Panic Disorder

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.

The Body’s Natural Reaction: Fight or Flight

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 understand what a panic attack is.

What is a Panic Attack?

A panic attack is 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.

Diagnosing Panic Disorder

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 experienced differently 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.

Misconceptions About Panic Disorder

A panic attack 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.

Like all mental health issues, panic disorder is complicated. The causes and risk factors of panic disorder can include a number of things working in combination, like genetics, biology, personality environmental or life experiences.

Possible Causes and Triggers of Panic Disorder

Some possible causes/triggers for panic disorder could include:

• Family history – anxiety disorders, including panic disorders, can run in families.
• Genetics/Biology – there is some evidence that the biochemistry of the brain can be linked to panic disorder.
• Life experiences – distressing life events or trauma might contribute to panic disorder for some.

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 about the signs and symptoms of panic disorder. If you think you might be experiencing panic disorder, you should see your doctor to receive a proper diagnosis.

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.

Thoughts Experienced During a Panic Attack

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 of Panic Disorder

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 of Panic Disorder

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

Co-occurring Mental Health Issues

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

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.

Panic disorder is treatable. For panic disorder or any other mental health concern, if signs or symptoms are interfering with your life in any way, it’s time to seek professional help.  You don’t have to wait for things to get really “bad” before seeking help.

If panic attacks are interfering with your work, school, relationships or other parts of your life, it’s probably time to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or counselor.

Helping a Friend with Panic Disorder

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. Panic attacks can be frightening and can make individuals feel like they are losing control, which can lead to feelings of embarrassment or shame. As a result, your friend might avoid talking about their experiences or even downplay the severity of what they’re going through. They might need you to take the first step.

As always, if you feel like you or your friend might hurt him/herself or someone else, it’s time to call emergency services.

Visit the Help Section to find out how to get help for yourself or a friend.

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 for panic disorder 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.

Effective Therapies for Panic Disorder

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 and Coping Strategies

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 counselling, therapy, support groups or benefit from learning about it and ways to support their loved one at home.

The Role of Medication in Managing Panic Disorder

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.

Inpatient vs. Outpatient Treatment Options

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 mental health support while you wait. Find out where to call in your area.

Along with panic disorder 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 panic disorder 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 support in their life.

Panic disorder is often misunderstood, with many people mistakenly viewing it as just extreme anxiety, rather than recognizing it as a complex mental health condition. Here are some common myths and misconceptions about panic disorders and other anxiety disorders:

Myth: Panic attacks are an overreaction to stress and anxiety.

Fact: Being really worried or scared at times is a normal part of life. But when we throw around the term “panic attack” to describe any reaction to fear or worry, we’re missing the point and seriousness of panic attacks. Saying something like “Oh I was so worried for the test that I was having a panic attack” might undermine someone’s actual experiences with panic disorder. Also, panic attacks aren’t an “overreaction”. Thinking this implies that someone chooses when and how a panic attack happens, which isn’t the case. Someone might learn how to manage and lessen their panic attacks, but that’s not the same as choosing to have them in the first place.

Myth: I’ve had a panic attack. I must have panic disorder.

Fact: Having panic attacks is definitely a symptom of panic disorder, but panic attacks can be brought on by other mental and physical health issues. Panic attacks have also been associated with mental health disorders such as generalized anxiety disorder (GAD), phobias, obsessive compulsive disorder (OCD), eating disorders, social anxiety disorder, depression, and bipolar disorder. There are also some physical illnesses, like digestive and sleep disorders, that have also been connected to having panic attacks.

Myth: Panic attacks can cause you to lose control permanently.

Fact: Panic attacks are usually caused by a mental health issue. It can certainly feel overwhelming and like a loss of control when a panic attack strikes. Thoughts like “I’m going ‘crazy’” or “I’m losing it” are common while someone is having a panic attack. Panic attacks should be taken seriously, as they are distressing and can be very debilitating. Usually, however, a panic attack often lasts only a few minutes (but for someone having one, it can seem like a LOT longer!). While a person might feel ‘on edge’ for a while after a panic attack, it’s not causing you permanent mental or physical damage.

Myth: You can die from a panic attack.

Fact: Panic attacks can be extremely alarming, especially if you’re not sure what’s happening. Many people end up in the emergency room the first time they have one, as they can feel like they are dying or having a heart attack. The physical symptoms are very intense, but not life threatening. Panic attacks should still be taken seriously, however, as they are often a sign of a mental illness or other issue, many of which are very treatable.

Myth: Avoiding things that trigger panic attacks is the best way to cure panic disorder.

Fact: For many people with panic disorder, panic attacks can come on suddenly and unexpectedly. If they are not caused by any one specific thing, it can be impossible to avoid them. For others, there might be certain things that cause or trigger a panic attack. Sometimes this results in someone actively avoiding certain places or situations in order to avoid triggering a panic attack which can get in the way of living a happy, healthy life (avoiding crowds can turn into withdrawing from friends, family, school, work, etc.) and even 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). Some treatment strategies for panic disorder and other anxiety disorders actually involve exposing the person to things that might trigger their anxiety in a controlled way in order to help them learn coping strategies.

Myth: Panic disorder isn’t treatable.

Fact: Panic disorder is treatable through medications and psychotherapy. In many cases, panic disorder can be managed well, or even effectively cured, with professional help.

Myth: Panic disorder is caused by poor upbringing, family dysfunction or low self-esteem.

Fact: The causes of anxiety disorders are not entirely understood by industry professionals. Panic disorder seems to be triggered by any number of factors including upbringing, biological/genetic factors, learned behaviours, brain chemistry and challenging life experiences. People who come from caring, supportive families can still develop an anxiety disorder, or any mental illness, like panic disorder.

Myth: Since anxiety is “in your head,” anxiety disorders are not true illnesses.

Fact: In fact, an anxiety disorder is an extreme form of uncontrollable worry and fear that causes serious misery and impairment. If it’s not treated properly, it can dramatically limit a person’s quality of 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 include:

Recognize Panic Disorder and its Symptoms

Know the signs and symptoms of panic disorder and other anxiety disorders.

Understand 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.

Provide Support During a Panic Attack

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.

Avoid Logic & Embrace Empathy

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.

Be a Supportive Listener

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-judgmental.

Respect the Treatment Process

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 as your friend undergoes treatment. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.

Visit a Friend in the Hospital

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 visitors’ rules first.

Encouraging Professional Help

Encourage professional help for your friend when needed (see Help Section).

Set Boundaries

Set some boundaries for yourself and take care. You can’t help someone if you’re feeling overwhelmed by yourself.

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

Some tips and coping strategies for managing anxiety.

Anatomy of a Panic Attack, a tool that illustrates how panic attacks can feel and what you can do to get through.

A video, “Anxiety Attack”, that describes what it feels like for one young person.

Find more about Panic Disorder.

The information on this page about panic disorder is a simple overview of a complicated health issue. For more in-depth information, please speak to a qualified medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line. You can find resources near you on the free and confidential Be Safe App.

Please see the Help Section for more information and resources.

References

1. Centre for Addiction and Mental Health (CAMH)
2. Canadian Mental Health Association (CMHA)
3. “Psychology Works” Fact Sheet: Panic Disorder, Canadian Psychological Association