Panic Disorder

A panic attack is a brief episode of intense fear. It is accompanied by multiple physical and cognitive symptoms that occur repeatedly and unexpectedly in the absence of any external threat.

People with panic disorder experience recurrent and unexpected panic attacks and persistent fears of repeated attacks.

People are diagnosed as having a panic disorder if they have had four attacks within a four week period, or following one or more attacks, have the persistent fear of having another attack. Anticipatory fears of having panic attacks in public places, or where no help or escape seems possible may lead to the individual becoming housebound and the development of agoraphobia.

While panic attacks are common, with up to 30 per cent of the population experiencing a panic attack during a given year, panic disorder is less common, affecting 2 to 3 percent of the population. 


A panic attack includes four or more of the following symptoms:

  •  Shortness of breath or smothering sensation
  •  Feeling of choking
  •  Dizziness, unsteady feelings or faintness
  •  Palpitations, pounding heart or accelerated heart rate
  •  Trembling or shaking
  •  Sweating
  •  Nausea or abdominal distress
  •  Numbness or tingling sensations
  •  Flushes or chills
  •  Feelings of unreality and detachment from self or the environment
  •  Fear of dying
  •  Fear of going crazy or doing something uncontrolled. 
Treatment for Panic

The above techniques are all valuable in the management of Panic Disorder and Agoraphobia. Treatment along these lines should lead to significant improvement within 4-6 weeks with major improvement by 3-6 months. Patients with high levels of symptomatology may feel uncomfortable with the idea of performing such techniques, including those which are sometimes anxiety provoking in themselves. In this context use of medications, specifically the antidepressant group, may help to lower the anxiety to a level to enable performance of these techniques. In this situation reduction and eventual cessation of the medication should be possible because of the ongoing use of these effective cognitive behavioural strategies. Whilst pharmacological treatments are known to be very effective in the management of anxiety disorders, they do not provide long term relief from these symptoms unless continued indefinitely. In this context Cognitive Behavioural Therapy for Panic Disorder and Agoraphobia must be regarded as the treatment of choice with addition of antidepressant medications a potentially useful adjunct to treatment. Combined treatment with pharmacological and psychological measures is usually very effective, often with one treatment improving both the compliance and effectiveness of the other.

Useful links:

Fear Anxiety and Panic Booklet 2012