Panic disorder is defined as recurring panic attacks, or episodes of intense fear accompanied by an array of physical symptoms that strike often and without warning, even during sleep. Mercifully, panic attacks tend to brief, usually lasting a few minutes, although in rare instances they can persist for an hour or more. For reasons as yet unclear, panic disorder is twice as common in women as in men and afflicts 3 million to 6 million Americans. The disorder usually begins in young adulthood but can strike at any age.

Symptoms

According to American Psychiatric Association's official diagnostic manual, DSM-IV, a panic attack includes four or more of the following symptoms:

• Pounding heart, or palpitations
• Sweating
• Trembling of shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, lightheaded, or faint
• Feelings out of touch with reality
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flushes

An isolated panic attack is probably nothing to worry about. But recurring episodes can cause considerable disability and should be investigated by a psychiatrist or another physician skilled at identifying and helping people with anxiety disorders. Without treatment, people with panic disorder may develop a fear of supermarkets, public transportation, parties, restaurants or other places or situations in which they have experienced previous panic attacks.

In about one-third of cases, these irrational fears progress to agoraphobia, or the fear of being in a place or situation from which escape might be difficult or embarrassing. Some agoraphobics are afraid to leave home or other familiar surroundings. In many cases, early diagnosis and treatment can alleviate panic symptoms before agoraphobia has a chance to develop.

Treatments

According to research, at least 70 percent of people with panic disorder can be helped by cognitive-behavioral psychotherapy, medications, or a combination of both. Among those who respond to treatment, significant improvement is usually seen within six to eight weeks.

Cognitive-behavioral psychotherapy operates under the theory that panic attacks are basically a learned response to something the patient is afraid of. Therapy sessions focus on helping the patient "unlearn" those physical reactions. The therapist may suggest certain relaxation techniques, such as slow, controlled breathing, to refocus attention when panic begins to rise. The therapist might also offer a reality check by pointing out, for example, that a slightly elevated heart rate cannot cause a heart attack. Aside from the therapeutic exercises, talking things out during therapy sessions can be extremely beneficial to patients as they combat panic disorder.

Like cognitive-behavioral psychotherapy, medications such as benzodiazepines, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SRIs), and tricyclic antidepressants (TCAs) have been shown to reduce the frequency and severity of panic attacks.