Panic disorder and panic attacks

Panic disorder is an anxiety disorder where you regularly have sudden attacks of panic or fear.

Everyone experiences feelings of anxiety and panic at certain times. It's a natural response to stressful or dangerous situations.

But for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time, often for no apparent reason.

Anxiety

Anxiety is a feeling of unease. It can range from mild to severe, and can include feelings of worry and fear. The most severe form of anxiety is panic.

You may start to avoid certain situations because you fear they'll trigger another attack.

This can create a cycle of living "in fear of fear". It can add to your sense of panic and may cause you to have more attacks.

Panic attacks

A panic attack is when your body experiences a rush of intense mental and physical symptoms. It can come on very quickly and for no apparent reason.

A panic attack can be very frightening and distressing.

Symptoms include:

• a racing heartbeat
• feeling faint
• sweating
• nausea
• chest pain
• shortness of breath
• trembling
• hot flushes
• chills
• shaky limbs
• a choking sensation
• dizziness
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears
• a feeling of dread or a fear of dying
• a churning stomach
• a tingling in your fingers
• feeling like you're not connected to your body

Most panic attacks last for between 5 and 20 minutes. Some panic attacks have been reported to last up to an hour.

The number of attacks you have will depend on how severe your condition is. Some people have attacks once or twice a month, while others have them several times a week.

Although panic attacks are frightening, they're not dangerous. An attack won't cause you any physical harm, and it's unlikely that you'll be admitted to hospital if you have one.

Be aware that most of these symptoms can also be symptoms of other conditions or problems, so you may not always be experiencing a panic attack.

For example, you may have a racing heartbeat if you have very low blood pressure.

When to get help

See a GP if you have been experiencing symptoms of panic disorder.

They'll ask you to describe your symptoms, how often they occur, and how long you have had them.

They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.

Although it can sometimes be difficult to talk to someone else about your feelings, emotions and personal life, try not to feel anxious or embarrassed.

You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least a month of continuous worry or concern about having further attacks.

Treatment aims to reduce the number of panic attacks you have and ease your symptoms.

Psychological (talking) therapies and medicine are the main treatments for panic disorder.

Depending on your symptoms, you may need 1 of these treatments or a combination of the 2.

Psychological therapies

You can refer yourself directly to a psychological therapies service for treatment based on cognitive behavioural therapy (CBT).

If you prefer, you can see a GP and they can refer you.

You might discuss with your therapist how you react and what you think about when you're experiencing a panic attack.

Your therapist can teach you ways of changing your behaviour, such as breathing techniques to help you keep calm during an attack.

See your GP regularly while you're having CBT so they can assess your progress and see how you're doing.

Medicine

If you and your doctor think it might be helpful, you may be prescribed:

• a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) or, if SSRIs aren't suitable, a tricyclic antidepressant (usually imipramine or clomipramine)
• an anti-epilepsy drug such as pregabalin or, if your anxiety is severe, clonazepam (these medicines are also beneficial for treating anxiety)

Antidepressants can take 2 to 4 weeks before their effect builds up, and up to 8 weeks to work fully.

Keep taking your medicines, even if you feel they're not working, and only stop taking them if your GP advises you to do so.

Referral to a specialist

If your symptoms do not improve after CBT, medicine and connecting with a support group, your GP may refer you to a mental health specialist such as a psychiatrist or clinical psychologist.

The specialist will carry out an assessment of your condition and devise a treatment plan to help you manage your symptoms.

What to do during a panic attack

The next time you feel a panic attack coming on, try the following:

• do not fight the attack
• stay where you are, if possible
• breathe slowly and deeply
• remind yourself that the attack will pass
• focus on positive, peaceful and relaxing images
• remember it's not life threatening

Preventing a further attack

It may also help to:

• read a self-help book for anxiety based on the principles of cognitive behavioural therapy (CBT) – ask your GP to recommend one)
• try complementary therapies such as massage and aromatherapy, or activities like yoga and pilates, to help you relax
• learn breathing techniques to help ease symptoms
• do regular physical exercise to reduce stress and tension
• avoid sugary food and drinks, caffeine and alcohol, and stop smoking, as all these things can make attacks worse

It may help to read our article on how to deal with panic attacks.

You'll also find mental health apps and tools in the NHS Apps Library.

Support groups

Panic disorder can have a big impact on your life, but support is available. It might help to speak to others who have the same condition, or to connect with a charity.

You may find the following links useful:

• Anxiety UK
• Mind: understanding anxiety and panic attacks
• No Panic
• Triumph Over Phobia (TOP UK)

Ask your GP about support groups for panic disorder near you.

Find anxiety services in your area

Complications of panic disorder

Panic disorder is treatable and you can make a full recovery. It's best to seek medical help as soon as you can if possible.

If you do not get medical help, panic disorder can escalate and become very difficult to cope with.

You're more at risk of developing other mental health conditions, such as agoraphobia or other phobias, or an alcohol or drug problem.

If you have panic disorder, it may also affect your ability to drive. Legally, you need to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could impact your driving ability.

Visit GOV.UK for further information about driving with a disability or health condition.

Causes

As with many mental health conditions, the exact cause of panic disorder is not fully understood.

But it's thought the condition is probably linked to a combination of things, including:

• a traumatic or very stressful life experience, such as bereavement
• having a close family member with the disorder
• an imbalance of neurotransmitters (chemical messengers) in the brain

Panic disorder in children

Panic disorder is more common in teenagers than in younger children.

Panic attacks can be particularly hard for children and young people to deal with. Severe panic disorder may affect their development and learning.

If your child displays the signs and symptoms of panic disorder, they should see a GP.

A GP will take a detailed medical history and carry out a thorough physical examination to rule out any physical causes for the symptoms.

They may refer your child to a specialist for further assessment and treatment. The specialist may recommend a course of CBT for your child.

Screening for other anxiety disorders may also be needed to help determine what's causing your child's panic attacks.

Read more about anxiety disorders in children or find out about mental health services for children and young people.