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Panic Attacks and Panic Disorder

What is panic disorder?

Panic attacks are the defining feature of panic disorder. Panic attacks are episodes of extreme anxiety and/or bodily discomfort which come on quite suddenly and unpredictably. Panic attacks are much more intense and upsetting than "regular anxiety" that we all experience. In fact, during a panic attack, most people feel a profound sense of danger that their physical safety or their capacity to control themselves is threatened. Although distressing panic attacks are the defining feature, worry about having panic and attempts to control or avoid panic become the controlling and self-perpetuating factors in panic disorder.

Symptoms of panic disorder

Not every person has the same pattern of symptoms.

However, every person with panic disorder has some combination of the following symptoms:


1. Shortness of breath or smothering sensations

2. Dizziness, unsteady feelings or faintness

3. Palpitations or accelerated heart rate

4. Trembling or shaking

5. Sweating

6. Choking sensations

7. Nausea or abdominal distress

8. Depersonalization or derealization (feeling outside yourself, strange, unreal)

9. Numbness or tingling sensations

10. Hot flashes or chills

11. Chest pain or discomfort

12. Fear of dying, going crazy, fainting, losing control, becoming confused, causing an embarrassing "scene" or being unable to get to a "safe" place

Panic attacks often lead to "catastrophizing" and a vicious cycle

Individuals with chest pain, palpitations, rapid heart rate and tingling in their fingertips may feel quite certain they are having a heart attack and may make repeated visits to emergency rooms or to cardiologists. Those with dizziness, sensations of unsteadiness, "jelly legs" and numbness may feel quite certain they are having a stroke or a neurological problem and may persist with many related consultations. If depersonalization and derealization are the primary symptoms, the individual is likely to fear "going crazy" or losing control and is likely to be both terrified and secretive about such fears. Some people become very preoccupied with all bodily sensations, as if they were potential signals of an illness that all the doctors have missed.

Panic attacks often lead to agoraphobia

Of those who develop panic disorder, up to half also manifest agoraphobic avoidance. Although the extreme may be virtual houseboundedness in hopes of avoiding panic attacks, avoidance of a constellation of situations that raise uncertainty and make ready escape difficult is more common.

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