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Panic disorder

Introduction

Panic disorder is an anxiety disorder where you regularly have sudden attacks of panic or fear.

Everyone experiences feelings of anxiety and panic at certain times. It's a natural response to stressful or dangerous situations.

However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time, often for no apparent reason.

Symptoms

Anxiety

Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear. The most severe form of anxiety is panic.

You may start to avoid certain situations because you fear that they will trigger another attack. This can create a cycle of living "in fear of fear". It can add to your sense of panic and may cause you to have more attacks.

Panic attacks

A panic attack is when your body experiences a rush of intense mental and physical symptoms. It can come on very quickly and for no apparent reason.

A panic attack can be very frightening and distressing. Symptoms include:

  • a racing heartbeat
  • feeling faint
  • sweating
  • nausea
  • chest pain
  • shortness of breath
  • trembling
  • hot flushes
  • chills
  • shaky limbs
  • a choking sensation
  • dizziness
  • numbness or pins and needles
  • dry mouth
  • a need to go to the toilet
  • ringing in your ears
  • a feeling of dread or a fear of dying
  • a churning stomach
  • a tingling sensation in your fingers
  • feeling like you're not connected to your body

Most panic attacks last for between five and 20 minutes. Some panic attacks have been reported to last up to an hour.

The number of attacks you have will depend on how severe your condition is. Some people have attacks once or twice a month while others have them several times a week.

Although panic attacks are frightening, they're not dangerous. An attack won't cause you any physical harm, and it's unlikely that you'll be admitted to hospital if you have one.

Be aware that most of these symptoms can also be symptoms of other conditions or problems so you may not always be experiencing a panic attack – for example, if you have very low blood pressure you may have a racing heartbeat.

When to see your GP

See your GP if you've been experiencing symptoms of panic disorder.

Your GP will ask you to describe your symptoms, how often they occur and how long you've had them. They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.

Although it can sometimes be difficult to talk to someone else about your feelings, emotions and personal life, try not to feel anxious or embarrassed.

You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks.

Treatments for panic disorder

Treatment aims to reduce the number of panic attacks you have and ease your symptoms.

Psychological therapy and medication are the two main treatments for panic disorder. Depending on your symptoms, you may need one of these treatments or a combination of the two.

Psychological therapy

Your GP can refer you to a therapist for cognitive behavioural therapy (CBT). You might discuss with your therapist how you react and what you think about when you're experiencing a panic attack.

Your therapist can teach you ways of changing your behaviour – for example, breathing techniques to help you keep calm during an attack.

See your GP regularly while you're having CBT so they can assess your progress and see how you're doing.

Medication

If you and your doctor think it might be helpful, you may be prescribed:

  • a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), or if SSRIs are not suitable, a tricyclic antidepressant (usually imipramine or clomipramine)
  • an anti-epilepsy drug such as pregabalin or, if your anxiety is severe, clonazepam (these medicines are also beneficial for treating anxiety)

Antidepressants can take two to four weeks before their effect builds up, and up to eight weeks to work fully.

Keep taking your medications, even if you feel they're not working and only stop taking them if your GP advises you to do so.

Referral to a specialist

If your symptoms don't improve after CBT, medication and connecting with a support group, your GP may refer you to a mental health specialist such as a psychiatrist or clinical psychologist.

The specialist will carry out an assessment of your condition and devise a treatment plan to help you manage your symptoms.

Things you can try yourself

What to do during a panic attack

The next time you feel a panic attack coming on, try the following:

  • don't fight the attack and stay where you are, if possible
  • breathe slowly and deeply
  • remind yourself that the attack will pass
  • focus on positive, peaceful and relaxing images
  • remember it isn't life threatening

It may help to read our article on How to deal with panic attacks.

Preventing a further attack

It may also help to:

Support groups

Panic disorder can have a big impact on your life, but support is available. It might help to speak to others who have the same condition, or to connect with a charity.

You may find the following links useful:

Ask your GP about support groups for panic disorder near you. You can also use the services directory to find anxiety services in your area.

Complications of panic disorder

Panic disorder is treatable and you can make a full recovery. It's best to seek medical help as soon as you can if possible.

If you don't get medical help, panic disorder can escalate and become very difficult to cope with. You're more at risk of developing other mental health conditions, such as agoraphobia or other phobias, or an alcohol or drug problem.

If you have panic disorder, it may also affect your ability to drive. Legally you need to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could impact your driving ability.

Visit GOV.UK for further information about driving with a disability or health condition.

Causes

As with many mental health conditions, the exact cause of panic disorder isn't fully understood.

However, it's thought the condition is probably linked to a combination of things, including:

  • a traumatic or very stressful life experience, such as bereavement
  • having a close family member with the disorder
  • an imbalance of neurotransmitters (chemical messengers) in the brain

Panic disorder in children

Panic disorder is more common in teenagers than in younger children.

Panic attacks can be particularly hard for children and young people to deal with. Severe panic disorder may affect their development and learning.

If your child displays the signs and symptoms of panic disorder, they should see a GP. A GP will take a detailed medical history and carry out a thorough physical examination to rule out any physical causes for the symptoms. They may refer your child to a specialist for further assessment and treatment.

The specialist may recommend a course of CBT for your child. Screening for other anxiety disorders may also be needed to help determine what's causing your child's panic attacks.

Read more about anxiety disorders in children or find out about mental health services for children and young people.


Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
Panic
To panic is to be overcome with a feeling of fear or worry.
Mental
Mental refers to the processes in the mind.
Nausea
Nausea is when you feel like you are going to be sick.
Heart
The heart is a muscular organ. Its function is to pump blood around the body.
Palpitations
Palpitations refer to an irregular heartbeat, or the sensation of skipped or extra heartbeats.