Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep, or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.
SYMPTOMS
Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.
Panic attacks typically include some of these signs or symptoms:
- Sense of impending doom or danger
- Fear of loss of control or death
- Rapid, pounding heart rate
- Sweating
- Trembling or shaking
- Shortness of breath or tightness in your throat
- Chills
- Hot flashes
- Nausea
- Abdominal cramping
- Chest pain
- Headache
- Dizziness, light-headedness, or faintness
- Numbness or tingling sensation
- Feeling of unreality or detachment
One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur.
CAUSES
It's not known what causes panic attacks or panic disorder, but these factors may play a role:
- Genetics
- Major stress
- Temperament that is more sensitive to stress or prone to negative emotions
- Certain changes in the way parts of your brain function
Panic attacks may come on suddenly and without warning at first, but certain situations usually trigger them over time.
Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's unknown why a panic attack occurs when there's no apparent danger present.
RISK FACTORS
Symptoms of panic disorder often start in the late teens or early adulthood and affect more women than men.
Factors that may increase the risk of developing panic attacks or panic disorder include:
- Family history of panic attacks or panic disorder
- Significant life stress, such as the death or severe illness of a loved one
- A traumatic event, such as sexual assault or a severe accident
- Substantial changes in your life, such as a divorce or the addition of a baby
- Smoking or excessive caffeine intake
- History of childhood physical or sexual abuse
GENETICS
Research on whether your genes can make you more likely to develop the panic disorder is mixed.
A 2020 study has suggested that panic disorder may have a genetic component. Researchers claimed to have found 40 different genes linked to panic disorder, most of which were connected to our body's system of neurotransmitters (which regulate communications between our nerve cells). As a result, they argued testing for biomarkers might be a helpful tool in diagnosing panic disorder.
A 2018 study noted research on panic disorder and genetics is very inconsistent, and more extensive studies are needed before any conclusions are possible. Researchers emphasized that life stress, trauma, and anxiety sensitivity are significant social and psychological factors contributing to the condition.
Both the 2020 and the 2018 studies noted that changes in the “COMT” gene show the most evidence for being connected to panic disorder. This gene is responsible for an important enzyme (protein), which affects our cognitive abilities and behavioral control.
A 2019 study found a “significant genetic correlation” between panic disorder and other conditions, including major depressive disorder and neuroticism.
OTHER RISK FACTORS
Although the causes of panic disorder are not clearly understood, information about the condition does indicate that certain people are more likely to develop it.
The most-cited statistics on panic disorder come from the 2001-2003 National Comorbidity Survey. The NCS-R is a representative survey of mental health conditions in the United States and includes over 9,000 participants.
The NCS-R reported 2.7 percent of people reported having panic disorder within the past year. The condition had a lifetime prevalence of 4.7 percent.
The NCS-R and other data cited below categorized participants according to their sex and gender assigned at birth.
Here’s what we know about risk factors:
- According to NCS-R, female people are more likely to have panic disorder than males. In the NCS-R, 3.8 percent of women reported having panic disorder within the past year, compared to 1.6 percent of men.
- Overall, research shows that anxiety disorders, including panic disorders, are more common in women than in men.
- Panic disorder is also more common in young adults than in other age groups. Symptoms of panic disorder often begin to appear between 20 and 24 years old.
LIFE CHANGES
Panic disorder is associated with significant life changes and stressful life events, like arguing with family. And even when life changes are exciting and positive, they can create new challenges and daily stressors.
For example, such changes and events may include:
- leaving home for college
- moving
- the death of a loved one
- getting married
- having your first child
- starting a new job
It's essential to take care of your mental and physical health during transitional periods in life. You also deserve support when going through periods of high stress and managing difficulties or trauma.
Consider reaching out to trusted loved ones for emotional support. Set boundaries and communicate when you’re feeling overwhelmed. A therapist or mental health professional can also be your ally by listening, providing resources, and helping you develop coping tactics.
ANXIETY
A tendency to be anxious and having an anxiety disorder is also connected to panic attacks and panic disorder. In the DSM-5, panic attacks are listed under the umbrella of anxiety disorders. Both anxiety and panic disorder can be long-term conditions.
Anxiety usually manifests as being worried, nervous, or overwhelmed. For example, social anxiety may occur when you're nervous about performing in social situations or environments with many people. As a result, you may feel particularly self-conscious and even have physical symptoms like sweating or trembling.
It’s natural for human beings to be anxious sometimes. But being anxious all the time is a cause for concern and could indicate generalized anxiety disorder (GAD).
The DSM-5 diagnostic criteria for GAD are met when someone has "excessive anxiety and worry," often for at least six months. These feelings could be about several different events or activities (such as work or school performance).
It would help if you didn't have to live in a constant state of worry and stress. If you frequently experience anxiety, it's essential to reach out for help. Therapy, lifestyle adjustments, or medications can all help get anxiety under control.
COMPLICATIONS
Left untreated, panic attacks and panic disorders can affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.
Complications that panic attacks may cause or be linked to include:
- Development of specific phobias, such as fear of driving or leaving your home
- Frequent medical care for health concerns and other medical conditions
- Avoidance of social situations
- Problems at work or school
- Depression, anxiety disorders, and other psychiatric disorders
- Increased risk of suicide or suicidal thoughts
- Alcohol or other substance misuses
- Financial problems
For some people, panic disorder may include agoraphobia — avoiding places or situations that cause you anxiety because you fear being unable to escape or get help if you have a panic attack. Or you may become reliant on others to be with you to leave your home.
TREATMENT
MEDICATIONS
Medications used to treat panic disorder can include selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants. SSRIs prescribed for panic disorder may include:
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
Other medications sometimes used to treat the panic disorder include:
- serotonin-norepinephrine reuptake inhibitors (SNRIs), which are also antidepressants
- monoamine oxidase inhibitors (MAOIs), which are antidepressants that are used infrequently because of rare but severe side effects
- benzodiazepines (commonly used as tranquilizers), including alprazolam (Xanax) or clonazepam (Klonopin)
In addition to these treatments, there are several steps you can take at home to reduce your symptoms. Examples include:
- maintaining a regular schedule
- exercising regularly
- getting enough sleep
- avoiding stimulants like caffeine
PSYCHOTHERAPY AND MENTAL HEALTH TREATMENTS
Medications aren’t the only option for treating panic disorder. There are several steps you can take to help calm yourself down and lessen the symptoms of a panic attack while it’s happening.
These techniques include:
- Removing yourself from the stressful situation or environment
- Listen to calming music
- Taking slow, deep breaths
- Counting slowly to 10
- Talking to someone you trust about what’s happening
There's no sure way to prevent panic attacks or panic disorder. However, these recommendations may help.
- Get treatment for panic attacksas soon as possible to help stop them from getting worse or becoming more frequent.
- Stick with your treatment planto help prevent relapses or worsening of panic attack symptoms.
- Get regular physical activity,which may play a role in protecting against anxiety.
- Cognitive behavior therapy(CBT) is another non-medication option. CBT is a type of talk therapy where people with panic disorder work with a mental health professional to identify triggers, understand symptoms, and develop responses to panic attacks. CBT is a first-choice option for treating this condition, and studies show CBT can be used by itself for panic disorder or as an add-on treatment to medications.
SUMMARY
Panic disorder is often a long-term condition that can be difficult to treat. You may have the panic disorder if you've experienced multiple panic attacks and have a persistent fear of them reoccurring.
It may not be possible to fully "cure" your panic disorder, but treatment can help. Therapy, including CBT, reducing life stressors, and taking medication are all potential options.
The onset of panic disorder is often in the early twenties, and statistics show it affects women more than men. In addition, a preexisting anxiety condition can increase your risks of panic attacks and panic disorder.
Try to be mindful of any anxiety symptoms following a significant life event. If you're distressed by something, you experienced or were exposed to, consider discussing it with your primary care physician or mental health professional.
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. Anxiety disorders. (2018).
Forstner AJ, et al. (2019). Genome-wide association study of panic disorder reveals genetic overlap with neuroticism and depression.
Hantsoo L, et al. (2017). Anxiety disorders among women: A female lifespan approach.
Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. (2016). Table 3.10. Panic disorder and agoraphobia criteria changes from DSM-IV to DSM-5.
Kim EJ, et al. (2018). Panic disorders: The role of genetics and epigenetics.
Munir S, et al. (2022). Generalized anxiety disorder.
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