Panic disorder

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

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

For someone with panic disorder, feelings of anxiety, stress and panic can happen regularly and at any time. They often happen for no obvious reason.

Symptoms

Anxiety

Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear.

You may start to avoid certain situations because you fear they'll cause another attack.

This can add to your sense of panic and may cause you to have more attacks.

Generalised anxiety disorder in adults

Panic attacks

A panic attack is when you have a rush of intense mental and physical sensations. It can come on very quickly and for no clear reason.

A panic attack can be very frightening and distressing.

Symptoms include:

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

Most panic attacks last for between 5 and 20 minutes. Some panic attacks can 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. Others have them several times a week.

Panic attacks can be frightening, but they're not dangerous. An attack will not cause you any physical harm. It's unlikely that you'll be admitted to hospital if you have one.

The symptoms of panic attacks can also be symptoms of other conditions or problems. You may not always be having a panic attack. For example, you can have a racing heartbeat if you have very low blood pressure.

When to see your GP

Talk to your GP if your symptoms have made everyday activities difficult for you.

They'll ask you:

• what symptoms you have
• how often the symptoms happen
• how long you have had the symptoms

They may also do a physical examination to rule out other conditions.

It can be difficult to talk to someone else about your feelings, emotions and personal life. But try not to feel too embarrassed.

You may be diagnosed with panic disorder if you have experienced at least:

• two unexpected panic attacks
• a 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 medicines are the 2 main treatments for panic disorder.

You may need 1 of these or both, depending on:

• your symptoms
• the severity
• how distressed you've been
• how long you've been having them
• the impact on your day-to-to day life

Psychological therapies

You can refer yourself to primary care psychology for treatment based on cognitive behavioural therapy (CBT).

If you prefer, you can see your GP and they can refer you.

Cognitive behavioural therapy (CBT) helps you manage problems by thinking in a more balanced way. It can help you to recognise unhelpful patterns of behaviour and recommend ways of coping.

You can talk to your therapist about how you react to a panic attack and what you think about when it happens.

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

Talk to your GP regularly while you're having CBT. They can assess your progress and see how you're doing.

Talking therapies

Medicine

If you and your doctor think it might be helpful, you may be prescribed an antidepressant.

You may also be prescribed an anti-epilepsy drug such as pregabalin.

If your anxiety is severe, a benzodiazepine such as clonazepam may be prescribed. This is for short-term or occasional use.

Referral to a specialist

Your GP may refer you to a mental health specialist such as a psychiatrist or psychologist. This can happen if your symptoms do not improve with CBT, group support or medicine.

The specialist will assess you and create a treatment plan to help you manage your symptoms.

Things you can try yourself

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

• do not 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 is not life-threatening

To reduce the chances of a further attack, it may also help to:

• read a self-help book about how to control anxiety using CBT
• try other therapies such as massage and aromatherapy
• try activities like yoga and Pilates to help you relax
• learn breathing techniques to help ease symptoms
• do regular physical exercise to reduce stress and tension
• avoid sugary food and drinks, caffeine, alcohol and smoking as these can make attacks worse

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.

Ask your GP about support groups for panic disorder near you.

Organisations that provide mental health support

Complications of panic disorder

Panic disorder is treatable and you can make a full recovery. It's best to get help from your GP as soon as you can.

If you do not get help from your GP, panic disorder can 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.

Find out more about phobias.

Causes

The exact cause of panic disorder is not fully understood.

But it is probably linked to more than 1 thing, including:

• a traumatic or very stressful life experience, such as bereavement
• having a close family member with the disorder

Panic disorder in children

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

Panic attacks can be hard for children and young people to deal with. If they do not get early treatment, severe panic disorder can have a big impact on their life.

If your child displays the signs and symptoms of panic disorder, they should see their GP.

Their GP will go through their medical history and do a 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.

They may also screen for other anxiety disorders to find the cause of your child's panic attacks.