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Panic Disorder


COEXISTING CONDITIONS At the NIH conference on panic disorder, the panel recommended that patients be carefully evaluated for other conditions that may be present along with panic disorder. These may influence the choice of treatment, the panel noted. The following are among the conditions frequently found to coexist with panic disorder:

Simple Phobias.   People with panic disorder often develop irrational fears of specific events or situations that they associate with the possibility of having a panic attack. Fear of heights and fear of crossing bridges are examples of simple phobias. Generally, these fears can be resolved through repeated exposure to the dreaded situations, while practicing specific cognitive-behavioral techniques to become less sensitive to them.

Social Phobia.   This is a persistent dread of situations in which the person is exposed to possible scrutiny by others and fears acting in a way that will be embarrassing or humiliating. Social phobia can be treated effectively with cognitive-behavioral therapy or medications, or both.

Depression.   About half of panic disorder patients will have an episode of clinical depression sometime during their lives. Major depression is marked by persistent sadness or feelings of emptiness, a sense of hopelessness, and other symptoms.

When major depression occurs, it can be treated effectively with one of several antidepressant drugs, or, depending on its severity, by cognitive-behavioral therapies.

Symptoms of Depression

  • Persistent sadness or feelings of emptiness
  • A sense of hopelessness
  • Feelings of guilt
  • Problems sleeping
  • Loss of interest or pleasure in ordinary activities
  • Fatigue or decreased energy
  • Difficulty concentrating, remembering, and making decisions


Obsessive-Compulsive Disorder (OCD).   In OCD, a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. Such rituals as counting, prolonged handwashing, and repeatedly checking for danger may occupy much of the person's time and interfere with other activities. Today, OCD can be treated effectively with medications or cognitive-behavioral therapies.

Alcohol Abuse.   About 30 percent of people with panic disorder abuse alcohol. A person who has alcoholism in addition to panic disorder needs specialized care for the alcoholism along with treatment for the panic disorder. Often the alcoholism will be treated first.

Drug Abuse.   As in the case of alcoholism, drug abuse is more common in people with panic disorder than in the population at large. In fact, about 17 percent of people with panic disorder abuse drugs. The drug problems often need to be addressed prior to treatment for panic disorder.

Suicidal Tendencies.   Recent studies in the general population have suggested that suicide attempts are more common among people who have panic attacks than among those who do not have a mental disorder. Also, it appears that people who have both panic disorder and depression are at elevated risk for suicide. (However, anxiety disorder experts who have treated many patients emphasize that it is extremely unlikely that anyone would attempt to harm himself or herself during a panic attack.)

Anyone who is considering suicide needs immediate attention from a mental health professional or from a school counselor, physician, or member of the clergy. With appropriate help and treatment, it is possible to overcome suicidal tendencies.

There are also certain physical conditions that are often associated with panic disorder:

Irritable Bowel Syndrome.   The person with this syndrome experiences intermittent bouts of gastrointestinal cramps and diarrhea or constipation, often occurring during a period of stress. Because the symptoms are so pronounced, panic disorder is often not diagnosed when it occurs in a person with irritable bowel syndrome.

Mitral Valve Prolapse.   This condition involves a defect in the mitral valve, which separates the two chambers on the left side of the heart. Each time the heart muscle contracts in people with this condition, tissue in the mitral valve is pushed for an instant into the wrong chamber. The person with the disorder may experience chest pain, rapid heartbeat, breathing difficulties, and headache. People with mitral valve prolapse may be at higher than usual risk of having panic disorder, but many experts are not convinced this apparent association is real.

Brain and Mental Health


References and Sources: Medline, Pubmed, National Institutes of Health


last update: February 2009


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