What Are the Signs of Panic Disorder?

Each year six million American adults experience intense and recurring panic attacks, which are the definitive signs of panic disorder. These attacks produce alarming symptoms of extreme anxiety, and panic disorder sufferers will go to elaborate lengths to avoid circumstances they believe may trigger such attacks in the future.

Panic attacks generally occur in situations that are not truly threatening or dangerous, and when they first appear people experiencing them may think they’re suffering a heart attack, or some other kind of serious physical problem. The symptoms they cause usually last for 10-20 minutes, but they may go on indefinitely if the individual suffering the attack is unable to escape to a more comfortable environment.

The signs of panic disorder are distinctive and impossible to miss, once sufferers understand what is really going on.

Anxiety and the physiological effects it triggers are a normal response to perceived danger. The brain must mobilize all the body’s physical and mental resources to deal with any type of threat, and anxiety helps to jumpstart the process by providing a burst of energy that can be converted into quick protective action.

The physiological side effects of panic-based anxiety include:

• A sudden and significant increase in heart rate
• Contraction of the muscles
• The cessation of saliva production
• An increase in glucose (blood sugar) production that boosts energy levels
• Dilated pupils
• Shallow breathing, or hyperventilation
• Complete mental absorption in the moment

This set of symptoms is sometimes referred to as the “flight-or-fight” response, and it can be a useful reaction of the sympathetic nervous system in the face of a life-or-death situation.

But the human body can respond anxiously to a wide variety of triggers, many of which don’t involve any real threat to life or limb. In these instances, the body relies on the parasympathetic nervous system to correctly assess the situation and create a counter-response, relaxing the body and helping it return to a normal state.

This physiological reaction is usually effective. But when a panic attack is occurring the symptoms of anxiety are so strong they overwhelm the parasympathetic nervous system and hinder its effectiveness.

During a panic attack, there are two areas of the brain that become hyperactive and resist the body’s attempt to slow them down: the amygdala, which is responsible for emotional regulation and reactions associated with fear, and an area of the midbrain known as the periaqueductal gray, where the body’s defensive reactions are converted into physiological reactions.

Hyperactivity in these areas puts the anxiety response into overdrive, escalating it to the point where it causes an uncontrollable panic attack. Anxiety in the form of panic is more intense and long-lasting than typical anxiety responses, and it may take the parasympathetic nervous system several minutes to return the body to a normal state.

One 2004 study found a shortage of receptors for the neurochemical serotonin in the brains of people who suffer from panic disorder (and depression). Serotonin is a chemical that helps preserve or restore emotional equilibrium, and when serotonin activity is suppressed by receptor deficits it can make it harder for a person to manage their anxiety.

The physical symptoms of panic attacks include:

• Rapid heartbeat
• High blood pressure
• Heavy sweating
• Stomach cramps or nausea
• Chest tightness
• Feelings of choking
• Labored breathing
• Shaking, trembling
• Numbness or tingling in the extremities
• Lightheadedness
• Dizziness
• Seeing stars or other visual disturbances

Many people having panic attacks are afraid they might be on the verge of passing out, or possibly even dying of a heart attack. Neither is likely to happen, but these kinds of fears tend to make the symptoms of panic even worse.

Panic attack sufferers are desperate to flee and will do so if they have the chance, usually to someplace quiet where they can sit or lay down, or outside if the attack occurs inside a building, or to their homes if they are close enough to reach them quickly. But if those options aren’t available, their fear can escalate to the point where it becomes impossible to think about anything else. People having panic attacks become highly self-conscious, feeling certain that others will notice their reactions and stare at them or even laugh at their discomfort.

The primary behavioral trait of panic disorder is avoidance. Men and women who’ve suffered panic attacks come to fear them so intensely that they rearrange their daily activities to avoid environments where they believe the risk of attack is high. This can impact their lives in numerous ways, and possibly force them to leave their jobs or withdraw from school if those environments seem overly threatening.

Some men and women with panic disorder only experience attacks in certain places or in specific circumstances, while others experience them more randomly and unpredictably.

Those who suffer from unpredictable attacks may come to see the entire world as a potential trigger, which puts them at high risk for developing panic disorder with agoraphobia, a form of the condition that affects more than one-third of all sufferers. Agoraphobia is a deep, paralyzing fear of open spaces or unfamiliar places, and those who suffer from agoraphobia often become homebound, interfering with their capacity to live a normal life.

Panic disorder sufferers experience chronic and overwhelming feelings of stress and anxiety. The fear of having another attack puts men and women with panic disorder under constant strain, and over time this can have a devastating effect on their overall mental and physical health.

Stress and anxiety are associated with an increased risk for multiple physical health problems, including:

• Heart disease and heart attack
• Stroke
• Higher levels of blood sugar that can exacerbate diabetes
• Weakened immune system functioning and increased susceptibility to disease
• Insomnia
• Respiratory problems, including asthma
• High blood pressure
• Digestion problems, possibly leading to diarrhea and/or constipation
• Chronic tension or migraine headaches
• Ulcers
• Metabolism issues leading to weight gain

People with panic disorder are also at risk for other types of mental health conditions, including depression (up to 50 percent of panic sufferers may experience it), other anxiety disorders (which often precede the onset of panic disorder), and substance use disorders, which can easily develop in anxiety sufferers who turn to drugs and alcohol to self-medicate.

If a panic disorder is left untreated for an extended period, additional health problems will almost surely develop.

Disabling panic attack symptoms must be experienced for one month or more before panic disorder can be diagnosed. Once a mental health professional has identified panic disorder, treatment should begin immediately, since the suffering this condition causes is so devastating and life-altering.

Despite the intensity of its symptoms, panic disorder is a highly treatable disorder. Treatment regimens for panic disorder will usually include both medication and psychotherapy, which together can help sufferers cope with the physical and mental symptoms of their condition.

It can take time and great effort for people with panic disorder to overcome the fear that accompanies their panic attacks, and that is especially true for those who have panic disorder with agoraphobia, or any other co-occurring mental or behavioral health condition. Regardless of the circumstances or complications, patients who begin their treatment in a residential mental health facility have the best odds of recovery.

Inpatient treatment (or intensive outpatient treatment) for panic disorder lets sufferers focus completely on the healing process, without distraction and in an environment where they can connect with others who understand how anxiety disorders can disrupt daily functioning. A panic disorder sufferer’s support network will include both trained mental health professionals and peers who are working to overcome similar conditions, and during daily therapy sessions panic disorder patients will have extensive opportunities to interact with people who have wisdom and insights to share.

Holistic healing practices like meditation, yoga, biofeedback, art and music therapy, massage therapy, and acupuncture all come highly recommended for anxiety disorder patients, and most high-quality mental health treatment facilities now offer them as a supplement to individual, group, and family therapy.

The signs of panic disorder are a cry for help. Fortunately treatment works, and those who seek it have an excellent chance of overcoming the disabling effects of this troublesome and intimidating disorder.