What is Panic Disorder?
Panic Disorder is a treatable mental health condition where people experience repeated, unexpected panic attacks and then become very worried about having more attacks or change their behaviour significantly because of them. Panic disorder affects roughly 1–5% of people over their lifetime, with many first experiencing symptoms in late adolescence or early adulthood. It is about twice as common in women as in men.
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes, usually with several physical and emotional symptoms (for example: palpitations, shortness of breath, chest pain, dizziness, sweating, shaking, feelings of unreality, fear of dying or “going crazy”).
In panic disorder, these attacks keep coming back, and you may:
- Worry constantly about the next attack
- Worry about what the attacks mean (“I’ll die”, “I’ll lose control”, “I’ll embarrass myself”)
- Start avoiding places or activities where you fear an attack might happen.
Effective therapies and medications exist; combined with lifestyle changes, many people notice strong improvements within weeks to months.
Panic Disorder in the workplace
At work, panic disorder can show up as:
- Avoiding meetings, presentations, public speaking or travel
- Leaving situations suddenly due to anxiety or physical symptoms
- “Presenteeism” – being at work but working far below your potential due to fear and exhaustion
- Worry about being judged or losing your job if a panic attack happens at work.
With understanding, clear plans and reasonable adjustments (like flexible breaks, predictable time to step out, or remote options), many people with panic disorder function very well and bring strong empathy, preparation and problem-solving skills to their roles.
Panic Disorder Symptoms
Core symptoms
- Recurrent, unexpected panic attacks – intense fear or discomfort that reaches a peak within minutes, often with:
- Pounding or racing heart
- Sweating, shaking, or feeling very hot or cold
- Shortness of breath, choking sensation or chest discomfort
- Dizziness, light-headedness or feeling faint
- Nausea or stomach upset
- Numbness or tingling sensations
- Feelings of unreality (derealisation) or feeling detached from yourself (depersonalisation)
- Fear of losing control, “going crazy” or dying.
- Persistent worry for at least a month about:
- Having more panic attacks
- What the attacks mean (e.g. “I must have a serious heart problem”).
- Behaviour changes related to the attacks, such as:
- Avoiding exercise, travel, crowds, public transport, driving or being far from home
- Always needing a “safe person” or quick escape route
Symptoms must cause significant distress or interference with daily life and not be better explained by substances, medications or other medical conditions.
How it may feel day-to-day
- Fear of panic attacks starts to shape your calendar and travel routes. You leave early or skip work/school because you fear an attack.
- You scan your body constantly for signs that an attack is starting, reassurance seeking.
- Everyday things – like getting on a bus, sitting in the middle of a row, or exercising may feel risky.
- Sleep disruption, including waking in panic, "nocturnal panic" can occur.
- You may swing between hyper-vigilance (“I need to monitor everything”) and exhaustion from constant fear.
- It can feel embarrassing or shameful, especially if people around you don’t understand.
- Frequent ER or GP visits for chest pain or breathlessness with normal tests.
When to seek help
Seek (emergency department/ambulance) if:
- You have chest pain, severe shortness of breath, or other symptoms that could indicate a heart or breathing emergency, especially if it’s your first time or the symptoms feel different or worse than usual.
Talk with a mental health professional if:
- You’ve had repeated panic attacks and are worrying about the next one
- You are avoiding important parts of life (work, study, parenting, travel, social events) because of fear
- You’re using alcohol, nicotine, or other drugs to try to manage panic
- There are thoughts of self-harm or suicide, or you feel hopeless about getting better.
How Do You Assess for Panic Disorder?
Panic disorder often occurs alongside other mental health conditions. Assessing panic disorder can be difficult because panic attacks also occur as a part of other anxiety disorders, PTSD, substance use and certain medical conditions. Research suggests:
- Many people with panic disorder also experience major depression at some point.
- Agoraphobia (fear and avoidance of places where escape might be hard or help unavailable) can develop when people start to organise their lives around avoiding panic.
- Other anxiety disorders (GAD, social anxiety, specific phobias) and substance use can be common, particularly if people are using alcohol or drugs to try to "calm down".
Because of this, using single disorder assessment tools like the Panic Disorder Severity Scale (PDSS), Panic and Agoraphobia Scale (PAS), Beck Anxiety Inventory (BAI), or GAD-7 risks assessing someone with panic disorder but missing out on a co-occurring condition. It’s important to assess panic disorder in the broader context of your mental health, not as an isolated problem. Therefore, a formal diagnosis should involve a few steps:
- Start with a broad multi-disorder mental health screen: Multi-disorder tools (like Loffty) are better than single-disorder checklists at sorting out whether your symptoms fit best with panic disorder, another condition (such as GAD, depression, PTSD, social anxiety, substance use) or a combination. They also flag important co-occurring issues like insomnia, burnout or trauma.
- Share your results with a qualified clinician: Once assessed, depending on your country, a formal diagnosis may be made by a GP, psychologist, psychiatrist or other trained professional. They will:
- Take a detailed history of your panic attacks, triggers and avoidance
- Explore other symptoms (mood, trauma, obsessive thoughts, substance use)
- Look at how panic is affecting work, study, relationships and daily life.
- Rule out medical causes: Because panic and heart/breathing/thyroid/metabolic problems can share symptoms, your clinician may:
- Check heart rate, blood pressure and oxygen levels
- Order blood tests, an ECG or other investigations where appropriate
- Seek to rule out substance/medication effects (stimulants, cannabis; withdrawal from sedatives or other drugs).
What to bring to an appointment
- A panic attack diary (date/time, what you were doing, symptoms, duration).
- Details about medications/supplements/caffeine/alcohol use and any substance use.
- Medical history (thyroid, cardiac, respiratory), recent labs/ECG if available.
- Questions about therapy, medication, and self-management preferences.
How Do You Treat Panic Disorder?
Treatment is individual, and the best results often come from a combination of lifestyle changes, structured psychological therapy and, in some cases, medication.
Lifestyle
- Sleep & routine: Regular sleep and wake times, and a wind-down routine, help stabilise the nervous system and reduce vulnerability to panic.
- Movement: Regular moderate exercise supports mood and nervous-system regulation. If you fear bodily sensations (heart rate, breathlessness), this can be incorporated gradually under guidance.
- Reduce aggravators: Caffeine, nicotine, some cold medicines and stimulants can all mimic or amplify panic sensations. Reducing or avoiding them can lower background anxiety.
- Skills: Breathing retraining (slow, diaphragmatic breathing), grounding skills, muscle relaxation and mindfulness can help you stay present while you work on fear of bodily sensations.
- Social connection and support: Let trusted people know what helps in a panic episode (e.g. giving you space, staying calm, reminding you it will pass), and avoid well-meaning but unhelpful “rescue behaviours” that keep avoidance going. Supportive relationships reduce relapse risk.
Talk Therapy
Cognitive-behavioural therapy (CBT) is the best-supported psychological treatment for panic disorder. It usually includes:
- Psychoeducation: learning how panic works in the body and brain
- Interoceptive exposure: gently and repeatedly bringing on feared sensations (like dizziness or a racing heart) in a controlled way so you learn they are uncomfortable but not dangerous
- Situational exposure: gradually facing avoided places (e.g. public transport, shopping centres, lifts, driving) together with new coping skills
- Cognitive strategies: noticing and testing catastrophic thoughts (“I’ll die”, “I’ll faint and never get up”) against what actually happens
- Relapse prevention: planning how to respond to future spikes in anxiety so you don’t fall back into avoidance.
Other useful approaches can include Acceptance and Commitment Therapy (ACT) and mindfulness-based interventions, often blended with CBT principles.
Medication
Medication doesn’t “cure” panic disorder, but can reduce the intensity and frequency of attacks while you build long-term skills in therapy. Evidence and guidelines generally recommend:
- SSRIs / SNRIs (antidepressants)
- Often first-line for panic disorder (e.g. sertraline, escitalopram, paroxetine, venlafaxine – names vary by country).
- Usually taken daily, not as-needed.
- Effects build over several weeks; initial side effects (like mild nausea or jitteriness) often settle.
- Benzodiazepines
- Sometimes used short-term to manage severe symptoms or while waiting for antidepressants and therapy to work.
- Can cause dependence and tolerance if stopped abruptly after regular use.
- Because of risks, many guidelines recommend cautious, time-limited use under close medical supervision.
- Other medications
- Occasionally, prescribers may use other agents (e.g. some tricyclics, certain anticonvulsants or atypical antipsychotics) in complex cases, or to treat important co-occurring conditions.
Medication choices and dosing should always be discussed with a qualified prescriber who knows your medical history, current medications and preferences.
Other Treatments
- Group programs/workshops: CBT-based anxiety and panic groups, in person or online, can provide education, skills and peer support.
- Digital CBT: app- or web-based programmes can expand access, particularly when supported by a clinician or coach.
- Peer support: support groups or communities of people with lived experience of panic can be encouraging, but use online advice cautiously, as what helps one person may not suit another.
Panic Disorder Research
What is the state of the evidence?
Research shows that panic disorder arises from a mix of genetic vulnerability, life stress, learning history and how a person interprets bodily sensations. Brain circuits involving the amygdala, brainstem and prefrontal areas are key in rapid alarm responses and the regulation of fear and safety learning.
Key current research themes include:
- Etiology/biopsychosocial: Why some people develop panic disorder after an initial attack while others do not (e.g. genetic sensitivity, history of anxiety, learning experiences).
- Comorbidity: High overlap with depression, other anxiety disorders and substance use, which can worsen severity and increase suicide risk. Addressing both/all improves outcomes.
- Treatment efficacy: Strong evidence for CBT, including interoceptive/situational exposure. SSRIs/SNRIs are effective pharmacotherapies, but the choice should be guided by preference, access, and individual side-effect profiles.
- Relapse and long-term outcomes: Many people maintain gains after treatment, especially with CBT, but some experience relapse; there is growing research on booster sessions and relapse-prevention strategies.
Books and Resources About Panic Disorder
- Mastery of Your Anxiety and Panic (MAP) – David H. Barlow & Michelle G. Craske. Part of the Treatments That Work series, with a client workbook and therapist guide. A highly structured CBT programme for panic disorder and agoraphobia, including breathing skills, interoceptive and situational exposure and relapse prevention.
- Panic Attacks Workbook: A Guided Program for Beating the Panic Trick – David Carbonell. A practical self-help workbook that explains how panic attacks work and offers step-by-step CBT and ACT-informed strategies, worksheets and exercises to change your relationship with fear.
- Dare: The New Way to End Anxiety and Stop Panic Attacks – Barry McDonagh. A popular, skills-focused approach that encourages a different way of responding to anxiety and panic, built on accepting and moving through sensations rather than fighting them.
Methodology caveats: Varying diagnostic systems (DSM vs. ICD), sample bias toward higher-income countries, and limited long-term follow-up in many trials.
