Panic Disorder - When Fear Holds Sway
Panic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief.
Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.
Facts About Panic Disorder
Approximately 2.4 million American adults ages 18 to 54, or about 1.7 percent of people in this age group in a given year, have panic disorder.1
Panic disorder typically develops in late adolescence or early adulthood and is twice as common in women as in men.2
Panic disorder may coexist with other disorders, most often depression and substance abuse.3 Appropriate diagnosis and treatment of other disorders are important to successfully treating panic disorder.
Fortunately, research—including studies supported by NIMH—has led to the development of treatments to help people with panic disorder.
Treatments for Panic Disorder
Treatments for panic disorder include medications, commonly the selective serotonin reuptake inhibitors, and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety.4 NIMH is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70 to 90 percent of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.
Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder.4 The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders, such as panic disorder.5 Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala.
The amygdala, although relatively small, is a very complicated structure, and recent research suggests that anxiety disorders may be associated with abnormal activation in the amygdala. One aim of research is to use such basic scientific knowledge to develop new therapies.
1 Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.
2 Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
3 Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.
4 Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds. Scientific American® Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII, p. 1.
5 LeDoux J. Fear and the brain: where have we been, and where are we going? Biological Psychiatry, 1998; 44(12): 1229-38.
NIH Publication No. 01-4596