Panic disorder is an anxiety disorder in which a person has repeated, sudden panic attacks and then worries persistently about having more, or avoids situations because of them. A single panic attack is not panic disorder. A panic attack is a short episode of intense fear with physical symptoms such as a racing heart, and it is not dangerous.
Key points
- A panic attack is a sudden rush of intense fear with strong physical symptoms, usually lasting 5 to 20 minutes.
- Attacks are frightening but not dangerous, and will not cause physical harm.
- Panic disorder is more than one attack: it is repeated attacks plus lasting worry about more, or avoidance built around them.
- Attacks are often mistaken for heart problems: one review found panic disorder in 18% to 26% of emergency department chest pain patients.
- NICE recommends self-help first, then CBT of 7 to 14 hours or an antidepressant, and advises against benzodiazepines.
Symptoms
- A racing, pounding or irregular heartbeat, chest pain or tightness, shortness of breath or a choking feeling.
- Sweating, trembling, hot flushes, chills, dizziness or nausea.
- A sense of dread, or of losing control; fear of fainting, dying or having a heart attack.
- Between attacks: worry about the next attack, avoidance of places linked to a previous one, repeat visits to a GP or A&E.
Causes and risk factors
- Traumatic or very stressful life experiences; a close family member with panic disorder.
- An imbalance of neurotransmitters is one factor among several, not the whole explanation.
- Depression or substance misuse, which NICE names as common alongside it.
Treatment
- Step 2: self-help for mild to moderate panic disorder. Step 3: CBT (7 to 14 hours) or an antidepressant for moderate to severe cases.
- NICE states benzodiazepines are associated with a less good outcome long-term and should not be prescribed for panic disorder.
- An SSRI licensed for panic disorder is usually offered where medication is chosen.
When to speak to a professional
- You have had panic attacks and they are happening again.
- Worry about the next attack is changing where you go or how you travel.
- Self-help has not worked, or you are using alcohol or drugs to manage the attacks.
- You are 18 or over and in England: you can refer yourself to NHS Talking Therapies without a GP appointment.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.