People with panic disorder have feelings of terror that strike suddenly and repeatedly, most often with no warning. The frequency and severity of panic symptoms can vary widely. A person with this condition usually can’t predict when an attack will occur, and so many develop intense anxiety between episodes, worrying when and where the next one will strike. Between panic attacks there is a persistent, lingering worry that another one could come at any minute.
Panic disorder symptoms are primarily centered around panic attacks. Panic attacks often consist of a pounding heart, sweatiness, a feeling of weakness, faintness, or dizziness. The hands may tingle or feel numb, the person may feel flushed or chilled. There can be chest pain or smothering sensations, a sense of unreality, a fear of impending doom, or loss of control. The person may genuinely believe they are having a heart attack or stroke, losing their mind, or on the verge of death.
Panic attacks can occur any time, even during non-dream sleep. In the U.S., this type of panic attack has been estimated to occur at least one time in roughly one-quarter to one-third of individuals with panic disorder, of whom the majority also have daytime panic attacks. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more.
Panic disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men. It can appear at any age — in children or in the elderly — but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder. For example, many people have a single panic attack and never experience another. For those who do have panic disorder, though, it’s important to seek treatment. Untreated, the disorder can become debilitating.
In the U.S. and Europe, approximately one-half of individuals with panic disorder have anticipated panic attacks as well as unexpected panic attacks. Thus, as a recent change made to the criteria in the DSM-5, the presence of expected panic attacks no longer prevents the diagnosis of panic disorder. This change acknowledges that oftentimes a panic attack arises out of an already-anxious state (e.g., the person is worried about having a panic attack in a store and then actually has one).
Clinicians now make the decision whether a person’s expected panic attacks will count towards their client’s panic disorder diagnosis. They will usually classify expected panic attacks under panic disorder as long as the person’s concerns accompanying their panic attacks are centered around the fear of the panic sensations themselves, their consequences (e.g., “I could have died or gone crazy”), and of having them again in the future (e.g., the person makes special efforts to avoid returning to the place where that attack occurred).
Panic disorder is often accompanied by other conditions such as depression or alcohol/drug use to cope with or prevent symptoms. It may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you’re riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Some people’s lives become greatly restricted — they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house. On the other hand, they may be able to confront a feared situation only if accompanied by a spouse or another trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs.
When people’s lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.
Specific Symptoms of Panic Disorder
A person with panic disorder experiences recurrent either expected or unexpected panic attacks and at least one of the attacks has been followed by one month (or more) of one or more of the following:
- Persistent concern about about the implications of the attack, such as its consequences (e.g., losing control, having a heart attack, “going crazy”) or fears of having additional attacks
- A significant change in behavior related to the attacks (e.g., avoid exercise or unfamiliar situations)
The panic attacks may not be due to the direct physiological effects of use or abuse of a substance (alcohol, drugs, medications) or a general medical condition (e.g., hyperthyroidism).
Though panic attacks can occur in other mental disorders (most often anxiety-related disorders), the panic attacks in panic disorder itself cannot occur exclusive to symptoms in another disorder. In other words, attacks in panic disorder cannot be better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to a specific phobic situation), obsessive-compulsive disorder (e.g., on exposure to dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., in response to stimuli associated with a severe stressor), or separation anxiety disorder (e.g., in response to being away from home or close relatives).
Panic disorder is associated with high levels of social, occupational, and physical disability; considerable economic costs; and the highest number of medical visits among the anxiety disorders, although the effects are strongest with the presence of agoraphobia. Though agoraphobia may also be present, it isn’t required in order to diagnose panic disorder.
This criteria has been updated for the current DSM-5 (2013); diagnostic code: 300.01.