Panic disorder

Panic disorder is a type of anxiety disorder characterized by frequent panic attacks. Panic attacks involve sudden feelings of terror for no reason and can also be associated with other anxiety disorders.

People with panic disorder frequently experience sudden and unexpected feelings of terror known as 'panic attacks'.

You may also feel physical symptoms, such as:

  • fast heartbeat
  • chest pain
  • breathing difficulty
  • dizziness.

Panic attacks can happen anytime, anywhere and without warning. You may live in fear of another attack and may avoid places where you have had an attack.

For some people, fear takes over their lives and they cannot leave their homes.

Key points

  1. Panic disorder involves recurrent and often unexplained attacks of panic.
  2. People with less severe anxiety symptoms can often manage these by themselves.
  3. If you think it possible that you or someone you care about has panic disorder, check with your family doctor who may refer them to a psychiatrist or psychologist.
  4. Panic disorder affects 1 – 2% of the New Zealand and Australian populations each year.
  5. It usually begins during the teens or early twenties and is twice as common in women than men.
  6. The exact cause is unclear, however there is some evidence of a family/whanau tendency to nervousness and a link with major life events and stresses.

Click here for a screening test - panic disorder severity scale - self-reported  Good Medicine (UK)

Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress. Most people get better with treatment. Therapy can show you how to recognize and change your thinking patterns before they lead to panic. Medicines can also help and there are support groups to help you and your family to cope. 

Symptoms

Panic disorder involves recurrent, unexpected panic attacks. A panic attack is a sudden period of intense fear or discomfort, in which four or more of the following symptoms reach a peak within 10 minutes:

  • palpitations, pounding heart, or accelerated heart rate
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, lightheaded, or faint
  • feeling unreal or feeling detached from yourself
  • fear of losing control or going crazy
  • fear of dying
  • numbness or tingling sensations
  • chills or hot flushes.

At least one of these attacks is followed by one, or more, of the following, lasting a month, or more:

  • worry about having more attacks
  • worry about what the attacks ‘mean’ (e.g. losing control, heart attack, or ‘going crazy’)
  • a significant change in behaviour related to the attacks.

Treatment

The goal of treatment is to help you function well during everyday life. A combination of medication and cognitive-behavioral therapy (CBT) works best.

Medications

Four major classes of medications are used in the treatment of anxiety disorders:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine (Fluox), Sertraline (Zoloft) & Paroxetine (Aropax).
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).
  • Benzodiazepines - use cautiously as can cause dependence.
  • Tricyclic Antidepressants - work well, but side effects include dry mouth.

Cognitive-behavioral therapy (CBT)

This helps you understand your thoughts, behaviours and emotions and how to change them. Over a number of sessions you will learn how to:

  • Understand and control distorted views of life stressors, such as other people's behaviour or life events.
  • Recognize and replace panic-causing thoughts, and decrease the sense of helplessness.
  • Manage stress and relax when symptoms occur.
  • Imagine the things that cause the anxiety, starting with the least fearful. Practice in the real-life situation to help you overcome your fears.
  • When practiced regularly, CBT can be very effective and give you long-term benefits.

Self care

One of the best things you can do is educate yourself. Read about panic disorder and the many things you can do to help yourself, such as getting enough sleep. You should also:

Eat well

Eat at regular times, choose healthier foods and reduce or avoid caffeine, certain cold medicines, and stimulants.

Exercise regularly 

Many people with panic disorder avoid doing aerobic exercise as the increase in heart rate and faster breathing may remind them of panic symptoms. Through facing the symptoms and sensations that you fear (interoceptive exposure) you can gradually start increasing the amount of exercise you do. This is an important part of stress management. Aim for three sessions of exercise per week, choosing activities that you enjoy and varying the type of exercise so that you are able to establish and maintain a routine.

Some people find yoga, tai chi or meditation to be helpful from an exercise and relaxation perspective.

Relaxation training

Relaxation is the voluntary letting go of tension. This tension can be physical tension in the muscles or it can be mental (or psychological) tension.When we physically relax, the impulses arising in the various nerves in the muscles change the nature of the signals that are sent to the brain. This change brings about a general feeling of calm, both physically and mentally. Muscle relaxation has psychological benefits as well as physical.

Constant tension makes people over-sensitive and they respond to smaller and smaller events as though they were threatening.

By learning to relax, you can reduce general levels of arousal and tension, and gain control over these feelings of anxiety. View these practical techniques for managing stress from Computer Assisted Learning for the Mind, University of Auckland.

You can also reduce anxiety with slow breathing technique. To do this:

  • Take a regular breath (through your nose) and hold it for six seconds (use a watch). When you get to six, breathe out and say the word ‘relax’ to yourself in a calm, soothing manner.
  • Breathe in and out in a six second cycle (in for three, out for three).
  • Continue breathing in this way until the anxiety symptoms of overbreathing have gone.
  • Find a relaxation tape or CD to assist.

Expose yourself to things you fear…

..... but do it gradually. Write a list of things you avoid because of your anxiety and start to slowly reintroduce these activities into your life. Be kind to yourself and set achievable goals.
Reward yourself for success even if it didn’t go as well as you had hoped. For example, a person who is afraid of driving because of their anxiety may set a goal to be able to drive to an unknown suburb 20km away. They might start with short trips in familiar areas and gradually increase the distance from home and explore unknown places.

It is important to feel some anxiety during the exposure exercises and to ‘stay with’ the anxiety until it reduces.

If after trying this for a few weeks you are still experiencing panic attacks and/or avoiding situations, see your family doctor for referral to professional assistance.

Support

There are a range of organisations that can provide support and advice.

Learn more

Panic attacks and panic disorder  Ministry of Health (NZ). 2013.
Panic disorder  Mental Health Foundation of NZ, 2014.
Don’t panic!  Book by Dr Andrew Page. This is important advice and the title of a quick and easy-to-read book.
Living with it  Book by Bev Aisbett.

Credits: Content adapted from NZ Treatment Guide from RANZCP. Latest update by Dr Bycroft, Health Navigator August 2014. Reviewed By: Health Navigator