What is panic disorder?

When you have a panic attack, you are suddenly struck with an intense fear and sense of danger. You may have thoughts of doom or a fear of dying or of going insane. You also have physical symptoms such as dizziness or shortness of breath.

If you have panic attacks often or an ongoing fear of having another attack, you probably have panic disorder. You may not be able to predict when you will have panic attacks. They may even occur while you are asleep. The attacks can cause you to be afraid of being in places that might trigger an attack. Behavior to avoid this fear can be disabling.

People who have panic disorder usually begin having panic attacks when they are in their twenties. Over 1 million people in the U.S. have panic disorder. It is more common in women.

How does it occur?

The cause of panic disorder is not known, but it often runs in families. People with panic disorder have high rates of depression and bipolar disorder in their personal and family histories. Panic disorder sometimes occurs along with a fairly common heart condition called mitral valve prolapse.

Researchers are studying the chemistry and structure of the brain to try to discover the biological factors involved. They are also looking at possible emotional and mental factors that may contribute.

What are the symptoms?

Not everyone has the same symptoms, but possible symptoms include:

• sweating
• shortness of breath
• heart palpitations
• chest discomfort or pain
• unsteady feelings
• choking or smothering feelings
• tingling
• hot or cold flashes
• faintness
• trembling
• nausea or stomach distress
• feelings of unreality
• fears of losing control, dying, or going insane.

How is it diagnosed?

The doctor reviews your history and symptoms and does a complete physical exam. The doctor tests for physical illness, such as a heart attack or thyroid trouble.

You have panic disorder if you have:

• four or more panic attacks in a month or one panic attack in a month and an ongoing fear, which lasts at least a month, of having another panic attack
• at least four of the symptoms listed above.

How is it treated?

Your doctor may refer you to other health care providers for all or some of your treatment. The treatment may include some combination of the following three forms of therapy:

• Drug therapy (antianxiety and antidepressant medications), which helps weaken or block panic attacks.
• Cognitive therapy, which helps stop unrealistic "self- talk," such as "I'm losing my mind," which tends to make panic attacks worse. You learn to change anxious internal messages to more soothing commands, such as "Calm down, you're panicking over nothing."
• Skills to change your behavior, which will help you better tolerate the conditions that trigger your panic attacks. Relaxation exercises will help you learn how to relax your muscles and to breathe deeply and slowly when you feel an attack coming on. These skills will help you deal with anxiety caused by panic attacks.

There's a good chance that your panic attacks will weaken, occur less often, and go away entirely after several weeks of therapy.

Avoid drinks that contain alcohol or caffeine (coffee, tea, some soft drinks) because they can cause your attacks to recur. Use of cocaine, amphetamines, or marijuana can also trigger panic attacks.

For more information, contact:

National Institute of Mental Health, National Institutes of Health
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 800-64P-ANIC (800-647-2642)
Web site: http://www.nimh.nih.gov

You also may want to contact the National Mental Health Association (NMHA). NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's website address is http://www.NMHA.org.