Panic Disorder and Panic Attacks: What is it?

People often talk about having a “panic attack” and feeling “panicked” in an anxiety provoking situation, alluding to a state of heightened anxiety and arousal. But what exactly is a panic attack, and when does it become Panic Disorder?

A Panic Attack is defined by a sudden period of intense fear or discomfort, which reaches a peak within minutes, and during which time, four or more of the following symptoms occur:

  • Palpitations, pounding heart, or accelerate heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealisation (feeling 'unreal') or depersonalisation (feeling detached from yourself)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations
  • Chills or hot flushes

Panic attacks tend to start relatively quickly, and peak within 10 minutes. This peak generally lasts for approximately 5-10 minutes before gradually declining. However, it can take longer for all the symptoms of subside.

Panic Disorder is characterised by repeated panic attacks which occur often without warning and are accompanied with a preoccupation with the fear of experiencing another attack. It typically begins in adolescence or early adulthood; however, children can also experience panic-like symptoms and panic disorder. Panic Disorder affects 1-2% of the Australian population each year, and women seem to be two times more likely to develop Panic Disorder than men.

For a Panic Attack to become Panic Disorder, at least one of the panic attacks has been followed by one month or more of the following:

  • Persistent worry about additional panic attacks or their consequences (e.g., having a heart attack, fainting, embarrassing yourself, losing control, “going crazy”)
  • Significant change in behaviour related to the attacks that is classified as maladaptive (e.g., behaviours attempting to avoid experiencing panic attacks like avoiding exercise or unfamiliar situations)

Panic Attacks vs Panic Disorder

Experiencing panic attacks does not automatically mean you have Panic Disorder. Panic attacks are a relatively common experience and can occur for a variety of reasons, including feeling stressed, overtired, or even after excessive exercise. It is only when you become persistently and excessively worried and concerned about experiencing more panic attacks, or the consequence of experience a panic attack before panic attacks become panic disorder.

It is also possible to experience panic attacks when you have another anxiety disorder. For example, people with social anxiety experiencing a panic attack before or during an oral presentation, or someone with a specific phobia of dogs experiencing a panic attack whenever they are near a dog. However, because these attacks have a known trigger (e.g., being near/around a dog, the thought of giving a speech in front of 500 people), it does not fit the diagnostic criteria for Panic Disorder.

Panic attacks can also occur because of medical conditions (e.g., Thyroid Disorder). Hence it is important to speak to a trained healthcare professional if you are experiencing panic attacks often.

What causes it?

While the specific causes of panic attacks and panic disorders are unknown, research has identified several risk factors, that, in interaction with each other, can increase the likelihood for an individual to develop panic disorder. These include:

  • Having an anxious temperament
  • Family history of anxiety or other mental health disorders
  • Exposure to stressful life events
  • Misinterpreting harmless bodily sensations as threatening

What can be done?

Psychotherapy can be very useful in treating panic disorder, and typically involves an assessment session, where you and your psychologist identify your problematic symptoms, the triggers for these symptoms (thoughts and situations), and how these impacts you. This information will then be used by your psychologist to develop a tailored evidence-based intervention that will best suit you and your needs.

Cognitive Behavioural Therapy (CBT) has repeatedly been shown to be an effective first-line treatment for panic attacks and panic disorder. Working with a psychologist, CBT teaches you to develop different ways of thinking and behaving in response to the feelings and sensations that come on with a panic attack. Treatment for panic disorder also incorporates gradual exposure to bodily sensations and/or situations previously avoided due to panic attacks, with the goal of gradually decreasing the sensitivity of the anxiety system so that it is less frequently activated.

Other forms of therapy that are also effective in treating panic disorder include Acceptance and Commitment Therapy (ACT) and Mindfulness-based CBT. These strategies differ from traditional CBT in that they provide individuals with the tools to separate and distance themselves from their thoughts and feelings, and accept that these can be present without making a negative impact on their lives.