Panic disorder

There are many causes of panic. Most people experiencing panic disorder will have several of the following factors that contribute to an attack:

Panic runs in families, so if either parent has panic attacks, it may make you more susceptible.

Personality may play a part. Some people are more nervous and ‘highly strung’ than others. This may be good in some circumstances because they are more sensitive and cautious. But the down side is that they will be slightly more likely to have anxiety problems, including panic. Again this is not always the case. Some anxious people never experience sudden panics and some people who are very calm and confident by nature will develop panic attacks.

Events and situations in your life can put you under stress and make you more vulnerable to panic. Typically, events that make you feel unsafe or insecure or anxious may be causes. General stresses like poverty or relatives dying could make you vulnerable. Panic can also occur as part of another mental illness. It commonly occurs with depression.

Some common substances can cause panic. Caffeine, found in coffee and many soft drinks, is the most common. Tea has a similar but weaker effect. People who have panic attacks and panic disorder may be very sensitive to caffeine and even small amounts can be harmful. Alcohol does not directly cause attacks, but as its effects wear off, you are more likely to have a panic attack. Cannabis is another drug that some people are sensitive to, and for them, it can start panic attacks. The effects of cannabis are long-lasting as the body takes weeks to get rid of it.

Over-breathing, also called hyperventilation, is a problem for the majority of people with panic disorder. Anxiety makes you breathe too much. Over-breathing can directly cause physical symptoms like dizziness and tingling in your hands and feet, which makes you feel even more anxious. Strangely, when you are over-breathing, you may feel as if you are not getting enough air and breathe even harder. This makes you feel worse and you get caught in a vicious cycle.

For some people panic seems to start out of the blue. They may just have a strong inherited tendency to panic. For others there seem to be obvious stresses in their life. There are often some symptoms of general anxiety or depression, or other phobias, in the months before panic starts.

Note, if panic attacks follow an experience that really was extremely dangerous or horrific, like being assaulted or being in an accident, then it is usually part of a different condition known as post-traumatic stress disorder or PTSD.

It's important to remember that it’s not your fault if you are experiencing anxiety or panic.

The most obvious symptoms are the panic attacks themselves. These start suddenly, often in a few seconds, sometimes over five or ten minutes. Panic attacks normally last for 10 or 20 minutes but people can feel anxious or shaken up for some hours after.

As well as feelings of great anxiety, fear or terror, people may also have many other symptoms, most of which are physical. In an attack you may feel several of the following:

These are all symptoms of severe anxiety. Because many of them are physical sensations, people with panic attacks often think that there is something wrong with their body. They may think they are having a heart attack or stroke or that they are dying. They may call an ambulance and be rushed to an emergency medical service. People do not die of panic attacks, even though they may feel that way during an attack.

Panic attacks are common. Many people will have at least one attack during their lifetime. Panic disorder is also quite common. Women are affected twice as often as men. The problem usually starts between the late teenage years and the age of 35. Usually it causes problems for a few months and then lessens.

Unfortunately, panic attacks often come back again after a few months or years and a person's avoidance of places or situations for fear of a panic attack may get worse.

One third of people with panic attacks avoid places where they might panic. This is called agoraphobia. Most people who have not been treated for panic will still have some symptoms 10 years later. By then they may have become depressed or have started to overuse alcohol or other drugs because of repeated panic attacks and the restriction in their lives caused by panic.

If depression becomes severe they may feel suicidal.

Many people with panic attacks, sooner or later, go to see their doctor or a counsellor. When you see your doctor it’s important to tell them as much as you can about how you are feeling and what you are going through, especially if you experience any of the feelings listed above.

The doctor may do some tests to make sure there are no underlying medical conditions that are causing your symptoms. They may also refer you to a mental health professional if they suspect you have panic disorder.

Antidepressant or tranquilliser medication in conjunction with therapy has proven effective in improving the symptoms of panic disorder. 

You should be told what effects you should  notice from any medication, receive clear instructions about how you should take them and what precautions are necessary. 

If you are pregnant or breast feeding no medication is entirely safe.

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

For people who have panic attacks or a panic disorder, the following strategies have been found to be important and useful.

Try to remember that it’s your thoughts/anxiety that causes the feelings you have during an attack. If you do nothing the attack will do you no harm and it will pass.

If you find yourself thinking catastrophic thoughts like: "I am dying," remind yourself that this is not true. Remember that you have survived previous attacks. If you can, you should resist leaving places or situations because of attacks. This is because if you leave or avoid places you will find it increasingly hard to return there.

Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: September, 2014.