Panic Disorder Symptoms

Panic Disorder Symptoms

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

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

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

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
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

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

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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