James J. De Santis, Ph.D.
Post Office Box 894, Glendora, CA 91740-0894
(818) 551-1714

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What is Panic Disorder?

We can all experience anxiety from time to time, from pressures of work,
finances, or relationships. But panic disorder is something different.

The core symptom of panic disorder is a series of sudden, unexpected
surges of intense fear with no actual danger or threat.

While panic disorder usually begins without a precipitating event, research
suggests that the first episode may be preceded by a period of great

The first panic attack may have been completely spontaneous or may have
followed an exciting or traumatic incident. Panic attacks can happen at any

Episodes often begin with about ten minutes of rapidly increasing symptoms
that usually last no longer than an hour. Episodes occur on average twice a
week but may fluctuate.

Panic disorder occurs in about 1 to 2 percent of adults. It occurs in twice
as many women as men. The first episode tends to occur in young

Often, people with panic disorder are first diagnosed by their physician. In
many cases, people with panic disorder first seek treatment from an
emergency room, having feared they were experiencing a heart attack or

Panic disorder is a debilitating condition. Relationships as well as school or
work performance may suffer from its effects. A person may begin to fear
going to work or school, spending time with friends, or engaging in everyday

Signs of Panic Attack

The main physical signs of panic attack are:

Racing, pounding, or skipping heartbeat
Chest pain or chest tightness
A choking sensation or difficulty breathing
Dizziness, feeling unsteady, faintness
Numbness and tingling in the hands or feet
Nausea or abdominal pain
Trembling or shaking

The main psychological symptoms of panic attack are:

Intense fear or a sense of impending doom
Feeling like you are losing control of your mind
Difficulty concentrating
Feeling separated from your body
An urge to escape immediately

What You Can Do

Here is a series of steps you can use to manage a panic attack when it

1. Beforehand, accept that panic may appear.
2. When panic symptoms begin, just pause.
3. Focus your attention on doing manageable activities.
4. Avoid "what if" or catastrophic thinking.
5. Remind yourself that panic symptoms will pass.
6. Notice that symptoms are not intense for very long.
7. Appreciate your successes at functioning with panic.
8. Afterward, accept that panic may reappear.

When to Seek Help

If you experience recurrent unexpected panic attacks, if you experience
continuing concern about having more attacks, or if you begin to change
your behavior in response to the attacks, it is appropriate to seek a
professional consultation.


Panic disorder can be difficult to diagnose because it produces some of the
same symptoms as a variety of medical conditions, including cardiovascular
conditions like angina and hypertension; pulmonary conditions like asthma;
neurological disorders like epilepsy, migraine, and Meniere's disease; and
endocrine disorders like diabetes, premenstrual syndrome, menopause, and

A number of other biological factors can produce panic-like symptoms as
well, such as electrolyte disturbances and systemic infections.

Panic-like episodes can be induced by intoxication or withdrawal from
alcohol, caffeine, nicotine, cocaine, amphetamine, or sedatives.

Such potential alternate causes should be evaluated and ruled out by a
physician in a thorough physical examination. Once these factors are
eliminated as a possible cause, a mental health evaluation is the next step.


Panic disorder is a treatable condition. The following types of professional
treatment have been shown to be effective.

Cognitive exercises can be helpful to cope with the mental symptoms of
anxiety by identifying and changing fear-producing thoughts.

Specific relaxation techniques including muscle relaxation, imagery, and
breathing retraining may reduce the alarming physical symptoms.

Symptoms of anxiety can be treated by gradual exposure to build
confidence with feared places or situations.

Insight-oriented therapy can be of help by focusing on understanding and
resolving current life stresses or conflicts that may reinforce anxiety.

Medications can be of help to suppress or lessen the severity of physical
symptoms, especially if they are particularly disabling.

Consultations with the person's family can be useful to help family members
understand the problem, keep a positive attitude, and provide needed

Most patients diagnosed with panic disorder improve with treatment. About
half of all patients recover. About 20 percent do not change.

Those who have experienced symptoms for a shorter period of time and who
receive prompt treatment tend to show more improvement.

Alcohol and drug abuse complicate panic disorder in about 20 percent of
cases. Depression is involved in up to 70 percent of cases. These factors
may require treatment as well.
Overcoming Panic Attacks