Panic Disorder

Overview

Panic disorder refers to recurrent, unexpected panic attacks (e.g., heart palpitations, sweating, trembling) followed by at least one month of:

• constant concern about having another panic attack or the consequences of a panic attack (e.g., having a heart attack), and/or
• significant behaviour changes related to the attacks (e.g., avoiding exercise or places for fear of having a panic attack).

A panic attack is a sudden feeling of intense fear or discomfort that peaks within minutes. It includes stressful physical and cognitive symptoms as well as behavioural signs.

Signs & Symptoms

Physical symptoms include:

• pounding heart
• sweating
• trembling or shaking
• shortness of breath
• feelings of choking
• chest pain or discomfort
• dizziness or nausea
• sensations of heat or cold
• numbness or tingling
• feelings of unreality or being detached.

Cognitive symptoms include thoughts such as:

• “I’m having a heart attack.”
• "I’m suffocating.”
• "I'm losing control."
• "I'm going crazy."

Behavioural signs include:

• avoiding places where the person had anxiety symptoms in the past (e.g., a certain grocery store) or similar places (e.g., all grocery stores)
• avoiding travel, malls, line-ups
• avoiding strenuous activities (e.g., exercise).

Causes & Risk Factors

It is not known exactly why some people develop panic disorder, although research suggests that various factors may be involved. Like most mental health problems, panic disorder appears to be caused by a combination of biological and psychological factors and challenging life experiences, including:

• stressful or traumatic life events
• a family history of panic disorder
• other medical or psychiatric problems.

Diagnosis & Treatment

Many psychological treatments, such as relaxation training, meditation, biofeedback and stress management, can help with panic disorder. Many people with panic disorder also benefit from supportive counselling or family therapy. However, experts agree that the most effective form of treatment for panic disorder is cognitive-behavioural therapy (CBT). Medications have also been proven effective, and many people receive CBT and medication in combination.

Frequently Asked Questions

What is the difference between panic attacks and panic disorder?

Having a panic attack does not mean that you have panic disorder. You may experience a panic attack if you are stressed or overtired, or if you have exercised excessively. Panic attacks only become a problem if you are constantly worried about having another attack, or if you are afraid that something bad will happen because of a panic attack (e.g., fainting, having a heart attack, going crazy). This fear results because the panic attacks are unexpected and unpredictable. This is different from having an expected panic attack, which could occur if you go on a Ferris wheel and you are afraid of heights.

Sources:
Diagnostic and Statistical Manual of Mental Disorders (5th ed.) © 2013 American Psychological Association
Panic disorder © AnxietyBC

Related Programs and Services

• Treatment at CAMH: Access CAMH
• Help for families from CAMH 
• ConnexOntario
• Kids Help Phone at 1 800 668-6868

Additional Resources

• Anxiety: An Information Guide (PDF)
• Cognitive-Behavioural Therapy: An Information Guide  (PDF)
• Understanding Psychiatric Medications: Anti-anxiety medications (benzodiazapines)