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Frequently Asked Questions about Panic Disorder

Q: What is the difference between an anxiety attack and a Panic Attack?

A: You may have heard people use the term "anxiety attack" when referring to times where they are experiencing a lot of worry, stress, or anxiety. Sometimes people use this term interchangeably with "Panic Attack", which is the technical term used by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to characterize periods where people have overwhelming feelings of fear that come on suddenly. During these attacks people often feel like they are dying, "going crazy", or losing control, and may experience shortness of breath, heart palpitations, chest pain or discomfort, or a choking or smothering sensation. These symptoms often cause people to want to flee the situation. In other words, Panic Attacks are much more intense than the feeling of being overly stressed, which most people experience from time to time. During a Panic Attack a person will experience four or more of the following symptoms, which will develop abruptly and reach a peak within ten minutes:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Feelings of unreality or being detached from oneself
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Numbness or tingling sensations
  13. Chills or hot flashes

Panic Attacks occur suddenly, without any warning. The level of fear is way out of proportion to the actual situation. For instance, Panic Attacks can occur while driving or shopping at the supermarket when nothing dangerous is happening (e.g., no automobile accident involved, the store is not being robbed, etc.). These attacks typically last only a few minutes because the body cannot sustain the 'fight or flight' response for longer than that. 1 Individuals can experience repeated attacks over the course of several hours.

Q: What is Panic Disorder?

A: It is not uncommon for people to have isolated Panic Attacks without developing the disorder. 2 In order to meet criteria for Panic Disorder an individual has to have recurrent, unexpected Panic Attacks, and must have concerns about having subsequent attacks.

    Recurrent, Unexpected Attacks:

    Panic Attacks must occur out of the blue and are not associated with particular situations or triggers. People who experience panic symptoms in the presence of stimuli associated with particular fears or stressors may be suffering from other anxiety disorders. For instance, a person who only experiences panic in the presence of heights is likely to have a specific phobia. A former World Trade Center employee and 9-11 survivor who experiences panic symptoms when exposed to disaster-related media is likely suffering from Posttraumatic Stress Disorder.

    Concerns About Subsequent Attacks:

    For a month or more after at least one of the attacks, one or more of the following must occur:

    • Persistent concern about having additional attacks
    • Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
    • A significant change in behavior related to the attacks

If you think you might be suffering from Panic Disorder, complete this self-test. If you are interested in sharing the results with your provider, be sure to print out your results to discuss at your next doctor's appointment.

Q: What is Agoraphobia?

A: Panic Disorder is diagnosed with or without Agoraphobia. Agoraphobia is the fear of being in places or situations (e.g., in public alone, in an automobile, or in crowds) because if one has a Panic Attack or panic-like symptoms it would be embarrassing, difficult to escape, or help may be unavailable. As a result, people will either avoid these situations, require someone to accompany them, or endure these situations with intense discomfort and fear about having a Panic Attack. Unlike a specific phobia where people will avoid particular feared situations (e.g., public speaking, riding in an airplane, entering the crawl space where spiders may be lurking), a person with agoraphobia will avoid numerous situations, including leaving the house all together. People with Posttraumatic Stress Disorder often avoid specific stimuli that are associated with a particular stressor (e.g., war movies, in the case of combat-related PTSD, or parking garages, if someone was assaulted in a parking garage), which is different from Agoraphobia.

Q: How does one distinguish between symptoms of Panic Disorder and serious medical problems, such as a heart attack?

A: It is not uncommon for people to think they are experiencing a heart attack, when in fact they are having a Panic Attack. Although chest pain or discomfort can occur during a Panic Attack, cardiac arrest entails a crushing pain in the chest, usually accompanied by pains that shoot downward through the arm. 2 More.

Sometimes people think that they are going to faint during a Panic Attack, which is probably due to the dizziness that accompanies hyperventilation. In fact hyperventilation and elevated heart rate and blood pressure protect against fainting. 2 Additionally, the fight or flight reaction experienced during a Panic Attack is designed to help the individual protect against threat, and therefore it is not dangerous. 2

Q: How common is Panic Disorder?

A: It is estimated that 2.4 million American adults ages 18 to 54 (1.7%) have Panic Disorder in a given year. 3 Twice as many women as men develop Panic Disorder. 4 People who suffer from Panic Disorder often suffer from other disorders, such as depression and substance abuse. 5

Q: What treatments are helpful for Panic Disorder?

A: Cognitive-behavioral therapy (CBT) has been shown to be beneficial in the treatment of Panic Disorder. 6 It includes multiple components:

  • Education about the nature of anxiety and panic
  • Cognitive strategies focused on changing unhelpful beliefs and shifting anxious thoughts that trigger panic and maintain anxiety (e.g., "I'm going to die if I have a panic attack" vs. "This is a feeling that will pass and will not kill me.")
  • Identifying triggers for panic
  • Developing skills to cope with Panic Attacks (e.g., relaxation techniques)
  • Reducing avoidance behaviors by exposure to feared, but not dangerous, bodily sensations (e.g., anxiety feelings) and stimuli (e.g., being in public or driving). Through exposure the person comes to see that the situation or feeling will not cause harm, and these experiences lose their ability to cause the individual to feel afraid. 2
  • Weekly homework assignments to practice strategies learned in treatment.

CBT can be applied in individual or group formats, and studies show that it has a high success rate of curing Panic Disorder. 2

Anti-anxiety and some antidepressant medications are effective for treating Panic Disorder. 2 Some medications work better for different people. There are individual patient factors and drug side effect profiles that may favor one class of antidepressants over another for a given individual. A provider can work with you to determine which medication is most effective for you. More about medications for Panic Disorder

Q: How do I locate specialists or support groups for Panic Disorder?

A: You can contact any of the following organizations, which have referral capabilities:

Q: Do I have to see a specialist in order to get help?

A: Your primary care manager or (PCM) may be able to prescribe an appropriate medication for treatment of Panic Disorder. If your PCM believes it is necessary to seek specialty care, they will be able to assist you to that next level of care. There are also a number of steps you can take on your own to address your panic symptoms. Check out the self-help tools offered by this site. Finally, not all helpers are professionals. Sometimes family, friends, or clergy can be the best sources of support.

Q: Is Panic Disorder treatment a covered TRICARE benefit?

A: TRICARE beneficiaries are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility. More

References:

1 The American Psychological Association(2006). Answers to Your Questions About Panic Disorder.

2 Vickers, K., & McNally, R. J. (in press).Evidence-based therapy for panic disorder.In J. E. Fisher & W. O'Donohue (Eds.), Practitioner's guide to evidence-based psychotherapy. New York: Kluwer.

3 Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.

4 Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

5 Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.

6 Chambless, D. L., Baker, M. J. Baucom, D. H., Beutler, L. E., Calhoun, K.S. Crits-Christoph, P., Daiuto, A. et al. (1998). Update on the Empirically Validated Therapies II. The Clinical Psychologist, 51, 1, 3-16.