One attack is not a disorder
Panic attacks are surprisingly common, and NIMH is clear that an isolated panic attack is not a mental disorder. Not everyone who has one goes on to develop panic disorder. If you have had a single frightening episode, perhaps during a stressful month or after too little sleep, that alone does not mean you have a condition.
Panic disorder is defined less by the attacks than by what happens between them. NIMH describes the diagnosis this way: recurrent, unexpected panic attacks, plus at least one month of worrying about having more, being scared about what the attacks mean, or changing your behavior to try to avoid them. The NHS describes the result as a cycle of living "in fear of fear."
NIMH estimates that 2.7% of U.S. adults had panic disorder in the past year and 4.7% will have it at some point. It often begins in the late teens or early adulthood, MedlinePlus notes, although it may first appear in the mid-30s, and it is about twice as common in women.
What the attacks themselves feel like
NIMH describes a sudden wave of fear or discomfort, or a sense of losing control, even when there is no clear danger. Physical symptoms can include a pounding or racing heart, sweating, chills, trembling, difficulty breathing, weakness or dizziness, tingly or numb hands, chest pain and nausea. An attack can last a few minutes or, less often, an hour or longer. Attacks can occur several times a day or only a few times a year, and sometimes during sleep.
If you want a closer look at the attack itself, and at how it differs from building anxiety, see Panic Attack or Anxiety Attack?
What changes between attacks
For many people, the hardest part of panic disorder is not the ten minutes of panic. It is the anticipation. Common patterns include:
- Scanning your body for the first flutter of a fast heartbeat
- Sitting near the exit, or skipping church, concerts or Red Wings games
- Avoiding highways or long drives, or only driving with someone else in the car
- Carrying water, medication or a phone as a safety ritual
- Repeated trips to urgent care or the emergency department, each one normal on testing
- Avoiding exercise, coffee or anything else that speeds up the heart
MedlinePlus notes that people with panic disorder may become afraid to be alone or far from medical help. NIMH warns that some people significantly change their lives to avoid another attack. Over time, the world can shrink.
When avoidance becomes agoraphobia
NIMH notes that agoraphobia can develop alongside panic disorder. The American Psychiatric Association describes agoraphobia as intense fear of situations where escape might be hard or help unavailable if panic symptoms struck, such as public transportation, open or enclosed spaces, lines or crowds, or being outside the home alone. Untreated, it can become severe enough that a person struggles to leave the house.
Why it happens
Panic disorder sometimes runs in families, but no one knows exactly why some relatives develop it and others do not. NIMH describes a useful way to think about it: panic attacks may be "false alarms," where the body's survival response fires too often or too strongly. Someone notices their heart pounding, concludes they are having a heart attack, and that fear drives the body harder. The cycle can make attacks seem to come out of nowhere. Researchers are also studying how stress and environment contribute.
Getting checked
Because attacks can feel like a heart problem, MedlinePlus notes that many people first seek help in an emergency room, and that other medical conditions and substance use must be considered before panic disorder is diagnosed. NIMH lists conditions that can occur alongside it, including heart and breathing problems, irritable bowel syndrome and thyroid problems. A thorough checkup with your primary care physician is a reasonable first step, and you should never assume chest pain is "just panic" without being evaluated.
NIMH also notes that panic disorder often coexists with depression, other anxiety disorders and post-traumatic stress, and is commonly associated with alcohol and substance misuse. Mention all of it at an appointment, including how much you drink to take the edge off.
How panic disorder is treated
NIMH describes treatment as psychotherapy, medication, or both. It describes cognitive behavioral therapy as the most studied therapy for panic, along with exposure methods, including interoceptive exposure, which means practicing contact with the bodily sensations of panic so they become less alarming. Different therapists use different approaches, so ask about training and how they would work with panic specifically.
Medication can be part of care. NIMH describes antidepressants, and in some situations short-term anti-anxiety medication, prescribed by a physician, psychiatrist or psychiatric nurse practitioner. If you already take something, talk with your prescriber before changing anything.
Daily habits can lower the background level of arousal. MedlinePlus suggests limiting alcohol, eating at regular times, getting exercise and enough sleep, and reducing caffeine, certain cold medicines and stimulants.
In anxiety therapy with Dr. Lehmann, the work often includes practical steps for riding out attacks and gradually reclaiming places you have been avoiding, along with an insight-oriented look at the pressures, losses or long-held fears that may be feeding the alarm. Sessions are available at the Franklin office or by telehealth for adults located in Michigan, which some people find easier while driving still feels hard.