Persistent and excessive fear of a specific object or situation, such as flying, heights, animals, toilets, or seeing blood. Fear is cued by the presence or anticipation of the object/situation and exposure to the phobic stimulus results in an immediate fear response or panic attack. The fear is disproportionate to the actual danger posed by the object or situation. Commonly, adults with specific phobias will recognize that their fear is excessive or unreasonable.
Your health care provider can determine if your panic disorder is caused by an underlying medical condition, such as heart disease or thyroid problems. This may require blood tests and an electrocardiogram (ECG). A complete assessment should also include questions about your caffeine and alcohol consumption, and any substance use, which can contribute to an anxiety disorder.
Simply put - agoraphobia means that you avoid a lot of ordinary activities and situations for fear of having panic attacks. To most people who get this diagnosis, the term sounds pretty scary, but that's all it means. It does not mean you are or will become house bound. That can happen to people, and is an extremely severe case of agoraphobia, but the great majority of people with agoraphobia do not experience it to that extent.
In deeper level psychoanalytic approaches, in particular object relations theory, panic attacks are frequently associated with splitting (psychology), paranoid-schizoid and depressive positions, and paranoid anxiety. They are often found comorbid with borderline personality disorder and child sexual abuse. Paranoid anxiety may reach the level of a persecutory anxiety state.[53]
According to the American Psychological Association, "most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases."[50] The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they are "going crazy" or that the panic might induce a heart attack. Cognitive restructuring helps people replace those thoughts with more realistic, positive ways of viewing the attacks.[51] Avoidance behavior is one of the key aspects that prevent people with frequent panic attacks from functioning healthily.[14] Exposure therapy,[52] which includes repeated and prolonged confrontation with feared situations and body sensations, helps weaken anxiety responses to these external and internal stimuli and reinforce realistic ways of viewing panic symptoms.
The typical course of panic disorder begins in adolescence and peaks in early to mid-twenties, with symptoms rarely present in children under the age of 14 or in older adults over the age of 64 (Kessler et al., 2012). Caregivers can look for symptoms of panic attacks in adolescents, followed by notable changes in their behavior (e.g., avoiding experiencing strong physical sensations), to help potentially identify the onset of panic disorder. Panic disorder is most likely to develop between the ages of 20-24 years and although females are more likely to have panic disorder, there are no significant sex differences in how the disorder presents (McLean et al., 2011).
But over time, you may find yourself experiencing more panic attacks, in a variety of circumstances. Most of these will not be entirely unexpected. Most subsequent attacks occur in response to various cues such as entering a crowded area; a traffic jam; or simply worrying about having a panic attack. But there may still be some surprises: for instance, you might have a nocturnal panic attack, which wakes you out of a sound sleep. Or you might find yourself experiencing odd feelings of depersonalization as you kill some time with friends or colleagues.
The theologian Paul Tillich characterized existential anxiety[27] as "the state in which a being is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority" even though such "undoubted certitude is not built on the rock of reality".[27]

Butterflies in your stomach before an important event? Worried about how you will meet a deadline? Nervous about a medical or dental procedure? If so, you are like most people, for whom some worry about major events (like having a child, taking an exam, or buying a house), and/or practical issues (like money or health conditions), is a normal part of life. Similarly, it is not uncommon to have fears about certain things (like spiders, injections, or heights) that cause you to feel some fear, worry, and/or apprehension. For example, many people get startled and feel nervous when they see a snake or a large insect. People can differ in what causes them to feel anxious, but almost everyone experiences some anxiety in the course of their life.
Some research suggests that people who have panic disorder might be very sensitive to sensory experiences (such as sunlight, smells and changes in the weather), but there's not enough evidence yet to say for sure. Also it's not clear whether having a high level of sensitivity to these sorts of things is something that might cause you to develop panic disorder, or whether it may be an effect of having it.
I don’t clearly know if it’s a panic attack. Sometimes I feel left out or secluded and then the feelings come over. Sometimes if I feel things are being unfair, it triggers again. I am diabetic patient suffering from fights to take medicines regualry. If this feeling of loneliness or being left out occurs, then i just can’t help but feel a lump in my throat, as if I can’t breathe. I get very frustrated, restless and often feel like crying but no voice will come out. Sometimes, heck no one ever understands my feelings and pain and it just gets worse. Mood swings, Shivering, body pain, restlessness dizzyness, headache, are few symptoms. And then I start thinking of how useless I am and there is a reason why I am not chosen for things thus making me feel like even more shit.
While obsessive-compulsive disorder is not officially classified by the American Psychological Association as an anxiety disorder, it shares many traits with common anxiety disorders, such as generalized anxiety disorder. In both conditions, you may know that your thoughts are irrational, but you feel unable to stop thinking them. Often, but not always, these thoughts may concern cleanliness, sex, or religion.
Everyone has probably experienced panic, or something like it, at least once in their lifetime: on a disturbingly turbulent plane, or before giving an important presentation, or after realizing you hit reply all when you really, really should not have. We all know the paralyzed feeling and the heightened physical sensations. But panic attacks and panic disorder take a different shape. Panic attacks have many physical symptoms and tend to peak around 10 minutes, and may last for 30. Panic disorder is diagnosed by the frequency of these attacks, and the presence of a fear of having them. 
Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Panic attacks may also be caused by substances. Discontinuation or marked reduction in the dose of a substance such as a drug (drug withdrawal), for example an antidepressant (antidepressant discontinuation syndrome), can cause a panic attack. According to the Harvard Mental Health Letter, "the most commonly reported side effects of smoking marijuana are anxiety and panic attacks. Studies report that about 20% to 30% of recreational users experience such problems after smoking marijuana."[16]
I had the biggest panic attack to date today, managed to get into the car with my friends to take my son for a hospital appointment, felt very unsafe and thought I was going to fall out of the car when it went around a corner. Talked to myself all through the journey telling myself I’d been round hundreds of corners and never fallen out out a car yet…got the hospital, got out the car, got half way across the carpark and had what I can only describe as the most hysterical panic/anxiety attack I have ever had. I,d dropped to the floor by now as I was with my friend Kay and I knew she wouldnt be able to run after me….I was screaming, pleading for help for what felt like forever, 2 paramedics came over and it took them a good 10 minutes to convince me I should stand up and go into A&E, I can only explain the whole thing as being hysterical, a Crisis nurse and doctor came to see my and gave me 4 diazepam, even after taking one – 5mg – I was hysterical and wouldnt then leave the hospital…I,m now at home and a lot calmer, the Crisis team are coming to see me between 10am and 1pm tomorrow to discuss meds, even the nurse said to the doctor ‘this isnt depression, this is severe anxiety..’ all I need is a tiny pinprick of light to look at to keep me hopeful. I honestly thought I could handle today but I didnt, I,m angry and disappointed with myself as this time a month ago I was fine
Beta Blockers, also known as beta-adrenergic blocking agents, work by blocking the neurotransmitter epinephrine (adrenaline). Blocking adrenaline slows down and reduces the force of heart muscle contraction resulting in decreased blood pressure. Beta blockers also increase the diameter of blood vessels resulting in increased blood flow. Historically, beta blockers have been prescribed to treat the somatic symptoms of anxiety (heart rate and tremors) but they are not very effective at treating the generalized anxiety, panic attacks or phobias. Lopressor and Inderal are some of the brand names with which you might be familiar.
Beta Blockers, also known as beta-adrenergic blocking agents, work by blocking the neurotransmitter epinephrine (adrenaline). Blocking adrenaline slows down and reduces the force of heart muscle contraction resulting in decreased blood pressure. Beta blockers also increase the diameter of blood vessels resulting in increased blood flow. Historically, beta blockers have been prescribed to treat the somatic symptoms of anxiety (heart rate and tremors) but they are not very effective at treating the generalized anxiety, panic attacks or phobias. Lopressor and Inderal are some of the brand names with which you might be familiar.
Panic disorder is diagnosed as occurring with or without agoraphobia. Agoraphobia involves a fear of having one of these intense panic attacks in a place or situation where it would be very difficult or embarrassing to escape. Often times, the fear associated with agoraphobia can lead to many avoidance behaviors. By limiting one’s ability to be in certain situations, people with agoraphobia often experience feelings of loneliness as well as an overall diminished quality of life.

Many of us may know what it feels like to be nervous before a party, or when meeting new people or making an important phone call. Those with social anxiety disorder have very intense versions of those fears — intense fears of being judged by others that cause them to avoid those kinds of situations. For most people, fears of social situations usually subside once the intimidating event has been faced. But in social anxiety disorder, these feelings are persistent and usually last for at least six months. 


Anxiety disorders increase one's chances for suffering from other medical illness, such as cardiovascular disorders, including obesity, heart disease and diabetes. More specifically, increased body weight and abdominal fat, high blood pressure, and greater levels of cholesterol, triglycerides, and glucose have all been linked to anxiety. While it is still unclear what causes the high co-morbidity between anxiety and bad physical health outcomes, research suggests that changes in underlying biology that is characteristic of anxiety may also facilitate the emergence for these other physical health outcomes over time. For example, changes in stress hormones, autonomic responses, as well as heightened systemic inflammation are all associated with anxiety disorders and negative health outcomes. These shared physiological states suggest a shared underlying biology and that anxiety maybe a whole-body condition.

Behaving in an apprehensive manner produces the physiological, psychological, and emotional state of anxiety. When we behave apprehensively (worried, fretful, concerned, afraid), the body activates the stress response, which secretes stress hormones into the bloodstream where they travel to targeted spots in the body to bring about specific changes that enhance the body’s ability to deal with danger. The stress response is often referred to as the fight or flight response because of how it equips the body to either fight with or flee from danger.

Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.
A licensed mental health professional that has earned a Master’s degree from a variety of educational backgrounds (e.g. general counseling background, social work, marriage and family counseling).  Once their formal education is completed, these clinicians are supervised in the field 1-2 years and pass a State exam to become fully licensed in the state in which they practice.  These mental health professionals are licensed to diagnose emotional, mental health and behavioral health problems.  They can provide mental health treatment in the form of counseling and psychotherapy, or work in other capacities as patient advocates or care managers. Licensed Master’s level clinicians work in many settings, including hospitals, community mental health clinics, private practice, school settings, nursing homes, and other social service agencies.  Titles and licensing requirements may vary from state to state.
While conducting research for this article, we encountered more than a dozen mental health professionals who mistakenly believed the terms “anxiety attack” and “panic attack” were synonymous. They were licensed professionals, but none of them had a specialty in anxiety. Because “anxiety attack” is not a clinical term, they assumed it was a synonym for “panic attack.” This caused them to use the terms interchangeably.
Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety. Some researchers think that people with panic disorder misinterpret harmless bodily sensations as threats. By learning more about how the brain and body functions in people with panic disorder, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.
Many people experience their first panic attack due a build up of chronic stress. Anxious personalities often then become afraid of them, which further stresses the body. As fear and stress increase, so does the likelihood of a subsequent panic attack. This scenario is a common catalyst into Panic Attack Disorder: becoming afraid of the feelings and symptoms of a panic attack, which causes further panic attacks.
Yes. There are many medications that have FDA approval to treat anxiety disorders. Several members of the benzodiazepine class are routinely used to provide relief from anxiety. These minor tranquillizers are safe and effective, but should be used for short-term relief. They have many side effects, including drowsiness, and can be habit forming at higher doses. People taking these medications should not use heavy machinery or drive until they understand how the medication might affect them.
Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behaviour such as pacing back and forth, somatic complaints, and rumination.[1] It is the subjectively unpleasant feelings of dread over anticipated events, such as the feeling of imminent death.[2][need quotation to verify] Anxiety is not the same as fear, which is a response to a real or perceived immediate threat,[3] whereas anxiety involves the expectation of future threat.[3] Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[4] It is often accompanied by muscular tension,[3] restlessness, fatigue and problems in concentration. Anxiety can be appropriate, but when experienced regularly the individual may suffer from an anxiety disorder.[3]
Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.
Generalized anxiety disorder is a condition in which your worries overwhelm you to the point where your daily routine seems difficult to carry out, and you have been worrying this way for at least six months. You may feel on edge and have difficulty focusing on tasks. There may be a tendency to fear and expect the worst; some call this catastrophic thinking. You even may know that your worries are perhaps irrational, but you still go on feeling them. 
Obsessive-Compulsive Disorder (OCD) is characterized by uncontrollable anxious thoughts or behaviors. Individuals with OCD are plagued by persistent, unwelcome thoughts and images or by the urgent need to engage in certain rituals. Some OCD sufferers may only have obsessive thoughts without the related rituals. The disturbing thoughts or images (e.g., fear of germs) are called obsessions, and the rituals performed to try to get rid of them (e.g., hand washing) are called compulsions. For example, people who are obsessed with germs may wash their hands excessively. The individual is not happy to be performing the ritual behaviors but finds this to be the only way to get temporary relief from the obsessive thought.
People generally can overcome panic attacks faster if they seek help after the first one or two, says psychologist Cheryl Carmin, PhD, director of clinical psychology training at the Wexner Medical Center and a professor at Ohio State University in Columbus. When you do seek help, your doctor or therapist will ask about your symptoms and the situations in which they arise, and might also recommend additional medical testing to rule out other health concerns.
Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating Panic Disorder in teenagers is Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about his or her fears) and Exposure (e.g., gradually exposing the teenager to his or her fears while keeping him or her safe and teaching him or her effective strategies for coping with fear). Sometimes this therapy is provided in groups. 
The symptoms of panic attacks typically occur rapidly and peak within minutes. Once a panic attack has subsided, the symptoms can taper off completely or the panic sufferer can remain in an anxious state, possibly repeating the panic attack cycle again. Limited-symptom panic attacks occur when all criteria are met, but the person experiences less than four of the listed symptoms.
^ Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Health and Clinical Excellence. Clinical Guideline 22. Issue date: April 2007 "Archived copy" (PDF). Archived from the original (PDF) on 24 August 2009. Retrieved 2009-07-21. ISBN 1-84629-400-2

Anxiety is a normal reaction to danger, the body’s automatic fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a stressful situation. In moderation, anxiety isn’t necessarily a bad thing. It can help you to stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming—when it interferes with your relationships and daily activities—you’ve likely crossed the line from normal anxiety into the territory of an anxiety disorder.


We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.
Medications — most often antidepressants and anti-anxiety drugs — can also be used to help treat panic disorder. Your doctor may initially prescribe you an anti-anxiety drug, such as Xanax (alprazolam), and then add an antidepressant, such as Effexor XR (venlafaxine). After a month or sooner, your doctor may stop the Xanax and have you remain on the antidepressant.
Abraham Lincoln addiction alcohol Andrew Verster Anger anxiety approval be creative be yourself Bill Clinton change your thinking cognitive therapy depression Dora Taylor drugs encouragement fight or flight forgiveness friends funny George Bernard Shaw guilt honesty hope interference J.K. Rowling Jared Diamond Collapse Joaquin Phoenix John Gurdon Joy Laurence Olivier life with purpose love nagging perfectionism perseverance poetry self-esteem shyness stress success trauma try again women workaholic
Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen.[1][2] The maximum degree of symptoms occurs within minutes.[2] Typically they last for about 30 minutes but the duration can vary from seconds to hours.[3] There may be a fear of losing control or chest pain.[2] Panic attacks themselves are not typically dangerous physically.[6][7]

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.
In people with anxiety disorders, the brain circuitry that controls the threat response goes awry. At the heart of the circuit is the amygdala, a structure that flags incoming signals as worrisome and communicates with other parts of the brain to put the body on alert for danger. Early life events, especially traumatic ones, can program the circuitry so that it is oversensitive and sends out alarms too frequently and with only minor provocations. Survival mandates a system for perceiving threats and taking quick, automatic action, but those with anxiety see threats where there are none, perhaps because emotional memories color their perceptions.

If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.
Behavioral choices can also significantly impact risk, as excessive tobacco or caffeine use can increase anxiety, whereas regular exercise can decrease anxiety. Specific temperament and personality traits also may confer risk of having an anxiety disorder. With regards to temperament, shyness and behavioral inhibition in childhood can increase risk of developing an anxiety disorder later in life. With regard to personality traits, the Five Factor Model of Personality consists of five broad trait domains including Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. An individual higher on trait Neuroticism or low on Conscientiousness is at a higher risk for all anxiety disorders, and an individual low on trait Extraversion is at a higher risk of developing social phobia and agoraphobia. Some more narrow personality traits have also been found to relate to risk for anxiety, including anxiety sensitivity, a negative or hostile attributional style, and self-criticism. Personality disorders have also been shown to relate to increased risk for anxiety disorders.
Panic attacks (or anxiety attacks - the terms are interchangeable) are intense episodes of fear which are so powerful that they trick you into fearing that you are dying, going crazy, about to faint, or losing control of yourself in some vital way. The symptoms of a panic attack feel so powerful and threatening that they convince you that you're in terrible danger.

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.[6][7] These disorders include certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[7][77] metabolic disorders (diabetes),[7][78][79] deficiency states (low levels of vitamin D, B2, B12, folic acid),[7] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[80][81][82] heart diseases, blood diseases (anemia),[7] cerebral vascular accidents (transient ischemic attack, stroke),[7] and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease), among others.[7][83][84][85]
Our experience has shown that the most effective treatment for anxiety attacks is the combination of good self-help information and Personal Coaching/Counseling/Therapy. Since the underlying factors that cause issues with anxiety are learned, generally a professional therapist is required to help uncover, identify, and successfully address them. Working with a professional therapist ensures that these underlying factors are effectively treated.[1]
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