Panic Disorder
Panic disorder1 is very different from everyday anxiety. Panic disorder is a condition that affects 1 – 2% of the Australian and New Zealand populations each year. It usually begins during the teens or early twenties and women are twice as likely as men to experience it.
The exact causes of panic disorder are still unclear but there is some evidence of a family tendency to nervousness and a link with major life events and stresses. What this means is that if a member of the family has suffered from panic, there is an increased risk of you suffering from it, especially when you are stressed. Often people with panic disorder have always thought of themselves as ‘worry worts’ or sensitive but this may not always be the case.
Agoraphobia
Agoraphobia is often thought to mean that people are afraid of ‘open spaces’. This is partly true. Many people with panic disorder avoid a number of situations because of their fears. This avoidance is known as agoraphobia, which is anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack.
For this reason people with agoraphobia often avoid places such as trains, crowds and queues or only enter these situations with a trusted friend or relative. Obviously this can be extremely disabling and often limits opportunities in terms of work, social or other activities.
Often there are many less obvious forms of avoidance that people with panic disorder will engage in. For instance, people may avoid exercise, sexual relations, going out in hot weather or experiencing strong emotions such as anger. These forms of avoidance, also known as ‘safety behaviours’ will also need to be addressed for treatment to be successful.
Causes of panic disorder and agoraphobia
The exact causes of panic disorder or agoraphobia are not known, but there are several risk factors, including:
- family history of anxiety disorders or depressive illness – some studies suggest a possible genetic component
- negative life experiences – extremely stressful experiences, such as childhood abuse, being made redundant or the death of a family member or friend, have been associated with recurring panic attacks
- physical medical conditions – some medical conditions, such as cardiac arrhythmias, asthma, chronic obstructive pulmonary disease, and irritable bowel syndrome, are associated with panic disorder.
How is a panic attack different from panic disorder?
In panic disorder, you have a lot of panic attacks, not just a few. You feel in constant fear of having another one.
Symptoms of panic disorder and agoraphobia
Not everyone who has a panic attack has a panic disorder, but having recurring panic attacks is a symptom of panic disorder. Some people with agoraphobia have panic attacks, but you can have agoraphobia without having panic attacks.
Symptoms of panic attacks
Panic attacks occur suddenly. Symptoms can vary for different people, but they tend to hit their peak within 10 minutes.
A panic attack typically has four or more of:
- chest pain
- chills or hot flushes
- dizziness or feeling faint
- fear of dying
- fear of losing control or ‘going crazy’
- feeling like you are choking
- feeling short of breath
- nausea
- pounding heart and rapid heart rate
- sweating
- tingling or numbness
- trembling or shaking.
Symptoms of panic disorder
Rather than having just a single panic attack, if you have a panic disorder you will experience several recurring panic attacks.
Symptoms of panic disorder include:
- frequent and unexpected panic attacks
- ongoing worry about having another panic attack for more than one month after the panic attack
- ongoing worry about the consequences of having an attack – such as losing control, ‘going crazy’ or having a heart attack.
Symptoms of agoraphobia
Agoraphobia is often thought of as a fear of open spaces, but it is more than this. Agoraphobia is fear or anxiety of being in situations where you feel you cannot escape.
These include being:
-
- in an enclosed space – theatre, meeting room or small shop
- in an open space – bridge, car park or large shopping mall
- on public transport – bus, train or plane
- out of your home alone.
How is a panic disorder treated?
If you suffer from panic disorder, it can be helpful to know 2 things:
- there is probably no life-threatening danger
- the symptoms will go away
To manage the panic disorder, you need strategies to regain some control. Techniques that can help you feel calmer include:
- cognitive behavioral therapy
- relaxation strategies
- breathing exercises
- mindfulness
- meditation
- medication
Diagnosis of panic disorder and agoraphobia
Healthcare professionals who can diagnose a mental health condition include your GP, a psychiatrist and some psychologists. Each of these professionals offers different types of services, so the first step is to visit your GP to speak about your concerns. They can then refer you to other healthcare professionals if required.
Your doctor will do a physical examination and may take blood samples for testing. A diagnosis of panic disorder or agoraphobia will also involve your healthcare professional asking you questions about your symptoms and feelings, so they can understand your problem. If you experience panic attacks, they will want to know when, where and how often you have them.
They will also ask about your medical history. Some healthcare professionals may ask you to fill in some forms, which will also ask you a range of questions about your symptoms, moods and panic attacks. This will help the healthcare professional to understand and diagnose your problem so that you can get the best treatment possible.
Diagnosis of panic disorder
To fit the criteria for a diagnosis of panic disorder, you will need to have experienced the symptoms of panic disorder. Your doctor will also need to confirm that medication, substances or other physical or mental health conditions are not causing your symptoms.
Diagnosis of agoraphobia
To fit the criteria for a diagnosis of agoraphobia, you will need to have experienced the symptoms of agoraphobia and some additional signs. These include:
- your fear or anxiety is almost always experienced when you are in the same situation
- you avoid the situation that causes your symptoms
- your fear and anxiety is out of proportion to the actual situation.
Where to get help
If you are experiencing panic attacks, talk to your doctor. You may be eligible for a mental health care plan which can help you access Medicare funding for psychological therapies. Or you can contact one of the services below to speak with someone or chat online:
- Kids Helpline (telephone and online counseling for ages 5-25) — call 1800 55 1800.
- Mensline Australia (online counseling and forum for men) — call 1300 78 99 78.
- Lifeline (anyone having a personal crisis) — call 13 11 14.
- Suicide Call Back Service (anyone thinking about suicide) — call 1300 659 467
- MindSpot Clinic (anyone suffering from anxiety or depression) — call 1800 61 44 34.
- beyondblue (anyone feeling depressed or anxious) — call 1300 22 4636 or chat online.
- Black Dog Institute (people affected by depression and extreme mood swings) — online help.
Treatment for panic disorder and agoraphobia
Having early treatment is important for recovery from panic disorder or agoraphobia. Treatment can be very effective in reducing the number of panic attacks for most people. The first step is to visit your doctor and get professional help.
The treatment for panic disorder or agoraphobia is medication or psychological therapies. You can also make a number of changes in your life to support your treatment.
Psychological therapies for panic disorder and agoraphobia
Psychological therapies, which involve talking with a therapist, can be an effective form of treatment. The most common form used for panic disorder and agoraphobia is cognitive behaviour therapy (CBT).
CBT can be short-term and helps you to learn:
- what triggers your symptoms
- how to cope with your symptoms
- how to change unwanted behaviours.
When choosing a healthcare professional to treat your panic disorder or agoraphobia, do your research and check the therapist’s qualifications and experience. The booklet, Panic disorder and agoraphobia. Australian treatment guide for consumers and , from the Royal Australian and New Zealand College of Psychiatrists provides information about the types of qualifications to look for.
Medication for panic disorder and agoraphobia
Treatment for panic disorder or agoraphobia can include either antidepressant or anti-anxiety medication. Some antidepressant medication can also be used to treat anxiety.
Self-help for panic disorder and agoraphobia
Other ways you can support your own mental wellbeing include:
- eating a healthy diet
- exercising
- searching online to find information or courses – check out and This way .
- seeking out support groups or online forums
- staying connected with family and friends
- • training in relaxation practices.
Frequently Asked Questions about Panic Disorder
What are the common symptoms of panic disorder?
Common symptoms of panic disorder include recurrent, unexpected panic attacks that significantly worry about the person and impact their daily functioning. Panic attack symptoms include sweating, shaking, sensations of shortness of breath, feeling like one is being choked, chest pain, nausea, feeling dizzy, chills or heat sensations, pounding heart or palpitations, fear of losing control, and/or fear of dying.
How common is a panic disorder?
Between 2 to 3 percent of American adults will have a panic attack in the past year. Panic disorder usually begins in young adulthood (ages 20 to 24 years old is the usual onset time), but can also begin earlier or later in life. Latinos, African Americans, Asian Americans, and Carribean blacks all report lower rates of panic disorder compared to non-Latino whites.
Is panic disorder serious?
Panic disorder is real condition and is potentially disabling. The distress of the panic attack itself can rob a person of their quality of life. The anticipation of the next panic attack can be just as powerful, keeping people from driving their cars or, in extreme cases, even leaving their homes.
What causes panic disorder?
Like most mental illnesses, we don’t know exactly what causes the panic disorder. Scientists believe it is likely a combination of factors that include genetics, biology, and psychology.
Some researchers feel that the mechanism in the brain that alerts people to potential danger in the environment misfires during a panic attack. A person having a panic attack experiences this “false alarm” and feels as if his life is truly in jeopardy.
Will I always have panic disorder? Can it be cured?
Many people are successfully treated for panic attacks and no longer suffer from them, so being cured of panic disorder is quite possible (but full remission is rare). As with all mental disorders, one needs to work at overcoming panic disorder. Psychiatric medication can help with this, but long-term relief is usually provided through learning psychological techniques that will help you cope with the bodily sensations you feel when a panic attack begins.
Most people will experience a chronic waxing and waning of the disorder, where a person experiences an episodic outbreak of the disorder from time to time throughout their life.
What common treatments are available for panic disorder?
Psychotherapy is usually the recommended treatment for panic disorder. Because many people get treated for panic disorder from their primary care physician, though, most people simply take anti-anxiety medication for treatment. Psychotherapy is usually focused on helping a person identify triggers and bodily cues and sensations associated with panic, then learning to apply immediate relaxation and imagery techniques to demonstrate control over these sensations. When practiced regularly, these techniques can be more effective than medications in helping to alleviate the most worrisome symptoms associated with panic disorder.
Does having a panic attack mean I’m crazy?
No, not at all. Lots of people get panic attacks and researchers believe it’s just a way that some people have mistaken normal body sensations in a way that feels more intense and uncomfortable than normal.