Everyone experiences anxiety at some point in their life. People become anxious when they have to face a highly stressful situation like taking a test or going for a job interview. When one is anxious and under stress, the body reacts; hands become clammy, the heart beats a little faster; one can even feel lightheaded or dizzy. This is a natural and necessary “fight or flight” reaction! If you are in “danger” or perceived danger, this reaction is how your body prepares itself to deal with it. Anxiety in moderate doses is perfectly healthy. Worry can even be good for you; it can motivate you to get things done or protect you from danger.

Sometimes, however, our bodies can have a “fight or flight” or “panic” reaction even when we’re not in immediate danger. It’s almost like a fear button has been pushed by accident, causing our brains and bodies to have a panic reaction when there’s no real “threat”. When a fear response comes on strong and quickly, with no obvious reason, it could be a sign of panic disorder. To understand panic disorder, it’s important to know what a panic attack is.

Panic attack: A sudden episode of intense fear or anxiety that someone can experience even when there is no real threat. Panic attacks often have very intense physical symptoms. Some describe a panic attack as feeling like they are having a heart attack.

Panic attacks can be triggered by specific situations (like being in a crowded place, experiencing a stressful event, feeling nervous, etc.) but the defining characteristic of a panic attack is that it usually comes on when there’s no actual immediate threat (for example, an aggressive dog or a car speeding toward you). You’re not in danger, but it really feels like you are.

There are many different reasons why panic attacks may occur. When someone has recurring panic attacks, and other medical causes have been ruled out, this is when someone might be diagnosed with panic disorder.

Panic disorder is different for different people. The situations or places that cause or trigger a panic attack can differ from person to person. Also, not everyone experiences the physical symptoms of a panic attack in the same way. Some people with panic disorder develop other issues with anxiety or depression, while others don’t. Some people might have very obvious panic attacks (i.e. visual, physical, emotional symptoms), while others may have symptoms that are just as real, but not as obvious to others.

It is not:

• The result of any actions or personal failures of the individual.
• A sign or result of low intelligence or weakness.
• A funny or weird personality trait or “quirk”.
• The same as being worried about something.

Below is a list of signs and symptoms for panic disorder. The following list should not be used to diagnose yourself or someone else. It is only intended to provide general information. If you think you might be experiencing a mental illness, you should see your doctor.

You might notice that many of these signs or symptoms could be explained by any number of issues, not just panic disorder. Also, remember that every person is different. These symptoms might not describe every person's experience with panic disorder.

Someone having a panic attack might have thoughts like:

• “I’m having a heart attack”
• "I’m suffocating”
• “I’m going to die”
• “I’m going ‘crazy’”

Physical symptoms include:

• Trembling or shaking
• Shortness of breath
• Sensations of smothering or choking
• Palpitations, increased heart rate or pounding
• Sweating
• Chest pain, pressure or discomfort
• Nausea
• Dizziness, unsteadiness, light-headedness or fainting
• Numbness or tingling sensation in hands and feet
• Chills or hot flashes
• Sense of feeling unreal, disconnected from one’s surroundings or body

Behavioural signs include:

• Avoiding places where the person had anxiety symptoms in the past (e.g. a certain grocery store) or similar places (i.e. all grocery stores)
• Avoiding travel, malls, line-ups
• Avoiding strenuous activities (e.g., exercise)
• Avoiding crowds, school, work out of fear of triggering a panic attack

Some people who have panic disorder also have other mental health or substance use issues.

Panic disorder and agoraphobia: Some people who experience panic attacks or other anxiety disorders can develop more complications.  A person who experiences panic attacks might become so worried about experiencing a panic attack that they begin to avoid any places or situations that might bring one on, to the point where it interferes with their ability to live their life. This avoidance can develop into agoraphobia, which is the extreme fear and avoidance of crowded spaces or enclosed public places that may lead you to panic and feel trapped.

Like other mental health issues, panic disorder and how it is experienced will differ from person to person. Because each case is unique, the treatment will likely be unique for each individual. Someone with panic disorder may also have other mental health issues, so the best approach is to work with a doctor to address the individual and their specific issues.

Panic disorder can be treated with specific types of therapy, such as cognitive behavioural therapy (CBT is a form of talk therapy that helps you understand and cope with harmful thoughts, feelings and behaviours as they happen).

Counselling to learn coping skills and relaxation techniques in order to cope with panic attacks can also help someone with panic disorder.

Family members of someone who has panic disorder and/or other mental illnesses may participate in therapy, support groups or benefit from learning about it and ways to support their loved one at home.

Medication can also be helpful to help stabilize someone enough to get the most out of therapy, counselling and living life. Every person is different, so if medication is used, it may take a while to find the medication that works best for you.

For some people, spending time in a treatment clinic or hospital is necessary, while for others, outpatient (getting help for a professional without having to actually “stay over” in a hospital) is better.

If you have to wait to get an appointment, there are many places that offer support while you wait. Find out where to call in your area.

Along with treatment from your doctor or therapist, there are things you can do to help and support your own recovery.

Every story is different, and sometimes people need to try different types of supports before they find the right plan for them. Be patient, and don’t give up.

A person living with panic disorder, like any other person, will benefit from maintaining wellness and having good supports in their life. 

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with panic disorder:

• Know the signs and symptoms of panic disorder and other anxiety disorders
• Know what a panic attack is and what it might look like for someone who has them. If you are supporting a friend who has panic attacks, ask them when they are feeling calm what an attack feels like for them, and what is helpful for them in those moments.
• If a friend is experiencing a panic attack, remain calm and help them to a quiet place. Speak calmly and quietly, and try engaging them in a simple deep breathing exercise or other simple task. Helpful tasks could include counting backward, getting them to describe 5 things they see/hear/smell/feel, placing their arms in the air or having them sit with their head between their knees.
• Panic attacks, to the outside observer, often make little sense or seem to be brought on by “nothing”. Instead of trying to apply logic or explain the fears away, try thinking of a time when you were really worried and empathize with how your friend is feeling. Gently remind them that they aren’t in real danger, but avoid appearing frustrated with them.
• Try to avoid being critical. Someone who has panic disorder is likely already really critical of themselves and knows that their thoughts and behaviours are irrational. They probably need someone around who is non-judgemental.
• Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
• Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.
• If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.
• Encourage professional help for your friend when needed (see Help Section)
• Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself.

See the Help Section for more info about helping a friend and self care.