Panic Attack & Panic Disorder - Symptoms & Treatment
Anxiety and Panic Attacks

Panic Attacks: The Hallmark of Panic Disorder
A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience.

Symptoms of a panic attack include:
racing heartbeat
difficulty breathing, feeling as though you 'can't get enough air'
terror that is almost paralyzing
dizziness, lightheadedness or nausea
trembling, sweating, shaking
choking, chest pains
hot flashes, or sudden chills
tingling in fingers or toes ('pins and needles')
fear that you're going to go crazy or are about to die

You probably recognize this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms seem to rise from out of nowhere. They occur in seemingly harmless situations--they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following conditions:
-it occurs suddenly, without any warning and without any way to stop it.
-the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.
-it passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks can continue to recur for hours.

A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack.


How to Identify Panic Disorder
Please remember that only a licensed therapist can diagnose a panic disorder. There are certain signs you may already be aware of, though.

One study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. That's why it's important to know what the symptoms are, and to make sure you get the right help.

Many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry. The key symptom of panic disorder is the persistent fear of having future panic attacks. If you suffer from repeated (four or more) panic attacks, and especially if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional who specializes in panic or anxiety disorders.


What Causes Panic Disorder: Mind, Body, or Both?
Body: There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had a panic disorder or some other emotional disorder such as depression. Studies with twins have confirmed the possibility of 'genetic inheritance' of the disorder.

Panic Disorder could also be due to a biological malfunction, although a specific biological marker has yet to be identified.

All ethnic groups are vulnerable to panic disorder. For unknown reasons, women are twice as likely to get the disorder as men.

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack.

Both: Physical and psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack.

For example, if a person with panic disorder experiences a racing heartbeat caused by drinking coffee, exercising, or taking a certain medication, they might interpret this as a symptom of an attack and , because of their anxiety, actually bring on the attack. On the other hand, coffee, exercise, and certain medications sometimes do, in fact, cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack. That's why the right therapy for panic disorder focuses on all aspects -- physical, psychological, and physiological -- of the disorder.

Can People with Panic Disorder lead normal lives?

The answer to this is a resounding YES -- if they receive treatment.

Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective, and most people who have successfully completed treatment can continue to experience situational avoidance or anxiety, and further treatment might be necessary in those cases. Once treated, panic disorder doesn't lead to any permanent complications.


Side Effects of Panic Disorder
Without treatment, panic disorder can have very serious consequences.

The immediate danger with panic disorder is that it can often lead to a phobia. That's because once you've suffered a panic attack, you may start to avoid situations like the one you were in when the attack occurred.

Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, you might have an attack while driving, and start to avoid driving until you develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia -- fear of going outdoors -- because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help. The fear of an attack is so debilitating, they prefer to spend their lives locked inside their homes.

Even if you don't develop these extreme phobias, your quality of life can be severely damaged by untreated panic disorder. A recent study showed that people who suffer from panic disorder:

-are more prone to alcohol and other drug abuse
-have greater risk of attempting suicide
-spend more time in hospital emergency rooms
-spend less time on hobbies, sports and other satisfying activities
-tend to be financially dependent on others
-report feeling emotionally and physically less healthy than non-sufferers.
-are afraid of driving more than a few miles away from home

Panic disorders can also have economic effects. For example, a recent study cited the case of a woman who gave up a $40,000 a year job that required travel for one close to home that only paid $14,000 a year. Other sufferers have reported losing their jobs and having to rely on public assistance or family members.

None of this needs to happen. Panic disorder can be treated successfully, and sufferers can go on to lead full and satisfying lives.


How Can Panic Disorder Be Treated?
Most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases.

The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. 'Cognitive restructuring' (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.

Cognitive therapy can help the patient identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.

The behavioral components of the therapy can consist of what one group of clinicians has termed 'interoceptive exposure.' This is similar to the systematic desensitization used to cure phobias, but what it focuses on is exposure to he actual physical sensations that someone experiences during a panic attack.

People with panic disorder are more afraid of the actual attack than they are of specific objects or events; for instance, their 'fear of flying' is not that the planes will crash but that they will have a panic attack in a place, like a plane, where they can't get to help. Others won't drink coffee or go to an overheated room because they're afraid that these might trigger the physical symptoms of a panic attack.

Interoceptive exposure can help them go through the symptoms of an attack (elevated heart rate, hot flashes, sweating, and so on) in a controlled setting, and teach them that these symptoms need not develop into a full-blown attack. Behavioral therapy is also used to deal with the situational avoidance associated with panic attacks. One very effective treatment for phobias is in vivo exposure, which is in its simplest terms means breaking a fearful situation down into small manageable steps and doing them one at a time until the most difficult level is mastered.

Relaxation techniques can further help someone 'flow through' an attack. These techniques include breathing retraining and positive visualization. Some experts have found that people with panic disorder tend to have slightly higher than average breathing rates, learning to slow this can help someone deal with a panic attack and can also prevent future attacks.

In some cases, medications may also be needed. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place of therapy, but it can be a useful adjunct.

If you suffer from panic disorder, these therapies can help you. But you can't do them on your own; all of these treatments must be outlined and prescribed by a psychologist or psychiatrist.


How Long Does Treatment Take?
Much of the success of treatment depends on your willingness to carefully follow the outlined treatment plan. This is often multifaceted, and it won't work overnight, but if you stick with it, you should start to have noticeable improvement within about 10 to 20 weekly sessions. If you continue to follow the program, within one year you will notice a tremendous improvement.

If you are suffering from panic disorder, you should be able to find help in your area. You need to find a licensed psychologist or other mental health professional who specializes in panic or anxiety disorders. There may even be a clinic nearby that specializes in these disorders.

When you speak with a therapist, specify that you think you have panic disorder, and ask about his or her experience treating this disorder.

Keep in mind, though, that panic disorder, like any other emotional disorder, isn't something you can either diagnose or cure by yourself. An experience clinical psychologist or psychiatrist is the most qualified person to make this diagnosis, just as he or she is the most qualified to treat this disorder.

This brochure is designed to answer your basic questions about panic disorder; a qualified mental health professional will be able to give you more complete information.

Panic disorder does not need to disrupt your life in any way!

This part of our Article has been resourced from :
American Psychological Association
Office of Public Affairs
750 First St. N.E.
Washington, DC 20002-4242
(202) 336-5700


Panic Disorder
Panic Disorder is the fear of having an 'uncued'..spontaneous panic attack. It was first recognised and included in the American Psychiatric Association's Diagnostic& Statistical Manual (DSM) 111 in 1980.

Ongoing research has increased the knowledge and understanding of this Disorder and is clearly evident in the current version of the DSM...No-4. In the DSM-111 and the DSM-111R no distinction was made in the different types of panic attacks. A panic attack was a panic attack.


DSM 4 recognises three different types of panic attacks.
uncued (spontaneous) panic attacks
cued (specific) panic attacks
situationally predisposed panic attacks
Spontaneous panic attacks relate to panic disorder

Specific panic attacks relate to social anxiety disorder, obsessive compulsive disorder and post traumatic stress disorder. Situationally predisposed panic attacks may occur on exposure to the situational cue or trigger, but do not necessarily occur immediately after the exposure.

The symptoms of a panic attack are described in the DSM-4 as a "discrete period of intense fear or discomfort in which four (or more) of the above symptoms develop abruptly and reached a peak within ten minutes.
Mix &Match

Symptoms of a panic attack are palpitations, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealisation or depersonalisation, fear of losing control or going 'crazy', fear of dying, paresthesias, and chills or hot flushes'.... 'Attacks that have fewer than 4 symptoms are referred to as 'limited - symptom attacks.'

While the DSM-111R acknowledged that the avoidance behaviour (agoraphobia) relating to the panic disorder was a result of a fear of having a Panic Attack, this lack of distinction upheld the prevailing view of the time that a panic attack and the avoidance behaviour resulting from the attack was a "phobic" response to situations and/or places. Many of the earlier treatment methods for panic disorder/ agoraphobia focussed on gradual exposure to the avoided situation and/or place and did not directly deal with the panic attack itself. It is now recognised that a spontaneous panic attack is not associated with specific situations and places.

The avoidance behaviour associated to Panic Disorder is recognised "as anxiety about being in situations and places from which escape may be difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic like symptoms". The spontaneous panic attacks attack comes without any apparent warning warning, day or night irrespective of what the person is doing. Many people report that panic attacks happen when they are relatively 'calm' or 'relaxed' eg when they are watching TV or reading a book. In fact, a study we undertook in 1993 on the uncued/ spontaneous panic attack showed that 78% of Panic Disorder participants reported experiencing a panic attack when relatively 'calm'. 69% of Panic Disorder participants report they experience a panic attack while going to sleep and 86% report that the panic attack wakes them from sleep at night.

Three internationally recognised experts in Panic Disorder describe a panic attack as follows:

"An intense recurring spasm of panic that start ... just below the breastbone and seem to spread like a white hot flame .. passing through the chest, up the spine, into the face, down the arms and even down into the groin to the tips of the toes" C.Weekes.
"The attacks start with a tingling feeling going up my spine which enters my head and causes a sensation of faintness and nausea" J.Hafner.
"A rushing sensation of a hot flash through the body .. sometimes associated with a sick feeling and a sensation of fading out from the world but this faintness is more like a 'white out' than a 'black out' and that the head may literally feel light." Sheehan

C. Weekes (1962): Self Help for your Nerves. London: Angus & Robertson pp33.
J. Hafner (1986). Marriage and Mental Illness. New York: The Guildford Press pp 39
Sheehan (1983). The Anxiety Disease. Charles Scribner's Son N-1.
In our own research into the subjective experience of the spontaneous panic attack, we found that many people with Panic Disorder can experience a various sensations moving through their body - either before or during the actual panic attack. These sensations can change from one 'attack' to the next which only adds to the confusion people feel. These sensations can include:

electric current moving through the body
hot prickly sensation moving through the body
intense heat or burning pain moving through the body
"unusual" intense flows of energy throughout the body
rushes of 'energy' shaking the body
tingly sensation moving through the body
creeping sensation moving through the body
wave-like motion of energy moving through the body
vibration moving through the body
white hot flame through the body
ice cold sensation through the body
"ants crawling" sensation over the body
For more information see also

'An Analysis of an uncued panic attacks' - symptoms
The Evaluation of the Effectiveness of a panic anxiety management workshop
Our research also found many people can dissociate first and then panic as a result of the dissociation. Dissociation can include depersonalisation and derealisation. For more information see our Dissociation page

As with the other anxiety disorders, people with panic disorder also experience other symptoms including racing heart beat, 'missed heart beats', palpitations, difficulty breathing, chest pain, left arm pain, jaw pain, nausea, shaking and trembling, a choking sensation. For a full list of symptoms see our Symptom page

Many people who experience spontaneous panic attacks feel as if they are dying and / or having a heart attack, feel as if they are going insane or will lose control. The fear of having a spontaneous panic attack leads to panic disorder. This is turn can lead to the secondary conditions associated to panic disorder which include avoidance behaviour (agoraphobia), major depression and/or prescribed drug addiction and/or alcohol abuse. While the experience of spontaneous panic attacks can be minimised to a large degree, the development of panic disorder, and the secondary conditions can be prevented.

Anxiety and panic attacks
Picture this, your walking through the mall and all of a sudden you feel short of breath, you notice your heart is racing and your sweating. You begin to feel scared and wonder what is happening to you. Are you having a heart attack? Are you going to die? These are questions millions of Americans ask themselves at one time or another. The biggest question is "what's wrong with me"?

Many people visit countless numbers of doctors each year trying to figure out what their problem is. They are searching for reasone why they are experiencing nervousness, sweaty palms, a queasy stomach, or lightheadedness.

The first time you experience a panic attack, you may go to the doctor, only to be told there's nothing physically wrong. So you try to reason with yourself: "if nothing is wrong with me, then i'll just try to stay calm and the panic attacks will go away." But it seems the harder you try, the more frequently they return.

You may develop phobias, unreasonable fears of flying or riding in elevators or crossing bridges. You might even develop the most serious panic disorder, a fear of fear itself otherwise known as agoraphobia. This is the most severe a phobia that keeps you imprisoned in your home, afraid that if you go outside you will have another panic attack.


Here are some symptoms of anxiety:

1. Often feeling tired even though You have had a good night's sleep.

2. Your heart seems to race out of control even though the doctor says you dont have a heart problem.

3. Insomnia

4. Bouts of backache that hit for no apparent reason.

5. Indegestion, diarrhea, or headache frequently keeping you from functioning at your best.

6. Hyperventilating

7. Feeling like your falling to pieces

8. Noticing that certain situations make you feel extremely nervous.

9. Feeling like you are going crazy


Are you going crazy? No. You may have a chemical imbalance that predisposes you to feeling anxious. You may not be coping with stress in a constructive way so as to prevent your anxiety from becoming panic. You are not mentally ill, but if the fear that you have is irrational and keeps you from doing normal everyday things that most people take for granted, you may have a phobia which can go hand in hand with anxiety and panic attacks.

The good news is that anxiety and panic attacks are considered to be the most treatable of all psychiatric conditions. You can be taught mental tools to help you overcome your physical symptoms.

When you worry, think negatively, or have improper attitudes toward stress, you produce vivid mental pictures of the situation you fear. Your body becomes aroused just as if the situation you imagine is actually happening. Then it releases adrenaline, which brings on the physical anxiety symptoms. Therefore, if you can eliminate worry, negative thinking, and improper attitudes toward stress with your mind, you can overcome much of the anxiety that brings on a panic attack.

If you have a lot of stress and do not know how to cope with it, your body becomes aroused because it is being bombarded with anxiety producing stimuli. Nature's purpose in allowing the body to become aroused is protection. When faced with sudden danger, you become physically ready to react by either fighting the stressor or fleeing from it. When the brain puts into action what is called the "fight or flight" response, it releases hormones known as corticosteroids. These powerful hormones constrict the blood vessels in the peripheral parts of the body in order to drive blood into the brain and deep down into the large muscles for added strength. The heart pounds, digestion shuts down, breathing increases, and muscles tighten.

In the beginning of the 1980's, doctors began to frequently prescribe tranquilizers and antianxiety medications such as xanax, klonopin, and valium. These medications can help people to calm down, but seldom do they cure the problem.

First, go to your regular doctor to rule out any medical conditions that may be causing these problems. If nothing can be found, a good doctor should realize that you may be suffering from anxiety and panic attacks, and will refer you to a psychologist for some talk therapy.

Here are some things a psychologist may have you try after he or she evaluates you and decides that you are suffering from anxiety and panic attacks:

1. Visualizations:
Picture yourself with a relaxed look on your face at work and at home.

Visualize yourself refusing requests that will cause you to overwork.

See yourself being able to participate in hobbies that you have avoided because you have not felt like doing them.

2. Affirmations:
Tell yourself that you feel perfectly normal and that you can do any activity that you want.

Tell yourself that you are worthy of the love of others even when you don't think that you are.

When you wake up in the morning, look at yourself in the mirror and repeat positive affirmations to yourself. Anything that you can think of that is positive and not negative. You can find many books in the bookstore or library on positive affirmations. Make them part of your everyday routine.

3. Cognitive Restructuring:
Stop thinking in the black and white mode by stopping the thoughts that you will have a headache or you will have a panic attack if you go certain places or attend certain functions.


4. Relaxation Exercises:
These can be very helpful. Teach yourself how to breathe correctly. Most of us breathe from our upper chest area instead of our abdominal area. Practice deep breathing. Studies have found that it is impossible to have a panic attack when you are breathing deeply and properly.

Learn how to meditate, take yoga, get a massage, and most of all exercise.

Exercising can be the best prescription. You will have fewer anxiety producing illnesses if you achieve physical fitness. You can have a new and exciting lifestyle if you are functioning at optimal levels of health. Set a goal and become more physically fit and then commit yourself to achieving it. Your unconscious mind will make it easier to exercise and eat right if you program it with visualizations and affirmations.

Although these are just a few suggestions, there are many many more things that can be done to help alleviate the terrifying feelings that come along with anxiety and panic attacks. Make sure to schedule an appointment with your doctor and to see a psychologist to help you on your road to recovery. Also, the bookstore can be a great help. Because this is such a common problem and has been for years, there are a lot of self help books available. Not only can they help you to deal with the difficulties that accompany anxiety, they can help you to feel better instantaneously just by validating your feelings. You may pick up a book and feel like someone wrote it just for you.

The bottom line is that anxiety and panic attacks are 100% treatable. Don't suffer anymore than you have to. Take charge and get yourself on the track to a better quality of life. It may take some work, but I can assure you that it will be worth it.