What is panic disorder?

When you have a panic attack, you are suddenly struck with intense fear and an overwhelming sense of danger. You may have thoughts of impending doom or a fear of dying or of going insane. You also have a series of physical symptoms such as dizziness, shortness of breath, sweatiness, or nausea.

If you have panic attacks often or an ongoing fear of having another attack, you probably have panic disorder. People with panic disorder are often unable to predict when they will have panic attacks. They develop a fear of being in places or situations that might trigger an attack. The avoidance behavior associated with this fear (or agoraphobia) constitutes the major disability associated with panic disorder. Some attacks can occur while people are asleep.

People who have panic disorder usually begin having panic attacks in their twenties. Over one million Americans have panic disorder. It is more common in women.

How does it occur?

The cause of panic disorder is not known. The disorder often runs in families and therefore may be inherited. People with panic disorder also have high rates of mood disorders in their personal and family histories. Researchers are studying the chemistry and structure of the brain to try to discover the biological factors involved. Other studies are looking at possible emotional and psychological contributing factors. Panic disorder has occasionally been associated with a fairly common and nondangerous cardiac condition called mitral valve prolapse.

What are the symptoms?

Not everyone has the same symptoms, but possible symptoms include:

• sweating

• shortness of breath

• heart palpitations

• chest discomfort or pain

• unsteady feelings

• choking or smothering sensations

• tingling

• hot or cold flashes

• faintness

• trembling

• nausea or abdominal distress

• feelings of unreality

• fears of losing control, dying, or going insane.

How is it diagnosed?

The doctor reviews your history and your symptoms, gives you a thorough physical exam, and does any tests necessary to rule out physical illness, such as a heart attack or thyroid trouble. You have panic disorder if you have:

• four or more panic attacks in a month or one panic attack in a month and an ongoing fear, which lasts at least a month, of having another panic attack

• at least four of the symptoms listed above.

How is it treated?

Your doctor may refer you to other health care professionals for all or some of your treatment. The treatment may include some combination of the following three forms of therapy:

• Drug therapy (antianxiety and antidepressant medications), which helps weaken or block panic attacks.

• Cognitive therapy, which helps stop unrealistic 'self- talk,' such as 'I'm losing my mind,' that tends to magnify panic attacks. You learn to change anxious internal messages to more soothing commands, such as 'Calm down, you're panicking over nothing.'

• Techniques to change your behavior, which will help you better tolerate the circumstances that trigger your panic attacks. Relaxation exercises will help you learn how to relax your muscles and to breathe deeply and slowly when you feel an attack coming on. These techniques will help you deal with anxiety caused by panic attacks.

Your treatment may also include a kind of therapy called psychodynamic psychotherapy. This part of your treatment can help you deal with possible long-term psychological causes or consequences of panic disorder.

There's a good chance that your panic attacks will weaken, occur less frequently, and often go away entirely after several weeks of therapy.

Avoid drinking beverages that contain alcohol or caffeine (coffee, tea, soft drinks) because they can cause your attacks to recur. Use of cocaine, amphetamines, or marijuana can also trigger panic attacks.

For more information, call the National Institute of Mental Health Panic Disorder Education Program at 1-800-64-PANIC.