop a baseline level of worry about their health, with a hyperawareness of mild changes in bodily functions (e.g., noticing slight changes in heartbeat and fearing acute cardiovascular illness). This hyperawareness, as well as panic attacks, in general, often leads to frequent medical visits if not properly identified and treated.

Panic attacks can also cause disruptive or distressing changes in a person’s behavior, another primary feature of panic disorder. For example, a person who has a panic attack in a certain place (e.g., a car) may begin to associate the attacks with this place or activity and begin to avoid it due to fear of triggering additional attacks. This avoidance is often a prominent source of disruption to a person’s ability to function. The newly feared place can even generalize to avoidance of similar situations and related activities (e.g., avoiding driving entirely, avoiding riding in a car, avoiding other modes of transportation), causing additional impairment.

It is important to note that not all individuals who experience a panic attack go on to develop panic disorder. Furthermore, panic attacks can occur in the context of other mental disorders and medical conditions. An evaluation by a trained professional is important to properly identify the cause of panic attacks and to facilitate the potential diagnosis of panic disorder. If left untreated, the usual course of panic disorder is chronic, although symptoms can fluctuate in frequency and intensity over time. Some individuals experience episodic outbreaks of panic attacks followed by years of remission, although full remission without any symptom recurrence is rare without treatment.

Panic disorder tends to develop during early adulthood (median age of onset in the US is 20-24 years). Individuals with panic disorder can also develop anxiety triggered by real or anticipated exposure to places or situations from which it may be difficult or embarrassing to escape (a condition known as agoraphobia). Additionally, individuals with panic disorder may be more likely to have other co-occurring anxiety or mental health disorders (e.g., depression, agoraphobia, substance use disorders).