Panic disorder is 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
Signs of a panic disorder include anxiety and panic attacks.
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 a feeling of sudden and intense anxiety. It can come on very quickly for no clear reason, and can be very distressing.
Symptoms include:
- shaking, tingling, numbness (especially in hands, legs, or face)
- feeling disorientated, dizzy, lightheaded, faint
- feeling disconnected from your body
- feeling sick (nausea)
- rapid and irregular heartbeats (palpitations)
- dry mouth
- shortness of breath
- sweating, hot flushes
- a need to go to the bathroom urgently
- a ringing in your ears
- a feeling of dread or a fear of dying
In most cases, panic attacks last between 5 and 30 minutes before going away.
The number of attacks you have will depend on how severe your panic disorder is. Some people have attacks once or twice a month. Others have them a few 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 need to go to hospital if you have one.
The symptoms of panic attacks can also be symptoms of other health conditions. You may not always be having a panic attack. For example, you can have a racing heartbeat if you have very low blood pressure.
Causes of panic disorder
The exact cause of panic disorder is not known.
Most experts think it is a combination of biological and psychological factors.
Biological factors
This is when your body reacts in a certain way to specific situations.
Fight, flight or freeze response
Panic disorder is linked to your body's natural fight, flight or freeze response. This is your body's way of protecting you from stressful or dangerous situations - both real and imagined.
Anxiety and fear cause your body to release hormones like adrenaline. This can cause your breathing and heart rate to increase.
When you feel threatened, your body responds by preparing you to fight, run away or freeze. This automatic reaction is your body's way of protecting you from the threat.
With panic disorder, your fight, flight or freeze response may be triggered when it is not needed. This results in a panic attack, even if there is no obvious or imminent threat.
The fear network
This theory suggests that the brains of people with panic disorders may create stronger emotions, including fear. This can trigger a panic attack.
Spatial awareness
There is a link between panic disorder and spatial awareness. Spatial awareness is the ability to judge where you are in relation to other objects and people.
Some people with panic disorder have a weak sense of balance and awareness of space. This can cause them to feel overwhelmed and disorientated in crowded places. This can lead to a panic attack.
Psychological factors
Psychological factors that increase your risk of developing panic disorder include:
- a traumatic childhood experience
- a stressful event
- past mental health difficulties
- alcohol or drug use
- being in an unhappy relationship
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.
Talk 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
Talk therapy
Your GP may recommend talk therapy (counselling and psychotherapy).
They may be able to refer you for talk therapy or tell you ways to find a therapist.
Talk to your GP regularly while you're having therapy. They can assess your progress and see how you're doing.
The type of talk therapy you may have is cognitive behavioural therapy (CBT).
CBT and panic attacks
CBT is a type of talk therapy that helps you manage difficulties 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.
Medicine
If you and your GP 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
It's important to not to let your fear of panic attacks control you. Read our tips on how to handle panic attacks.
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 it.
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.
If untreated, panic disorder can increase your risk of:
Panic disorder in children
Panic disorder is more common in young people than in 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 has signs and symptoms of panic disorder, bring them to 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 CBT for your child.
They may also check for other anxiety disorders to find the cause of your child's panic attacks.
Content supplied by the NHS and adapted for Ireland by the HSE