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.

A nurse with a master's or doctoral degree in mental health disorders. A psychiatric nurse can diagnose and treat mental health disorders. They mainly provide psychotherapy but in some states that can also prescribe medications. Psychiatric nurses also serve as patient advocates and provide case-management services. They often work in private practices, hospitals and schools.
A panic attack begins suddenly and unexpectedly and most often peaks within 10 to 20 minutes. At times, the resulting anxiety may last a couple of hours. Panic attacks can occur whether the person is calm or anxious. Recalling a past attack may trigger a new one. The frequency of panic attacks can vary, and for some people the fear of having an additional attack may lead them to avoid situations where escape may be difficult, such as being in a crowd or traveling in a car or bus. 
In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.
Other research suggests that social structures that contribute to inequality, such as lower wages, may play a part. In a study published in January 2016 in the journal Social Science and Medicine, Columbia epidemiologists reviewed data on wages and mood disorders, and noted that, at least in their data set, when a woman's pay rose higher than a man's, the odds of her having both generalized anxiety disorder and major depression decreased. (10)
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At some point in our lives, most of us will experience a panic attack in response to an actual danger or acute stress. But when panic attacks occur or recur for no reason and in the absence of danger or extreme stress, or when the fear of experiencing another attack is so strong that you change your behavior by avoiding certain places or people, you may have panic disorder.
Now as you feel slightly calmer, you need to identify and face the roots of the anxiety attack. The truth is – there’s always a trigger for it. Even if it’s not obvious, it’s always there. Panic attacks can happen as a response to a stressful or traumatic issue that happened months ago.  Try digging into your mind and thinking of the exact cue that might have caused it.  Remember, an anxiety attack is just a host of physical reactions. No matter how real it feels, the danger is usually non-existent.
Have you ever worried about your health? Money? The well-being of your family? Who hasn’t, right? These are common issues we all deal with and worry about from time to time. However, if you find yourself in constant worry over anything and everything in your life, even when there should be no cause for concern, you might be suffering from Generalized Anxiety Disorder. People with this condition often recognize they are “over-worrying” about a lot of issues, but have no control over the worry and associated anxiety. It is constant and can interfere with your ability to relax or sleep well and can cause you to startle easily.
If you're experiencing panic attacks, your doctor or qualified mental health provider can determine if your panic symptoms are an indication that you have panic disorder or a different condition. Your practitioner can provide you with an accurate diagnosis and a proper treatment plan. The earlier you get treated for your panic symptoms, the sooner you can expect to manage your panic attacks.
ACT is a type of CBT that encourages patients to again in positive behaviors even in the presence of negative thoughts and behaviors. The goal is to improve daily functioning despire having the disorder. It is particularly useful for treatment-resistant Generalized Anxiety Disorder and Depression. The length of treatment varies depending on the severity of symptoms.
No matter what your plan is, having one in place is the most important thing. You can think of your plan as your go-to set of instructions for yourself when you feel a panic attack coming on. One plan might be to take yourself out of your current environment, sit down, and call a friend or family member that can help distract you from your symptoms and help you to calm down. Then you can incorporate the following techniques.
“One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn’t get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn’t think straight.
As is true for other mood and anxiety disorders, the use of Selective Serotonin Reuptake Inhibitors (SSRI's; e.g.., Paxil, Prozac, Zoloft), Benzodiazepines (e.g., Xanax, Lorazepam), and Selective Norepinephrine Reuptake Inhibitors (SNRI's; e.g., Cymbalta, Effexor, Pristiq) are common medical treatments for panic disorder. Additionally, D-cycloserine is a medication that is now being explored as a way to enhance effects of CBT (e.g., Hofmann et al., 2013). These medications may have side effects and taking them can lead to tolerance, withdrawal symptoms, and dependence, so it is important that you consult with a physician before starting or stopping these medications. There is evidence that taking one of these medications in addition to receiving behavioral therapy (e.g., CBT) can significantly benefit patients with panic disorder, although seeking psychotherapy in itself is largely effective (Arch et al., 2017).
Anxiety can be caused by numerous factors, ranging from external stimuli, emotional abandonment, shame, to experiencing an extreme reaction when first exposed to something potentially anxiety-provoking. Research has not yet explained why some people will experience a panic attack or develop a phobia, while others growing up in the same family and shared experiences do not. It is likely that anxiety disorders, like all mental illness, is caused by a complex combination of factors not yet fully understood. These factors likely include childhood development, genetics, neurobiology, psychological factors, personality development, and social and environmental cues.
Only 16, Caroline, had her first panic attack a year ago. Her mother was dropping her off at her summer job at a local school when, without warning, a full-blown panic attack engulfed her. “My heart started racing and my body felt so hot. I started to sweat and shake uncontrollably. My vision became distorted and my body felt limp, like a wet noodle,” she says. For 20 minutes, until the panic attacked passed, Caroline refused to get out of the car. Her mother didn’t know what to do.
A healthy diet is also important to reduce and prevent anxiety. It seems counterintuitive that you can "eat your way to calm" but sustaining a healthy diet can really help you to feel more at ease on a regular basis, despite stressors. Some foods that are particularly helpful for reducing anxiety include foods with omega 3 fatty acids (i.e., salmon, walnuts, and flaxseed) and probiotics. Avoid greasy, sugary, high-fat, and processed foods. Additionally, avoiding caffeine when feeling anxious as well as unhealthy substances (i.e., alcohol) could be beneficial. Drinking alcohol might seem like a good way to calm down, but it can lead to sustained anxious symptoms. Incorporating a healthy diet into your lifestyle is fundamental to preventing and reducing anxiety.
Additionally, there is some evidence that Acceptance and Commitment Therapy (ACT), Mindfulness-based Stress Reduction treatment (MBSR), as well as online and computerized treatments are effective in treating panic disorder (Arch et al., 2017). However, the overwhelming majority of research supports the long-term success of CBT for treating panic disorder. More research is needed to explore the extent to which MBSR and ACT work when compared to CBT and other treatments, but preliminary results are positive. In general, empirically-supported treatments that are founded on the basis of research within the psychological and medical fields are recommended for treating panic disorder.

Some research shows that people who have close and supportive friendships have a greater ability to fight mental and physical diseases than people who are isolated. The mind can be our worst enemy when feeling anxious and having a supportive network that you can discuss and decompress your deepest worries to could help prevent anxiety from consuming your life. Find trusted friends during times of anxiety that you can open up to and know that they will provide a listening ear and supportive feedback about your experiences.
Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:
4) Ice, Ice Baby. For nighttime panic attacks, Kirstie Craine Ruiz keeps about 4 ready-to-go ice packs—2 big and 2 small– in her freezer.  When she feels panic coming she puts two small ones in her hand and the 2 large ones on my lower back.  “If your heart is really racing and your breathing is bad, I would suggest taking the one on your belly and rubbing it from the middle of your chest down to the bottom of your belly, slowly, and over and over until your heart rate starts to mellow (over your shirt, of course- you don’t want to make yourself freezing!).  I feel like when I do this, it literally moves the hyper energy down from my chest and alleviates any chest pain. This method always helps me when it feels like my heart is in my throat.  Once you feel as though you can breathe again, place the packs on your lower belly or lower back, and in the palms of your hands. I don’t know if it’s pressure points but holding small smooth ice packs in both hands with palms up, does wonders for my panic, to this day.”
Guided imagery is another relaxation strategy that can help reduce or prevent overwhelming anxiety. Guided imagery involves directed mental visualization to evoke relaxation. This could involve imagining your favorite beach or a peaceful garden that can distract you from your anxious state and allow your mind and body to focus on the positive thoughts and sensations of the imagery exercise.
It is not unusual to experience only one or two symptoms at a time, such as vibrations in their legs, shortness of breath, or an intense wave of heat traveling up their bodies, which is not similar to hot flashes due to estrogen shortage. Some symptoms, such as vibrations in the legs, are sufficiently different from any normal sensation that they clearly indicate panic disorder. Other symptoms on the list can occur in people who may or may not have panic disorder. Panic disorder does not require four or more symptoms to all be present at the same time. Causeless panic and racing heartbeat are sufficient to indicate a panic attack.[9]

A collection of activities focused in which an individual consciously produces the relaxation response in their body. This response consists of slower breathing, resulting in lower blood pressure and overall feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises.
Most people have experienced fleeting symptoms associated with anxiety disorders at some point in their life. Such feelings — such as having a shortness of breath, feeling your heart pounding for no apparent reason, experiencing dizziness or tunnel vision — usually pass as quickly as they come and don’t readily return. But when they do return time and time again, that can be a sign that the fleeting feelings of anxiety have turned into an anxiety disorder.

Mindfulness practice, meditation, and mindfulness yoga can increase one's awareness of the world around you and increase your control over how you experience situations and how you respond. Loss of feelings of control is often a symptom of anxiety when a person is feeling overwhelmed and stressed. Practicing these strategies can help you live life in the present moment and enjoy the present things in your life that bring you joy.
Panic disorder is a diagnosis given to people who experience recurrent unexpected panic attacks— that is, the attack appears to occur from out of the blue. The term recurrent refers to the fact that the individual has had more than one unexpected panic attack. In contrast, expected panic attacks occur when there is an obvious cue or trigger, such as a specific phobia or generalized anxiety disorder. In the U.S., roughly 50% of people with panic disorder experience both unexpected and expected panic attacks.
Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.
A condition in which parting with objects (e.g., household items or personal possessions) causes significant distress. In addition, many individuals continuously acquire new things and experience distress if they are not able to do so. The inability to discard possessions can make living spaces nearly unusable. Relatedly, the cluttered living space can interfere with the performance of daily tasks, such as personal hygiene, cooking, and sleeping (e.g., the shower is full of stuff, the bed is covered with clutter).

Demographic factors also impact risk for anxiety disorders. While there is not a strong consensus, research suggests that risk for anxiety disorders decreases over the lifespan with lower risk being demonstrated later in life. Women are significantly more likely to experience anxiety disorders. Another robust biological and sociodemographic risk factor for anxiety disorders is gender, as women are twice as likely as men to suffer from anxiety. Overall symptom severity has also been shown to be more severe in women compared to men, and women with anxiety disorders typically report a lower quality of life than men. This sex difference in the prevalence and severity of anxiety disorders that puts women at a disadvantage over men is not specific to anxiety disorders, but is also found in depression and other stress-related adverse health outcomes (i.e. obesity and cardiometabolic disease). Basic science and clinical studies suggest that ovarian hormones, such as estrogen and progesterone, and their fluctuations may play an important role in this sex difference in anxiety disorder prevalence and severity. While changes in estrogen and progesterone, over the month as well as over the lifetime, are linked to change in anxiety symptom severity and have been shown to impact systems implicated in the etiology of anxiety disorders (i.e. the stress axis), it still remains unclear how these hormones and their fluctuations increase women's vulnerability to anxiety.
Dr. John Grohol is the founder, Editor-in-Chief & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member and treasurer of the Society for Participatory Medicine. He writes regularly and extensively on mental health concerns, the intersection of technology and psychology, and advocating for greater acceptance of the importance and value of mental health in today's society. You can learn more about Dr. John Grohol here.
Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside. Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced they have a life-threatening issue.
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