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Panic Attacks
(Panic Disorder)

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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• What are panic attacks?
• What are panic attack symptoms and signs in adults, teenagers, and children?
• Are panic attacks serious?
• What causes panic attacks?
• What is the treatment for panic attacks? What medications treat panic attacks?
• What are complications of untreated panic attacks?
• Panic Attack At A Glance
• Patient Discussions: Panic Attacks - Symptoms
• Patient Discussions: Panic Attacks - Symptoms
• Patient Discussions: Panic Attacks - Effective Treatments
• Find a local Psychiatrist in your town

"All of a sudden, I felt a tremendous wave of fear for no reason at all. My heart was pounding, my chest hurt, and it was getting harder to breathe. I thought I was going to die."

"I'm so afraid. Every time I start to go out, I get that awful feeling in the pit of my stomach and I'm terrified that another panic attack is coming or that some other, unknown terrible thing was going to happen."

Panic Attack Symptoms Medical Author: Melissa Conrad Stöppler, MD Medical Editor: William C. Shiel Jr., MD, FACP, FACR Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: "Racing" heart Feeling weak, faint, or dizzy Tingling or numbness in the hands and fingers Sense of terror, of impending doom or death Feeling sweaty or having chills Chest pains Breathing difficulties Feeling a loss of control Panic attacks are generally brief, lasting less than ten minutes, although some of the symptoms may persist for a longer time. People who have had one panic attack are at greater risk for having subsequent panic attacks than those who have never experienced a panic attack. When the attacks occur repeatedly, a person is considered to have a condition known as Panic Disorder. Find out about treatments for and causes of panic attacks » Top Searched Panic Attack Terms: panic disorders, treatment, temazepam, anxiety, fear, stress

What are panic attacks?

Panic attacks may be symptoms of an anxiety disorder. These attacks are a serious health problem in the U.S. At least 20% of adult Americans, or about 60 million people, will suffer from panic attacks at some point in their lives. About 1.7% of adult Americans, or about 3 million people, will have full-blown panic disorder at some time in their lives, twice as often for women than men. The peak age at which people have their first panic attack (onset) is 15-19 years. Another fact about panic is that this symptom is strikingly different from other types of anxiety; panic attacks are so very sudden and often unexpected, appear to be unprovoked, and are often disabling.

Childhood panic disorder facts include that about 0.7% of children suffer from panic disorder or generalized anxiety disorder and that although panic is found to occur twice as often in women compared to men, boys and girls tend to experience this disorder at an equal frequency.

Once someone has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point at which the mere idea of engaging in the activities that preceded the first panic attack triggers future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus, there are two types of panic disorder, panic disorder with or without agoraphobia. Like other major illnesses, panic disorder can have a serious impact on a person's daily life unless the individual receives effective treatment.

Panic attacks in children may result in the child's grades declining, avoiding school and other separations from parents, as well as substance abuse, depression, and suicidal thoughts, plans, and/or actions.

What are panic attack symptoms and signs in adults, teenagers, and children?

As described in the first example above, the symptoms of a panic attack appear suddenly, without any apparent cause. They may include

• racing or pounding heartbeat (palpitations);



• chest pains;



• stomach upset;



• dizziness, lightheadedness, nausea;



• difficulty breathing, a sense of feeling smothered;



• tingling or numbness in the hands;



• hot flashes or chills;



• trembling and shaking;



• dreamlike sensations or perceptual distortions;



• terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it;



• a need to escape;



• nervousness about the possibility of losing control and doing something embarrassing;
  
  
• fear of dying.

Although the duration of a panic attack can vary greatly, it typically lasts for more than 10 minutes, is one of the most distressing conditions that a person can experience, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause, or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include posttraumatic stress disorder (PTSD), schizophrenia, and intoxication or withdrawal from certain drugs of abuse.

Certain medical conditions, like thyroid abnormalities and anemia, as well as certain medications, can produce intense anxiety. Examples of such medications include stimulants like methylphenidate (Ritalin), diabetes medications like metformin and insulin, antimalarial medications like quinine, as well as corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron). As individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP), this possibility should be investigated by a doctor since MVP may dictate the need for special precautions to be taken when the individual is being treated for any dental problem. While the development of panic attacks have been attributed to the use of food additives like aspartame, alone or in combination with food dyes, more research is needed to better understand the role such substances may have on this disorder.

Anxiety attacks that take place while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic symptoms while sleeping tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and other psychiatric disorders compared to people who do not have panic attacks at night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.

While panic disorder in adolescents tends to have similar symptoms as in adults, symptoms of panic disorder in younger children are less likely to include the thought-based or so-called cognitive aspects. Specifically, teenagers are more likely to feel unreal or as if they are functioning in a dream-like state (derealization) or be frightened of going crazy or of dying.

Symptoms of panic attacks in women tend to include more avoidance of anxiety provoking situations, show more frequent recurrence, and more often result in the use of medical care compared to panic attack symptoms in men. The frequency of panic attacks may increase, decrease, or remain unchanged during pregnancy.