You may have panic disorder if you find panic attacks are becoming a regular occurrence, and you live in fear of them.

If you’ve had a panic attack before, it’s natural to feel apprehension about having another one. This is part of living with panic disorder.

You might cringe at the thought of it but go on with your life. Or you might start changing your routines, creating new habits, and avoiding certain situations altogether because you fear another panic attack.

This, of course, is not a personal choice. It’s the strategy you’ve developed to cope with the strong emotions this situation causes you. Thankfully, there are a few options to manage and treat your symptoms.

Panic disorder is a type of anxiety disorder. It’s characterized by either recurrent panic attacks, an intense fear of these attacks, or both.

In other words, some people with panic disorder have frequent panic attacks. Others might only have a few, but their intense fear of having another one interferes with their quality of life.

Panic attacks might happen after you’re exposed to specific environmental or emotional triggers. But sometimes, their cause isn’t as evident.

Panic attacks aren’t the same as anxiety attacks, although anxiety is an essential aspect of panic disorder.

Anxiety may feel like a sense of worry or dread that comes on gradually. High levels of anxiety can sometimes act as triggers for panic attacks. This is why some people think panic attacks are the same as anxiety attacks.

But anxiety attacks don’t have a formal diagnosis or criteria. Both panic disorder and panic attacks do.

The symptoms of panic disorder don’t vary much between sex, gender, or age.

What a panic attack feels like is different for everyone, though.

Certain panic attack symptoms could be very intense for one person and not show up at all in someone else.

This might play a role in someone developing the disorder or not. People who experience more intense or frequent panic attacks might be more likely to develop panic disorder.

The most common symptoms of panic disorder include:

  • history of sudden, debilitating panic attacks
  • tendency to avoid places, people, or objects associated with traumatic events or previous panic attacks (or potentially stressful situations in general)
  • constant fear of a panic attack, even if you haven’t had one in a while

What is a panic attack?

Panic attacks can feel like many things if you aren’t aware you’re having one.

Some people believe they’re having a heart attack because some symptoms can feel similar.

There are three different kinds of panic attacks:

  • Uncued. The attack comes on with no clear reason.
  • Cued. A specific trigger, or the anticipation of one, causes the panic attack.
  • Situationally predisposed. This can come in response to a specific trigger, but the panic attack may not actually be caused by it.

To be diagnosed as a panic attack, four or more of these symptoms need to occur:

  • heart palpitations
  • sweating
  • trembling or shaking
  • shortness of breath
  • feeling like you’re choking
  • chest pain
  • nausea
  • dizziness or lightheadedness
  • derealization or depersonalization
  • fears of losing control or dying
  • numbness
  • chills or hot flashes

Can you inherit panic disorder? Is it the result of your experiences or childhood? Researchers aren’t completely sure.

In general, panic disorder is thought to be caused by:

Genetics

There might be some genetic predisposition if other people in your family have panic disorder. However, this isn’t always the case.

Trauma

People who’ve experienced a traumatic event in their lives may experience a panic attack if reminded of the event in some way.

A 2015 study even concluded that the chronic stress from sleep apnea may increase someone’s chances of developing panic disorder.

For many people, waking up repeatedly with a choking sensation can be a traumatic experience, similar to what you feel during a panic attack or when you’re shocked or scared.

All of the above

Panic disorder might be the result of trauma in people who have a family history of it and are genetically predisposed.

Triggers

Panic attacks usually come on after you’ve been exposed to a certain trigger, even if you’re not aware of it.

These triggers can be anything:

  • objects
  • places
  • people
  • smells
  • sensations
  • noises

The fear of another attack could also be a trigger itself.

A mental health professional can accurately diagnose panic disorder.

But diagnosing the condition may happen in two stages: a physical exam and a mental health evaluation.

Physical exam or review

Ruling out a physical condition that might induce panic attacks or mimic its symptoms is often the first step a doctor will take.

Having a clean bill of physical health can also help during a panic attack to remind you the symptoms you’re experiencing are not fatal.

A health professional might want to order tests or exams. This way, they can make sure your symptoms aren’t caused by an underlying physical condition, an earlier injury, or a substance used.

A doctor might specifically look for signs and symptoms of:

  • a thyroid condition
  • heart disease
  • asthma
  • epilepsy
  • abnormal hormone activity
  • infections
  • cerebrovascular disease
  • disturbances of some blood chemical levels

They might also test for substances like:

  • alcohol
  • cannabis
  • cocaine
  • amphetamines
  • hallucinogens
  • prescription medications (regardless if they’re taken under a doctor’s order)

Meeting with a mental health professional

Once possible physical causes are ruled out, a mental health professional will be able to help you understand your panic attacks, even if you don’t fit the criteria for panic disorder.

You’ll often be asked questions like:

  • How often do you have panic attacks?
  • How do the panic attacks after your daily life?
  • Do you have symptoms of other mental health conditions?

Your health professional will likely take this information and compare it to criteria for panic disorder:

  • unexpected, recurrent panic attacks
  • an attack followed by 1 month or more of constant concern over additional attacks or what they might cause, or a significant change in behavior brought on by the attacks

Symptoms of panic disorder may overlap with symptoms of other mental health conditions, including:

Panic disorder treatment usually consists of therapy, medication, or a combo of both.

Talk therapy — aka psychotherapy — is considered a first-line treatment for panic disorder.

Cognitive behavioral therapy (CBT), specifically, is considered an effective treatment and can help you figure out possible triggers for your panic attacks.

CBT has been studied for its effectiveness in treating conditions like anxiety disorders.

One 2019 analysis found that participants who attended 12 weekly individual CBT therapy sessions demonstrated overall improvement in their panic disorder symptoms.

Medication is sometimes included as part of panic disorder treatment. Options might include:

  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • selective serotonin reuptake inhibitors (SSRIs)
  • benzodiazepines
  • beta-blockers

Depending on the med, it may take time to start working. You may want to talk with your healthcare team about possible side effects and when you can expect to feel some relief.

Untreated panic disorder

Symptoms of panic disorder may get worse when the condition goes untreated.

This, in turn, may lead you to develop other symptoms and conditions like:

  • depression
  • agoraphobia
  • drug and alcohol use
  • suicidal thoughts

Panic disorder doesn’t have to stand in your way. It’s a manageable condition with a positive outlook.

Decreasing your anxiety levels and fears is possible.

To get support and more information, consider these resources: