ICD-10 code: F41.0
Panic disorder is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. People with generalized anxiety disorder spend a lot of time worrying about a lot of different things. People with social anxiety disorder feel very anxious around other people because they are afraid of embarrassing themselves or being disliked. People with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. People with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like or other embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. People with a specific phobia are afraid of a certain object or situation, such as flying, heights, animals, or seeing blood. People with separation anxiety disorder are afraid of being away from a certain person, usually because they are afraid that something bad might happen to them or the other person if they are separated.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the person is only excessively fearful of a very specific object or situation. In other anxiety disorders, like GAD, the person may feel anxious a great deal of the time or about a lot of different things.
Panic disorder is a psychiatric disorder that affects approximately 2 - 4% of adults. Panic disorder is characterized by recurrent unexpected panic attacks, along with fear of having additional attacks. A panic attack is a sudden rush of intense fear or discomfort, accompanied by at least four of the following symptoms:
Nearly a quarter of adults in the United States have had one or more panic attacks in their lifetimes. Having panic attacks does not necessarily mean the individual has panic disorder. To receive a diagnosis of panic disorder, a person must also experience a month or more of at least one of the following:
Panic disorder is only diagnosed when at least some of the panic attacks are not expected ("out of the blue"). If a person only has panic attacks in specific situations, like when giving a speech, panic disorder would not be diagnosed.
Panic disorder severity can range from mild to very severe. In severe cases, panic disorder can lead to inability to travel independently (for example, if the person begins to fear driving), to perform well at work or school, or to engage in previously-enjoyed hobbies. Many people with panic disorder also have other psychiatric conditions, most commonly agoraphobia, other anxiety disorders, and depression.
Panic disorder is characterized by abnormalities of brain function (including abnormal activation in the amygdala and other regions implicated in fear circuitry, such as the anterior cingulate cortex and insula), the nervous system (including the hypothalamic-pituitary-adrenal axis), and the respiratory system (including hyperventilation resulting in low levels of carbon dioxide), which are all thought to contribute to symptoms. In addition, misinterpreting bodily sensations as dangerous and avoiding certain bodily sensations are thought to contribute to the onset and persistence of panic disorder. Panic disorder is thought to have a genetic component, although having a genetic predisposition to panic disorder does not necessarily mean that someone will develop panic disorder.
Panic disorder is treatable. Published treatment guidelines for panic disorder include those from the American Psychiatric Association, the Society of Clinical Psychology, and the National Institute for Clinical Excellence.
First Line Treatments
For more information about drug prescribing in panic disorder, click here.
Other Treatments
In cases of nonresponse to first-line treatment, clinical research suggests that the following treatments are effective:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered: