What Is Panic Disorder (And What Can You Do About It)?
What is panic disorder?
Panic disorder is a specific type of anxiety disorder that occurs when people experience repeated and unexpected panic attacks. A panic attack is “a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause.” As you can imagine, panic attacks are very scary for the person experiencing them, and even for the people around them.
Some people have one or two panic attacks in their life, often in response to situational stress that goes away eventually. For others, the panic attacks happen unexpectedly, and often cause them to live in fear of the next attack. When a person has frequent panic attacks that cause them to live in fear in this way, they may have panic disorder.
What causes panic disorder?
The exact cause of panic disorder is unknown, like many mental health disorders. Experts suspect that there are a mix of causes and risk factors that can make developing panic disorder more likely. These include genetics, age, gender, environment, and trauma. Women are almost two times as likely to develop panic disorder than men, according to the National Institute of Mental Health (NIMH).
Research from the NIMH also suggests that about 2.7% of adults in the United States experience panic disorder, although this data was from 2001-2003, so the numbers may be different now.
What does a panic attack feel like?
A panic attack is a frightening experience. They often come without warning, though sometimes they occur in expected situations, like when taking off during a flight if the person experiencing them has a fear of flying. A lot of the time, though, panic attacks happen during ordinary, non-threatening situations and there’s no specific trigger. They cause intense physical reactions.
Many people describe it as feeling like they’re having a heart attack or even like they’re dying. Some of the symptoms of a panic attack include:
Sweating profusely
Rapid heart rate or pounding heart
Feeling dizzy or lightheaded
Chest pain
Trembling or shaking
Feeling extreme terror or impending doom
Nausea or other gastrointestinal issues
Chills
Shortness of breath or hyperventilating
Tingling or numbness
Headache
Feeling like you’re choking or your throat is closing up
Derealization (feeling detached from reality) or depersonalization (feeling detached from yourself)
Feeling like you’re dying or going crazy
Panic attacks typically last anywhere from a few minutes to an hour or more. Once a person has experienced a panic attack, they often live in fear of experiencing another one. This can cause major disruptions to their life as they try to avoid triggering another panic attack. They may become socially withdrawn or develop phobias as they try to keep themselves safe from feeling those symptoms again.
How is panic disorder diagnosed?
To be diagnosed with panic disorder, your provider has to rule out other causes of your panic attacks first, like another medical or psychiatric condition or responses to medications or substances.
The criteria for diagnosis in the DSM-5 (the diagnostic handbook in the US) states that a person with panic disorder must experience recurrent and unexpected panic attacks, and at least one panic attack followed by a month or more of fear of another attack which causes them to change their behavior to avoid situations that may trigger a panic attack. It also states that the panic attacks must not be able to be explained by another psychiatric condition.
While panic attacks are the main symptom of panic disorder, it can co-occur with other psychiatric disorders, like anxiety disorder, phobias, mood disorders, trauma, and psychotic disorders. It’s helpful to be evaluated by a diagnostician who can determine if you are experiencing a co-occurring disorder in addition to panic disorder so you can receive the appropriate treatment and start to feel better.
What can you do when you’re having a panic attack?
If you’re having a panic attack, it can be very difficult to think of what to do in the moment. It may be helpful to have a list of coping skills ready on your phone or in your bag so you can refer to it when panic hits.
Remind yourself it will pass
Write something down like, “This won’t last forever, it will pass,” or “It came, so it can go,” to remind you that the panic is temporary and that these feelings will eventually pass. It can be hard to remember that in the moment, so a reminder can make a difference.
Practice deep breathing
It may also be helpful to write down some calming breathing exercises to help control your breath, as panic attacks tend to change your breathing patterns. Helping yourself slow down your breathing can help make your body and mind feel more calm.
Try 4-7-8 breathing, where you breathe in for 4 seconds, hold for 7 seconds, and exhale for 8 seconds. An alternative is box breathing, where you inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, and hold for 4 seconds. When you’re doing these breathing exercises, make sure you’re breathing deeply from your belly, not shallowly from your chest. This will help you get out of fight or flight mode.
Distract yourself
Write down ideas for how to distract yourself during your next panic attack. Maybe it’s calling your best friend or a close family member. Maybe it’s listening to your favorite album, or going for a run. Maybe it’s cuddling your dog or cat.
Another way to distract yourself could be the 54321 method, which is helpful for grounding, but can also be distracting as it takes your mind off of the panic. To do it, you name 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell, and 1 thing you can taste.
Visualize yourself somewhere safe
Another way to help yourself through a panic attack to include on your list is to visualize. This might sound corny, but it can really help. Imagine a place where you feel safest, or happiest. Write it down in advance so you don’t have to think about it when you’re in the middle of a panic attack.
Close your eyes and imagine this place in the most detail you can. How does it feel to be there? If it’s warm there, can you feel the sun on your face? If it’s on a beach, can you hear the waves crashing? Picture yourself actually being there. What would you do when you’re there? The more detail you can imagine, the less focus your brain will have for your panic.
How is panic disorder treated?
Like many psychiatric disorders, panic disorder is often treated with a combination of medication and psychotherapy. If medication is the right choice for you, that’s often prescribed by your primary care provider or more typically, a psychiatrist who can help you figure out the right type of medication for your specific situation.
Sometimes it takes some trial and error to find the right medication or combination of medication to feel relief. There are a number of different evidence based psychiatric medications that have been shown to help with panic disorder, so you have options.
For psychotherapy, there are a few different modalities that have been shown to help with panic disorder. Cognitive behavioral therapy (CBT) can help you change negative thought patterns that contribute to panic and anxiety.
Exposure therapy can help safely and gradually expose you to triggers and even symptoms of panic while teaching you new coping strategies so you feel comfortable managing the disorder. Exposure therapy can also help if there are activities you’ve been avoiding or phobias you’ve developed as a result of your panic disorder.
What else can help you cope with panic disorder?
In addition to therapy and medication, there are other things that can help you cope with panic disorder. These can include:
Make your list of how to cope in the moment
As discussed above, it’s helpful to have a list of coping skills for during a panic attack so you don’t have to do any thinking when you’re in full blown panic. Figure out who you’ll call, what you’ll do to distract yourself, what breathing exercises you’ll try, how you’ll remind yourself that it will pass, and where you’ll visualize yourself feeling safe.
Journal to pinpoint triggers
Keep a journal where you track potential things that trigger your panic attacks. For some people, social situations or big presentations may be a trigger. For others, it might be things like flying or medical procedures, or reliving past trauma. If you can try to pinpoint what’s triggering your panic attacks, it can be helpful so you can spot them ahead of time and make a plan to cope with your therapist instead of trying to avoid your triggers and having that interfere with your life.
Avoid certain substances
Some substances or activities can make your body feel like it’s in a stressful situation, which can lead to panic. Things like excessive caffeine or alcohol may be best to avoid so your body doesn’t get pushed into fight or flight mode. Intense exercise may also trigger this reaction, but for some people it can also help them calm down, so your mileage may vary.
Manage stress
This can be a tall order, because often stress comes from things that are out of your control. For the things you can control, however, it’s important to do what you can to manage the stress in your life in whatever way you can.
Try things like gentle exercise, which has been shown to be helpful for managing anxiety. As mentioned above, if it triggers your panic, try something else. Spending time in nature has proven benefits for mental health, so if you’re able to, get outside when you can. Social connections are also good for mental health, so let your people support you, even when you’re struggling (especially when you’re struggling)! Some people find that practicing mindfulness and breathwork regularly helps manage stress. Taking your medication and being honest with your medical providers can also make a difference with stress management.
