panic disorder symptoms

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Panic Disorder Symptoms


SYMPTOMS AND COURSE OF PANIC DISORDER Initial Panic Attack
Often, a first panic attack seems to come out of nowhere, occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control.

This barrage of symptoms usually lasts several seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic attack can attest to the extreme discomfort they felt and to their fear that they had been stricken with some terrible, life-threatening disease or were "going crazy." Often people who are having a panic attack seek help at a hospital emergency room.

Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.

Nevertheless panic attacks usually take a person completely by surprise. This unpredictability is one reason they are so devastating.

Sometimes people who have never had a panic attack assume that panic is just a matter of feeling nervous or anxious – the sort of feelings that everyone is familiar with. In fact, even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, lose their minds, or be totally humiliated. These disastrous consequences don't occur, but they seem quite likely to the person who is suffering a panic attack.

Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, the attacks continue and cause much suffering.

Panic Attack Symptoms

During a panic attack, some or all of the following symptoms occur:

  • Terror – a sense that something unimaginably horrible is about to happen and one is powerless to prevent it
  • Racing or pounding heartbeat
  • Chest pains
  • Dizziness, lightheadedness, nausea
  • Difficulty breathing
  • Tingling or numbness in the hands
  • Flushes or chills
  • Sense of unreality
  • Fear of losing control, going "crazy," or doing something embarrassing
  • Fear of dying



Panic Disorder
In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear – called anticipatory anxiety or fear of fear – can be present most of the time and seriously interfere with the person's life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the grocery store.

People who develop these panic-induced phobias will tend to avoid situations that they fear will trigger a panic attack, and their lives may be increasingly limited as a result. Their work may suffer because they can't travel or get to work on time. Relationships may be strained or marred by conflict as panic attacks, or the fear of them, rule the affected person and those close to them.

Also, sleep may be disturbed because of panic attacks that occur at night, causing the person to awaken in a state of terror. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep and suffer from exhaustion. Also, even if there are no nocturnal panic attacks, sleep may be disturbed because of chronic, panic-related anxiety.

Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a physician yields no indication of a life-threatening condition. They may visit a succession of doctors seeking medical treatment for what they believe is heart disease or a respiratory problem. Or their symptoms may make them think they have a neurological disorder or some serious gastrointestinal condition. Some patients see as many as 10 doctors and undergo a succession of expensive and unnecessary tests in the effort to find out what is causing their symptoms.

This search for medical help may continue a long time, because physicians who see these patients frequently fail to diagnose panic disorder. When doctors do recognize the condition, they sometimes explain it in terms that suggest it is of no importance or not treatable. For example, the doctor may say, "There's nothing to worry about, you're just having a panic attack" or "It's just nerves." Although meant to be reassuring, such words can be dispiriting to the worried patient whose symptoms keep recurring. The patient needs to know that the doctor acknowledges the disabling nature of panic disorder and that it can be treated effectively.

Agoraphobia.   Panic disorder may progress to a more advanced stage in which the person becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. This condition is called agoraphobia. It affects about a third of all people with panic disorder.

Typically, people with agoraphobia fear being in crowds, standing in line, entering shopping malls, and riding in cars or public transportation. Often, these people restrict themselves to a "zone of safety" that may include only the home or the immediate neighborhood. Any movement beyond the edges of this zone creates mounting anxiety. Sometimes a person with agoraphobia is unable to leave home alone, but can travel if accompanied by a particular family member or friend. Even when they restrict themselves to "safe" situations, most people with agoraphobia continue to have panic attacks at least a few times a month.

People with agoraphobia can be seriously disabled by their condition. Some are unable to work, and they may need to rely heavily on other family members, who must do the shopping and run all the household errands, as well as accompany the affected person on rare excursions outside the "safety zone." Thus the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.

Brain and Mental Health


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


last update: February 2009


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