Educational summary
Overview
Panic disorder is an anxiety condition involving recurrent unexpected panic attacks together with ongoing concern about further attacks or what they might mean.
A panic attack is a sudden surge of intense fear or discomfort that builds within minutes. It is usually accompanied by strong physical sensations such as a pounding heart, shortness of breath, chest discomfort, dizziness, trembling, sweating, or a feeling of unreality. Attacks are intensely unpleasant, and many people describe fearing that they are seriously ill, losing control, or about to die.
Panic attacks by themselves are common and can occur in many circumstances and in other conditions. What distinguishes panic disorder is the pattern: attacks recur, at least some arrive unexpectedly rather than in response to a known trigger, and they are followed by persistent concern about further attacks or by changes in behaviour intended to prevent them.
That concern is central to how the condition maintains itself. Bodily sensations that would otherwise pass unnoticed can come to be monitored closely and interpreted as the beginning of an attack, which raises fear and makes an attack more likely.
Panic disorder is treatable, and recognized approaches exist. This page is educational and is not intended to diagnose a mental health condition or replace evaluation by a qualified health professional.
References
- [1]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderWhat is panic disorder?Supporting reference for the general educational overview.
Educational summary
Signs and Symptoms
Panic disorder involves panic attacks and the response to them. What follows describes patterns in general terms; it is not a checklist and is not used here to identify the condition in any individual.
An attack begins abruptly and reaches its peak within minutes. Physical sensations are prominent and commonly include a pounding or racing heart, shortness of breath or a smothering sensation, chest discomfort, dizziness or light-headedness, trembling, sweating, chills or hot flushes, nausea, numbness or tingling, and a sense of detachment from oneself or one's surroundings. Fear of losing control, of going mad, or of dying frequently accompanies these sensations.
Attacks usually subside within minutes, though people often feel drained afterwards. Some occur at night, waking the person from sleep.
Between attacks, two patterns are important. The first is persistent concern about further attacks or their consequences. The second is behavioural: changing routines, avoiding places where escape might be difficult or help unavailable, or carrying items that feel protective.
Chest pain, breathlessness and palpitations have physical causes as well as psychological ones. These symptoms should be assessed by a health professional rather than assumed to be panic, particularly when they occur for the first time.
References
- [1]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderWhat are the signs and symptoms of panic disorder?Supporting reference for the described features of a panic attack.
- [2]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderWhat is the difference between a panic attack and panic disorder?Supporting reference for the distinction between an isolated panic attack and panic disorder.
Educational summary
Causes and Risk Factors
No single cause of panic disorder has been identified. Several contributing factors are described, they vary between individuals, and having one or more does not mean a person will develop the condition.
Family history is associated with increased likelihood, and research indicates a genetic contribution without any single gene accounting for it. Differences in the brain systems involved in fear and threat detection are also described.
Temperament appears relevant, particularly a heightened sensitivity to bodily sensations and a tendency to interpret them as dangerous. This helps explain how an attack can escalate: a sensation is noticed, read as a sign of harm, and the resulting fear intensifies the sensation.
Stressful life events, bereavement, serious illness, and major transitions often precede a first attack. Physical factors including stimulant use, caffeine, some medications, and certain medical conditions can provoke or mimic attacks, which is one reason medical assessment is part of a thorough evaluation.
Onset is commonly in late adolescence or early adulthood, though it can occur at other ages. Contributing factors are described here to aid understanding and are not used to determine whether any individual has the condition.
References
- [1]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderWhat causes panic disorder?Supporting reference for the contributing factors described.
Educational summary
Related and Co-occurring Conditions
Panic disorder frequently occurs alongside other conditions, and several conditions share features with it. Distinguishing between them is a clinical task and is described here only to aid understanding.
Agoraphobia is closely related and often occurs with panic disorder. It involves fear of situations where escape might be difficult or help unavailable, such as public transport, queues, crowds or open spaces, and can lead to substantial restriction of daily activity.
Other anxiety conditions commonly co-occur. Worry in generalized anxiety disorder concerns everyday matters and builds gradually, unlike the sudden peak of a panic attack. In social anxiety, fear is tied specifically to situations involving scrutiny by others.
Depressive difficulties are common, particularly where avoidance has narrowed daily life over time.
Panic attacks also occur in other conditions, including post-traumatic stress disorder and specific phobias, where they follow identifiable triggers rather than arriving unexpectedly.
Medical conditions can produce similar symptoms, including thyroid disorders, cardiac and respiratory conditions, and the effects of some substances and medications. Assessment normally considers these, which is why a first presentation of chest pain, breathlessness or palpitations warrants medical evaluation.
References
- [1]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderWhat other illnesses can co-occur with panic disorder?Supporting reference for the co-occurring conditions described.
Educational summary
Treatment
Panic disorder is treatable, and several approaches have recognized evidence. Which is appropriate depends on the individual, the severity and duration of difficulties, other health conditions, personal preference, and what is available locally. These decisions are made with a qualified health professional.
Psychological therapy is a well-established option. Cognitive behavioural approaches for panic work on the interpretation of bodily sensations, on gradually reducing avoidance and safety behaviours, and in some forms on deliberately and safely bringing on the sensations that are feared so they become less alarming. Structured approaches working with physical tension and arousal are also used. Therapy may be delivered individually, in groups, or through guided self-help programmes.
Medication is also used in the treatment of panic disorder. Certain antidepressant medications are recognized for it. Some anxiolytic medications are used in anxiety conditions and require particular care around duration of use. Decisions about whether medication is appropriate, which type, at what dose and for how long are made by a prescribing clinician with the person concerned.
Understanding what happens during a panic attack is often part of treatment, since knowing that the sensations are intense but time-limited can reduce the fear that drives them.
Progress is usually reviewed over time, and approaches may be adjusted. If difficulties are worsening, or distress feels unmanageable, contact a qualified health professional. If there is immediate risk of harm, see our crisis resources page for how to find urgent support.
MOMD does not provide individual treatment advice and does not recommend starting, stopping, or changing any medication.
References
- [1]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderHow is panic disorder treated?Supporting reference for the treatment approaches described.
- [2]Panic Disorder: What You Need to KnowNational Institute of Mental HealthNational Institute of Mental Health - Panic DisorderPsychotherapySupporting reference for the psychological therapy described.
Associated features
Symptoms
- Unexpected Panic Attackscommon
A sudden surge of intense fear or discomfort that builds within minutes, often arriving without an obvious trigger.
Recurrent unexpected panic attacks are the defining feature. Attacks reach a peak within minutes, which distinguishes them from anxiety that builds and persists.
Ongoing concern between attacks about when the next will come or what it might mean, which is central to how panic disorder differs from an isolated panic attack.
Persistent concern about further attacks, or about what they mean, is what separates panic disorder from having experienced a panic attack. Panic attacks alone are common and occur in other conditions.
An awareness of the heart racing, pounding or skipping, commonly experienced during a panic attack.
Cardiac sensations are among the most frequently reported features of an attack and often drive the fear that something is physically wrong.
Difficulty getting a satisfying breath, or a sensation of being smothered or choking, during periods of intense fear.
Breathing changes are common during attacks and can intensify other sensations such as dizziness.
- Chest Pain or Discomfortcommon
Pain, tightness or discomfort in the chest occurring during intense fear. Chest pain always warrants medical assessment, because it has physical causes that must be ruled out.
Chest discomfort commonly occurs during attacks. It is also a symptom of physical conditions, so medical assessment is appropriate rather than assuming a psychological cause.
A sense of unsteadiness, light-headedness or faintness, often accompanying rapid breathing during a panic attack.
Light-headedness frequently accompanies rapid breathing during an attack.
An intense fear during an attack that one is losing control, going mad, or that the physical sensations signal something life-threatening.
The interpretation of bodily sensations as dangerous is central to how attacks escalate and to how psychological treatment approaches them.
Altering routines, routes or activities to reduce the chance of an attack or to ensure escape is possible, which can narrow daily life considerably.
Avoidance and safety behaviours reduce fear briefly while maintaining the pattern, and can progressively restrict where a person goes.
- Feeling On Edge or Keyed Upassociated
A sense of being restless, wound up, or unable to settle.
Heightened arousal between attacks is common, particularly where attacks have been frequent.
- Sleep Disturbanceassociated
A meaningful change in usual sleep, which may include difficulty sleeping, disrupted sleep, waking unusually early, or sleeping substantially more than usual.
Sleep may be disrupted, including by attacks that occur at night.
Difficulty sustaining attention, organizing thoughts, remembering information, or making everyday decisions.
Concentration is often affected when attention is occupied by monitoring for early signs of an attack.
Reference systems
Classifications
- System
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
- Classification
- Panic Disorder
- Category
- Anxiety Disorders
- Source
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
- System
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
- Classification
- Panic disorder [episodic paroxysmal anxiety]
- Code
- F41.0
- Category
- Mental, Behavioral and Neurodevelopmental disorders
- Source
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Treatment reference
Treatments
- Cognitive Behavioral Therapypsychotherapy
A structured psychological therapy focused on relationships among thoughts, emotions, behaviors, and coping patterns.
Psychological treatment option.
Structured cognitive behavioural therapy is the psychological approach most consistently identified for panic disorder, including work with the interpretation of bodily sensations and graded reduction of avoidance.
- Applied Relaxationpsychotherapy
A structured psychological approach that trains recognition of early tension and the use of relaxation skills in daily situations.
Psychological treatment option.
A structured approach working directly with physical tension and arousal, recognised in the management of anxiety conditions.
- Antidepressant Medicationmedication_class
A broad category of prescription medicines used in the treatment of depressive disorders. Selection and monitoring require individualized clinical assessment.
Medication option, prescribed and monitored by a qualified clinician.
Certain antidepressant medications are recognised in the treatment of panic disorder. Choice, dose and duration are clinical decisions.
- Anxiolytic Medicationmedication_class
A group of medicines used in the management of anxiety. Whether any medicine is appropriate, and for how long, is decided by a prescribing clinician.
Medication option requiring particular care around duration of use.
Some anxiolytic medications are used in anxiety conditions. Duration of use requires particular clinical care, and decisions rest with a prescribing clinician.
- Guided Self-Help Based on CBT Principlessupportive
Structured self-help material worked through with periodic support from a trained practitioner.
Supportive option, often used where difficulties are milder or while waiting for therapy.
Guided self-help based on cognitive behavioural principles is used in stepped-care approaches.
- Psychoeducation and Relapse Planningsupportive
Structured education about the condition, recognising early warning signs, protecting sleep and routine, and planning ahead for periods of illness.
Supportive option.
Understanding what happens during a panic attack, and planning for setbacks, commonly accompanies active treatment.
Evidence & references
Sources
- Panic Disorder: What You Need to KnowNational Institute of Mental Health