What Is Panic Disorder?

Panic disorder is a type of anxiety disorder that causes repeated and unexpected episodes of intense fear, known as panic attacks.

People with panic disorders may also develop an ongoing fear of experiencing another attack. This worry can affect daily activities, relationships, work and social situations, and may cause a person to avoid certain places or activities.

For some people, the fear of another attack can become as disruptive as the attacks themselves. But with appropriate assessment and treatment, panic disorder can be managed.

What Are the Symptoms of Panic Disorder?

Panic disorder can cause both physical and emotional symptoms. During an episode, symptoms may develop suddenly and become intense within a short period.

Physical symptoms may include:

• Racing or pounding heartbeat
• Chest discomfort
• Shortness of breath
• Sweating
• Trembling or shaking
• Dizziness or feeling faint
• Nausea
• Chills or hot flushes
• Numbness or tingling
• A chocking sensation

Some of these physical symptoms can be similar to those caused seen in other medical conditions. As a result, patients may initially consult different doctors or specialists before the possibility that their symptoms may be linked to panic disorder is recognised.

Medical assessment may also be needed to rule out other underlying conditions.

Emotional symptoms may include:

• Sudden intense fear
• Fear of losing control
• Fear of dying
• Feeling that your surroundings are unreal
• Persistent worry about having another episode

Between episodes, some people may continue to feel anxious about when another attack could occur.

This ongoing fear may lead them to avoid situations or activities they associate with previous attacks.

What Causes Panic Disorder?

The exact cause of panic disorder is not fully understood. It is thought to develop through a combination of biological, genetic, psychological, and environmental factors.

Factors that may be associated with panic disorder include:

• A family history of panic disorder or other anxiety disorders
• Significant or prolonged stress
• Traumatic or stressful life experiences
• Major life changes
• Increased sensitivity to physical sensations associated with anxiety
• Changes in how the brain and body respond to fear and stress

Panic disorder commonly begins during the late teenage years or early adulthood, although it can occur at any age.

Having one or more risk factors does not mean that a person will necessarily develop panic disorder.

How Does Panic Disorder Affect Daily Life?

Panic disorder can affect a person's life even when they are not experiencing an active episode. Someone may begin changing their routine because they are worried about experiencing symptoms again.

For example, they may:

• Avoid crowded places
• Avoid travelling alone
• Avoid public transport
• Stop exercising because an increased heart rate feels frightening
• Avoid places where previous attacks occurred
• Depend on another person for reassurance
• Withdraw from work or social activities

Over time, this avoidance can reinforce anxiety and make everyday activities increasingly difficult.

Some people with panic disorder may also develop agoraphobia, which involves significant fear or situations where leaving or getting help may feel difficult.

What Can Make Panic Disorder Symptoms Worse?

Certain factors may increase anxiety or make physical symptoms more noticeable in some people.

These can include:

• High levels of stress
• Lack of sleep
• Excessive caffeine
• Alcohol
• Smoking
• Recreational drugs
• Certain medicines

Identifying and reducing personal triggers may help with symptom management, but lifestyle changes alone may not be sufficient to treat panic disorder.

How Is Panic Disorder Diagnosed?

There is no single laboratory test or scan used to diagnose panic disorder. Diagnosis usually involves an assessment by a Psychiatrist or mental health professional.

The healthcare professional may ask about:

• The symptoms experienced
• How often episodes occur
• Whether they occur unexpectedly
• Duration and frequency of each episode
• Situations or activities that are being avoided
• How symptoms affect work, relationships, or daily life
• One’s physical and mental health history
• Medicines or substances being used

Because symptoms such as chest discomfort, palpitations, dizziness and shortness of breath can also occur with physical health conditions, physical examination or further tests to rule out other possible causes may be recommened.

How Is Panic Disorder Treated?

Treatment for panic disorder aims to:

• Reduce the frequency and severity of symptoms
• Reduce fear of future episodes
• Changes unhelpful thought and behaviour patterns
• Help a person return to activities they have been avoiding
• Improve everyday functioning and quality of life

Treatment may involve psychotherapy, medication, or a combination of both.

When Should You See a Doctor for Panic Disorder?

Speak with a healthcare professional if:

• You experience repeated unexpected episodes of intense fear
• Your frequently worry about having another episode
• You have started avoiding places, activities or situations because of your symptoms
• Your symptoms are affecting work, school, relationships or daily activities
• You are unsure whether your symptoms are caused by anxiety or another health condition
• Your symptoms are becoming more frequent or difficult to manage

Our Psychiatrists, Dr Thong Jiunn Yew, Dr Zheng Zhimin and Dr Seng Kok Han can assess your symptoms, check for other possible causes, and recommend suitable treatment.