Have you ever felt, all of a sudden, a sense of impending doom—feeling like you were losing control, going crazy, or even dying?  If you have a mental health condition called panic disorder, then you are quite familiar with this feeling.

So, what is panic disorder?  What causes it?  And how can it be treated?

The diagnosis of panic disorder

People with panic disorder experience recurrent and unexpected panic attacks (short episodes of extreme fear).

According to the DSM-5, the diagnostic manual published by the American Psychiatric Association, the diagnosis of the panic disorder requires the presence of at least four of the following 13 symptoms during the panic attack:

  • Heart palpitations
  • Sweating
  • Shaking
  • Feeling short of breath
  • Sensations of choking
  • Chest discomfort
  • Nausea
  • Dizziness
  • Chills or sensations of heat
  • Numbness and tingling
  • Feelings of unreality or detachment from oneself
  • Fear of going crazy
  • Fear of death

The diagnosis also requires that the afflicted individual constantly fear additional panic attacks or engage in avoidance behaviors (e.g., avoid going out alone) to prevent further attacks.

Causes of panic disorder

The DSM-5 suggests risk factors for panic disorder include genetic factors (such as parental anxiety, depression, and respiratory issues), a history of abuse, recent stressors, smoking, and certain personality features, like neuroticism and anxiety sensitivity.

The psychological processes underlying the development of panic disorder may involve the following.

  • Interoceptive fear conditioning: In interoceptive fear conditioning, certain sensations that accompany a panic attack become associated with the terror one feels during a panic attack.  As a result, even slight signs of somatic anxiety, like subtle changes in breathing or heart rate, become signals and may trigger a panic attack.
  • Catastrophic misinterpretation of physical sensations: Misinterpretation of bodily sensations occurs when one mistakenly assumes normal fear sensations or sensations resembling fear—whether produced by exercise, drinking too much coffee, hormonal changes or other factors—indicate something terrible is happening (e.g., one is going crazy or dying).


The most common treatments for panic disorder are medications and psychotherapy.

Medications include the following:

  • Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor).
  • Tricyclic antidepressants, particularly imipramine (Tofranil).
  • Benzodiazepines—alprazolam (Xanax), diazepam (Valium), and others.

Psychotherapy (e.g., psychodynamic therapy, applied relaxation) is helpful as well and is often more effective than medications.

One of the most effective psychotherapies for panic disorder is called cognitive-behavioral therapy (CBT).  CBT helps identify, challenge, and modify irrational thoughts (e.g., the thought that increased heart rate always signals danger).  It also aims to modify maladaptive behaviors, particularly avoidance.  How?  Through gradual exposure to feared sensations and feared situations:

  • Exposure to feared sensations often involves using interoceptive exposure techniques.  Some examples are spinning in a chair (to produce dizziness) and breathing through a straw (to produce breathlessness).
  • Exposure to feared situations involves gradually confronting activities and situations that had been avoided (e.g., movie theaters, crowded malls).

A primary goal of exposure therapy is to help patients realize the feared sensations and situations are not as dangerous or harmful as they believe them to be.

Last, in addition to therapy and medication, positive lifestyle changes may also benefit patients with panic disorder.  Eating healthy, getting enough sleep, minimizing caffeine and alcohol intake, engaging in regular exercise, and use of stress-management techniques (e.g., deep breathing, yoga) can help reduce general anxiety and make it easier to control the symptoms of panic disorder.