All humans have a built-in "alarm system" that goes off when they feel
threatened. This alarm starts chemical, physical and emotional changes that prepare us to
either flee or fight the danger that triggered the alarm ("Flight or Fight Response).
In some people, this alarm may go off unexpectedly, creating a very strong sense of threat
when no danger is present. This "false alarm" is called a panic attack. It
occurs in a condition known as panic disorder.
What is a panic attack?
A panic attack is a terrifying experience. Several physical and
emotional signs occur during a panic attack. The most common signs are a racing heart,
shortness of breath, faintness, hot or cold flushes, trembling, tingling, weakness and
nausea, or feeling as though one's self or the external world has changed somehow. In
addition, people with panic attack may fear that they are dying, or going crazy or are
about to lose control. Some panic attacks come on very quickly and involve many intense
feelings. Other attacks may be less intense and involve fewer feelings. The signs of panic
attacks can change or stay the same from one attack to another.
A panic attack sounds like a heart attack. Is it?
No. The symptoms of panic attacks can seem like those of other
serious medical events, like heart attacks and strokes. This makes panic attacks hard to
recognize. Many people who go to the Emergency Room for these symptoms, and are found not
to have heart disease, turn out to have Panic Disorder.
In addition, panic-like symptoms can be produced by other medical
problems (like respiratory and thyroid diseases). If you or your doctor think you may have
panic disorder, you will need to be checked carefully to rule out other problems.
What is agoraphobia?
Panic attacks can be so frightening that some people begin to
change their behavior because they're afraid of having an attack. They may avoid certain
activities, like exercise, that they think might cause an attack. They may avoid
activities (shopping) or places (like bridges) where escape isn't easy if a panic attack
Some people may be unable to do routine activities without the
company of a "safe person." This pattern of fear and avoidance is called
agoraphobia (say: uh-gor-uh-fo-bee-uh). The word "agora" means a market or
meeting place, and "phobia" means fear. Although agoraphobia is often understood
as a fear of open places, it also involves fear and avoidance of many activities and
Why do panic attacks keep happening?
Once panic disorder develops, it usually becomes a daily cycle of
fear. The cycle begins with advance anxiety about where, when and how the next panic
attack may occur.
People with panic disorder often become aware of and worried about
physical changes that might happen. This buildup of fear and anxiety ("anticipatory
anxiety) often leads to greater fear in the situation, a higher likelihood of actually
having a panic attack and, for some people, a reason to avoid the situation entirely.
People who have panic disorder with agoraphobia may spend a lot of time avoiding
activities and places they fear might trigger a panic attack.
Do many people have panic disorder?
Yes. Research has shown that many people have at least one panic
attack in their lives. Three out of every 100 people will develop panic disorder. Of those
who seek treatment of panic disorder, about two thirds have also developed some degree of
Panic attacks can be hidden, even from doctors. People often worry
about what others think. They fear that this strange experience is something that doesn't
happen to other people.
Panic disorder usually begins in the late teens through the
mid-thirties, but can also occur in children and older adults. Two thirds of patients with
panic disorder are women. The tendency to have panic attacks seems to run in families.
What else should I know about panic disorder?
As in any disease, people with panic disorder may have
complications. Some people think of themselves as weak or defective because they have
panic attacks. The strain that panic disorder puts on families can cause marital and
In addition, about one third of people with panic disorder also
have depression or problems with drugs or alcohol use. If you have panic disorder or
agoraphobia, a complete physical exam is the first step. You can talk with your doctor
about your panic attacks and other problems.
Is there a treatment for panic disorder?
Yes! Although panic disorder can feel terrible, it can be treated.
You can take medicine or have a special type of cognitive therapy, discussed below.
Several medicines can help control panic attacks. Some medicines
may be used for only a few weeks. Other medicines may be used for a year or longer.
Certain therapies, called cognitive and cognitive-behavioral
therapies, have been found to be effective in treating panic disorder. These therapies
include education about panic disorder, learning personal coping skills to manage and
change fearful thinking and anxious feelings, and gradually going back into feared or
avoided situations (this technique is called "exposure"). These treatments can
be done by yourself, or with a partner or a group.
Therapy can also help cut the risk of relapse (having the panic
attacks start again). If you get treated with medicine alone, you might start having panic
attacks again when you stop taking the medicine. About 80 to 90% of people who have
cognitive behavioral therapy are helped, even if they don't take medicine.
Talk with your family doctor if you think that you might
have panic disorder with or without agoraphobia. Your doctor can help you decide on the
best treatment approach for you.