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Panic Attacks and Panic Disorder


John W. Barnhill

, MD, New York-Presbyterian Hospital

Reviewed/Revised Aug 2023
Topic Resources

A panic attack is a brief period of extreme distress, anxiety, or fear that begins suddenly and is accompanied by physical and/or emotional symptoms. Panic disorder involves recurrent panic attacks that lead to excessive worry about future attacks and/or behavior changes intended to avoid situations that might trigger an attack.

  • Panic attacks can cause such symptoms as chest pain, a sensation of choking, dizziness, nausea, and shortness of breath.

  • Doctors base the diagnosis on the person's description of attacks and fears of future attacks.

  • Treatment may include antidepressants, antianxiety medications, exposure therapy, and psychotherapy.

Panic attacks are common, occurring in at least 11% of adults each year. Most people recover from panic attacks without treatment, but a few develop panic disorder.

Panic attacks may occur as part of any anxiety disorder Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of mental health conditions, including generalized anxiety disorder... read more . Panic attacks may also occur in people with other mental health disorders (such as depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more ). Some panic attacks occur in response to a specific situation. For example, a person with a phobia of snakes may panic when encountering a snake. Other attacks occur without any apparent trigger.

Panic disorder is when people worry that they will have more panic attacks and/or change their behavior to try to avoid attacks. Panic disorder is present in 2 to 3% of the population yearly. Women are about 2 times more likely than men to have panic disorder. Panic disorder usually begins in late adolescence or early adulthood (see Panic Disorders in Children and Adolescents Panic Disorder in Children and Adolescents Panic disorder is characterized by panic attacks that occur at least once a week. A panic attack is a brief (about 20-minute) episode of intense fear that is usually accompanied by physical... read more ).

Overview of Panic Disorder

Symptoms of Panic Attacks and Panic Disorder

A panic attack involves the sudden appearance of intense fear or discomfort plus at least 4 of the following physical and emotional symptoms:

  • Chest pain or discomfort

  • A sensation of choking

  • Dizziness, unsteadiness, or faintness

  • Fear of dying

  • Fear of going crazy or of losing control

  • Feelings of unreality, strangeness, or detachment from the environment

  • Flushes or chills

  • Nausea, stomachache, or diarrhea

  • Numbness or tingling sensations

  • Palpitations or an accelerated heart rate

  • Shortness of breath or a sense of being smothered

  • Sweating

  • Trembling or shaking

Did You Know...

  • Although panic attacks cause symptoms like shortness of breath or chest pain, they are not dangerous.

Symptoms of panic attacks include many types of physical symptoms, and people often worry they have a dangerous medical problem involving the heart, lungs, or brain. For example, chest pain may occur during a panic attack, and people may worry they are having a heart attack. Symptoms that are severe or persistent should be evaluated by a doctor. However, a person may see a doctor or visit a hospital emergency department many times until the correct diagnosis of panic attack is made.

Although panic attacks are uncomfortable—at times extremely so—they are not dangerous. Symptoms usually peak within 10 minutes and disappear within minutes, so a doctor may not be able to directly observe the symptoms.

Because the reason for a panic attack is often not clear, people who have them frequently anticipate and worry about another attack—a condition called anticipatory anxiety—and try to avoid situations that they associate with previous panic attacks.

The frequency of attacks can vary greatly. Some people have weekly or even daily attacks that occur for months, whereas others have several daily attacks followed by weeks or months without attacks.

Panic disorder is often accompanied by at least one other condition. Other anxiety disorders Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of mental health conditions, including generalized anxiety disorder... read more , major depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , bipolar disorder Bipolar Disorder In bipolar disorder (formerly called manic-depressive disorder), episodes of depression alternate with episodes of mania (or a less severe form of mania called hypomania). Mania is characterized... read more , and mild alcohol use disorder Alcohol-related disorders Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,... read more are the most common coexisting mental health disorders. Common coexisting medical conditions include abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Overview of Abnormal Heart Rhythms , hyperthyroidism Hyperthyroidism Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more Hyperthyroidism , asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more Asthma , and chronic obstructive pulmonary disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette... read more Chronic Obstructive Pulmonary Disease (COPD) .

Diagnosis of Panic Attacks and Panic Disorder

  • A doctor's evaluation, based on standard psychiatric diagnostic criteria

Because serious physical disorders often cause some of the same physical and emotional symptoms as panic attacks, doctors first make sure people do not have a physical disorder. A doctor gathers information about the person's experience of the attacks and may do tests for other problems.

Panic disorder is diagnosed when people have repeated unprovoked and unexpected panic attacks plus at least one of the following for at least 1 month:

  • Persistent worry that they will have more panic attacks or worry about the consequences of the attack (for example, that they will lose control or go crazy)

  • Changes in behavior due to the panic attacks (for example, avoiding situations that may cause an attack)

Once doctors are confident that a person's symptoms are caused by a panic disorder, they try to avoid doing extensive tests when future panic attacks occur unless the person's symptoms or physical examination results suggest a new problem.

Treatment of Panic Attacks and Panic Disorder

  • Antidepressants and/or antianxiety medications

  • Psychotherapy, including exposure therapy, cognitive-behavioral therapy, and interpersonal psychotherapy

Without formal treatment, some people recover, particularly if they continue to confront situations in which attacks have occurred. For others, symptoms wax and wane for years.

However, if people have had frequent attacks and have changed their behavior to avoid future attacks, treatment with medications and/or psychotherapy is usually necessary. People with panic disorder are more receptive to treatment if they understand that the disorder involves both physical and psychological processes and that treatment can usually control the symptoms.


Drugs that are used to treat panic disorder include

  • Antidepressants

  • Antianxiety medications such as benzodiazepines

Most types of antidepressants—tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin modulators, and serotonin-norepinephrine reuptake inhibitors (SNRIs)—are effective (see table ).

SSRIs or SNRIs are the preferred medications because they are as effective as the other drugs but usually have fewer side effects. For example, they are much less likely to cause sleepiness, and they do not cause drug dependence, although if stopped abruptly most SSRIs and SNRIs can cause uncomfortable withdrawal symptoms (eg, dizziness, fatigue, headache, nausea).

Initially, people may be given a benzodiazepine and an antidepressant. When the antidepressant starts working, the dose of benzodiazepine is typically decreased, then stopped. However, for some people, a benzodiazepine is the only effective long-term treatment.

Medications may prevent or greatly reduce the number of panic attacks. However, without psychotherapy, medications may not help people worry less about future attacks and stop avoiding situations that cause panic attacks.

A medication may have to be taken for a long time because panic attacks often return once it is stopped.


Most psychotherapies that target anxiety disorders—including panic disorder—teach techniques that promote relaxation. Relaxation strategies include mindfulness, meditation, hypnosis, exercise, and slow, steady breathing. These strategies are an important component of therapy since they both reduce the anxiety and also allow for the continuation of a psychotherapy that may be anxiety provoking.

Cognitive-behavioral therapy (CBT) has been shown to be effective for panic disorder. CBT is a term used to describe various talk therapies that focus on dysfunctional thinking and/or dysfunctional behavior.

People may have their own distinct but dysfunctional cycle of thinking that can induce anxiety and/or panic. For example, a person might have a baseline worry about having a heart attack and spend an inordinate amount of time scanning their bodies for signs of a heart attack. If they feel a twinge in their chest, they might then begin a cycle that quickly leads to a panicky, mistaken belief that they are about to die. CBT involves clarifying these cycles and then teaching patients to recognize and control their distorted thinking and false beliefs. They are then better able to modify their behavior so that it is more adaptive. In addition, the treatment encourages them to gradually expose themselves to situations that might be likely to induce the panic, thereby desensitizing their assumed association between the setting and the symptoms.

People may be taught the following:

  • Not to avoid situations that cause panic attacks

  • To recognize when their fears are not likely to result in bad consequences

  • To respond instead with slow, controlled breathing or other techniques that promote relaxation

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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