Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Panic Disorders

What Is It?

Panic disorder is a type of anxiety disorder. A person with panic disorder has panic attacks. These are repeated, unexpected episodes of intense fear and anxiety accompanied by physical symptoms that are similar to the body's normal response to danger.

If you are truly in danger (for example, if you are confronted by a criminal with a gun), your body readies itself for "fight or flight." Heart rate increases. Blood rushes to arm and leg muscles, causing a trembling or tingling sensation. You may sweat and become flushed. You become intensely fearful, aroused and very alert. For people having a panic attack, these changes occur even though there is no danger. At the height of a panic attack, there may be a frightening feeling that the environment has somehow become unreal or detached. The person may worry about dying, having a heart attack, losing control or "going crazy."

Some people with panic disorder have several panic attacks every day, while others go weeks or months between attacks. Since panic attacks occur without warning even during sleep people who suffer from panic disorder are usually anxious that an attack may begin at any moment. They worry not only about the psychological pain and physical discomfort of the panic attack, but also that their extreme behavior during a panic episode might embarrass them or frighten others. This unshakable fear and anticipation eventually may lead to avoiding public places where it would be difficult or embarrassing to make a sudden exit.

This fear is called agoraphobia. People who have agoraphobia may, for example, avoid attending a performance in a crowded stadium or movie theater; waiting in line at a store; traveling on a bus, train or plane; or driving on roads that have bridges or tunnels.

Although researchers do not completely understand why some people develop panic disorder, they believe that the illness involves a disturbance in brain pathways that regulate emotion. Also, it is possible that people with panic disorder may have inherited a "fight or flight" response that is either more sensitive than normal or responds more intensely than usual. Studies of close relatives of people with panic disorder show that this disease has a genetic (inherited) basis. These relatives are four to eight times more likely to develop the illness than people with no family history of the problem. In the United States, panic disorder affects an estimated 1.5% to 3.5% of people at some point during their lives. Women are two times more likely than men to have panic disorder, and about three times more likely to develop agoraphobia. On average, symptoms start at around age 25, but panic disorder and agoraphobia can affect people of all ages.

Some people with panic disorder first develop symptoms after a stressful life event, such as divorce, job loss or a death in the family. Scientists still do not understand exactly how panic attacks are triggered, but there is growing evidence that stress early in life makes a person more likely to develop panic symptoms.

People who have panic disorder have a relatively high risk for developing other types of psychiatric problems. In fact, at the time of diagnosis, more than 90% of people with panic disorder also have major depression, another anxiety disorder, a personality disorder or some form of substance abuse.