Panic disorder is an anxiety disorder characterized by panic attacks. The important distinguishable feature regarding panic disorder is the presence of repeated, unanticipated panic attacks. Panic disorder most often begins in late adolescence or early adulthood, and usually affects women more often than men. It is considered a rare disorder affecting less than 1% of the population.

Agoraphobia is anxiety related to being in places or situations, or the avoidance of places or situations in which escape might be difficult, or in which help may not be available.

The condition commonly arises from recurrent panic attacks that do not resolve. Persons with panic disorder usually worry about a future attack (anticipatory anxiety) and, in the case of panic disorder with agoraphobia, avoid places where they previously experienced attacks. First degree, biological relatives of individuals with Panic disorder have a four to seven times greater chance of developing the condition. Ninety-five percent of individuals with agoraphobia also have a current diagnosis of panic disorder.

The occurrence and severity of the panic attacks may vary greatly. Some attacks may occur quite frequently, e.g., once a week on a regular basis over several months, or others may experience short eruptions of more frequent attacks, e.g., daily for a week alternating with periods of no attacks, or less frequent attacks over many years.

Most often panic attacks peak within 10 minutes and usually dispel within minutes. Some of the most common symptoms include:

• Choking

• Trembling

• Gastrointestinal disturbance

• Diaphoresis

• Fear of losing control

• Dizziness

• Chest pain or discomfort

• Palpitations

• Increased heart rate

• Smothering sensation

• Fear of being detached from oneself

• Numbness or tingling sensation

• Chills or hot flashes.

• The diagnostic criteria for panic disorder without agoraphobia include:

• Both of the following components:

  • Repeated, unanticipated panic attacks

  • At least one of the panic-attack experiences is followed by:

    • Constant worry about having additional attacks

    • Concern about the repercussions of the attack or its consequences

    • Noteworthy behavioral changes related to the attacks.

• Absence of agoraphobia

• The panic attacks cannot be attributed to other causes, e.g., effects of substances (caffeine, drugs), or a general medical condition (hyperthyroidism)

• The panic attacks are not considered to be due to another mental disorder (social phobia, obsessive-compulsive disorder etc.).

Laboratory findings that assist in the diagnosis of this disorder have not been identified. However, there have been cases which have identified compensated respiratory alkalosis in patients with the disorder. On physical examination, some patients may exhibit periods of tachycardia and a mild increase in systolic blood pressure.

Medications and behavior therapy usually help control symptoms. Psychotherapy that includes supportive measures is an important part of the treatment. The medications most often used are antidepressants and anti-anxiety drugs to prevent or greatly reduce anticipatory anxiety, phobic avoidance, and the incidence and intensity of panic attacks. There are some new antidepressants that have shown promise for treating panic disorder. Some anti-anxiety drugs are considered to work more quickly than antidepressants, but have a tendency to cause physical dependence and adverse effects.

If the patient is taking an anti-anxiety drug, they may experience adverse effects including drowsiness, ataxia, and memory problems. Long-term drug treatment may be necessary because panic attacks often recur when drugs are discontinued. Exposure therapy can also be helpful. This form of behavior therapy confronts the patient with what is feared and often helps diminish the fear.