Mental Health:
Panic Disorder
Fear and anxiety are normal reactions to stressful events in our
lives. Panic disorder, however, is different. Panic disorder is a serious
condition that strikes without reason or warning, causing sudden attacks
of fear and nervousness, as well as physical symptoms such as sweating
and a racing heart. During a panic attack, the fear response is out of
proportion for the situation, which often is non-threatening. Over time,
the person develops a constant fear of having another attack, which can
affect daily functioning and general quality of life.
Panic disorder often occurs along with other serious conditions,
such as depression, alcoholism or drug abuse.
What Are the Symptoms of Panic
Disorder?
Symptoms of a panic attack, which often last about
10 minutes, include:
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Difficulty breathing.
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Pounding heart or chest pain.
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Intense feeling of terror.
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Sensation of choking or smothering.
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Dizziness or feeling faint.
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Trembling or shaking.
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Sweating
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Nausea or stomachache.
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Tingling or numbness in the fingers and toes.
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Chills or hot flashes.
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A fear that you are losing control or are about to die.
Beyond the panic attacks themselves, a key symptom of panic disorder
is the persistent fear of having future panic attacks. The fear of these
attacks can cause the person to avoid places and situations where an attack
has occurred or where they believe an attack may occur.
What Causes Panic Disorder?
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Although the exact cause of panic disorder is not fully understood,
studies have shown that a combination of factors, including biological
and environmental, may be involved. These factors include.
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Family history. Panic disorder has been shown to run in families. It
may be passed on to some people by one or both parent(s) much like hair
or eye color can.
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Abnormalities in the brain. Panic disorder may be caused by problems
in parts of the brain.
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Substance abuse. Abuse of drugs and alcohol can contribute to panic
disorder.
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Major life stress. Stressful events and major life transitions, such
as the death of a loved one, can trigger a panic disorder.
How Common Is Panic Disorder?
Panic disorder affects about 2.4 million adult Americans. Panic disorder
most often begins during late adolescence and early adulthood. It is twice
as common in women as in men.
How Is Panic Disorder Diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing
a complete medical history and physical examination. Although there are
no laboratory tests to specifically diagnose panic disorder, the doctor
may use various tests to look for physical illness as the cause of the
symptoms.
If no physical illness is found, you may be referred to a psychiatrist
or psychologist, mental health professionals who are specially trained
to diagnose and treat mental illnesses. Psychiatrists and psychologists
use specially designed interview and assessment tools to evaluate a person
for panic disorder.
The doctor bases his or her diagnosis on reported intensity and duration
of symptoms, including the frequency of panic attacks, and the doctor's
observation of the patient's attitude and behavior. The doctor then determines
if the symptoms and degree of dysfunction suggest panic
How Is Panic Disorder Treated?
A combination of the following therapies often is used to treat panic
disorder.
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Psychotherapy. Psychotherapy (a type of counseling) addresses the emotional
response to mental illness. It is a process in which trained mental health
professionals help people by talking through strategies for understanding
and dealing with their disorder.
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Cognitive-behavioral therapy. People suffering from panic disorder often
participate in this type of psychotherapy in which the person learns to
recognize and change thought patterns and behaviors that lead to troublesome
feelings. Therapy also aims to identify possibly triggers for panic attacks.
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Medication. The anti-depressant drugs Paxil and Zoloft and anti-anxiety
medications such as Xanax or Klonopin are used to treat panic disorders.
Sometimes, heart medications (such as beta blockers) are used to control
irregular heartbeats.
Some people will respond well to treatment only to experience panic
attacks later in life. When panic attacks continue after treatment has
stopped, additional treatment may still help control and reduce panic attacks.
In addition, relaxation techniques, such as breathing retraining and positive
visualization, may help a person during an attack.
What Is the Outlook for People
With Panic Disorder?
Panic disorder can be successfully treated, and sufferers can go
on to lead full and satisfying lives. With appropriate treatment, nearly
90% of people with panic disorder can find relief. Unfortunately, many
people with panic disorder do not seek treatment. Without treatment, panic
disorder can have serious consequences and can severely impair quality
of life. Complications of untreated panic disorder include.
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Avoidance. A person may discontinue any activities that seem to trigger
a panic attack. This can make a normal work and home life nearly impossible.
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Anticipatory anxiety. This refers to anxiety that is triggered merely
by thinking about the possibility of having an anxiety attack.
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Agoraphobia. This is the fear of being in places or situations in which
an attack may occur, or from which escape would be difficult or highly
embarrassing. This fear can drive people to avoid public places and crowds,
and may even progress to the point that the person will not leave his or
her home. About one-third of people with panic disorder develop agoraphobia.
Can Panic Disorder Be Prevented?
Panic disorder cannot be prevented, however, there are some things
you can do to reduce stress and decrease symptoms, including:
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Stop or reduce your consumption of products that contain caffeine, such
as coffee, tea, cola and chocolate.
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Ask your doctor or pharmacist before taking any over-the-counter medicines
or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
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Exercise daily and eat a healthy, balanced diet.
Reviewed by the doctors at The Cleveland Clinic Department
of Psychiatry and Psychology.
Medically reviewed by Cynthia Haines, MD, WebMD, July
2005.
Portions of this page © The Cleveland Clinic 2000-2005
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