Panic Disorder is an anxiety disorder that is characterized by panic attacks and the fear of experiencing future panic attacks.Panic attacks are unexpected attacks of intense fear, which may be accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. You may think you're losing control, having a heart attack, or even dying.


During a panic attack you may experience one or more of the following symptoms:

  • Chest pain or discomfort

  • Dizziness or faintness

  • Fear of dying

  • Fear of losing control

  • Nausea or stomachache

  • Tingling or numbness in the fingers and toes

  • Choking sensations

  • Feelings of detachment

  • Feelings of unreality

  • A sense of impending doom or death

  • Rapid heart rate

  • Trembling or shaking

  • Shortness of breath or difficulty breathing

  • Hyperventilation

  • Headache

  • Tightness in your throat

  • Trouble swallowing

  • Palpitations or pounding heart

  • Sweating, chills, or hot flashes

These attacks usually peak within 10 minutes and last about half an hour.A key symptom of Panic Disorder is the fear of having another panic attack. You may be afraid to be alone or be too far from medical help. You may also avoid places and situations where an attack has occurred or where you believe an attack may occur.Many individuals who suffer from other conditions (e.g. depression, anxiety, etc) may also experience panic attacks and those who have Panic Disorder may also have another condition.

Who Gets Panic Disorder?

The onset of Panic disorder usually begins in late adolescence or early adulthood, usually before the age of 25, however it can occur at later in life. Women are more likely to experience panic attacks then men. The chance of developing Panic Disorder is 1-2%, though as much as 10% of the population will have a panic attack during their lifetime.There are several risk factors for developing Panic Disorder including:

  • Family History of Panic Disorder or Panic Attacks

  • Stress (e.g., job loss, family conflict, physical illness)

  • Loss of a loved one

  • Life transitions (e.g. moving, having children, etc.)

  • Traumatic events

  • Childhood sexual or physical abuse

How Does Thinking Affect Panic Disorder?

Experiencing a panic attack usually begins with physical symptoms, such as increased heart rate, dizziness, sweating, and shaking. How you interpret those symptoms can contribute to having a panic attack. People with panic disorder interpret their physical symptoms as catastrophic or dangerous and have thoughts such as “Something terrible is happening,” “I’m going to die,” or “I’m going crazy.” You become very focused on any further internal physical sensations or feelings. This focused attention, known as “hypervigilance,” results in more physical arousal, more catastrophic thoughts, more hypervigilance, etc, until the symptoms spiral into a panic attack.

How Does Behavior Affect Panic Disorder?

People with Panic Disorder often try to escape or avoid situations they feel could bring on another panic attack. For example, if you had a panic attack in a restaurant you may begin avoiding all restaurants. Or you may avoid exercise or strenuous activity that increases your heart rate because rapid heart rate was a symptom of your panic attack. This avoidance reinforces the belief that the symptoms are dangerous and should be avoided. You may begin to avoid more and more situations, interrupting your daily routines, or in severe cases, making it difficult to leave your home.You may also engage in “safety behaviors,” which are behaviors that you believe will help prevent a panic attack. Examples of safety behaviors include distraction, carrying anti-anxiety medication, seeking reassurance, staying close to home, and traveling with a familiar companion

How Does CBT Help?

The good news is cognitive behavior therapy is an effective treatment for Panic Disorder. Studies done by various universities in the US and England have shown that undergoing CBT has an 80-85% efficacy rate after 20-25 sessions.During treatment, several goals are established. The clinician will educate you about Panic Disorder and help you understand the condition. You will then discuss the situations that bring on panic attacks and the symptoms you experience during an attack. Finally, the clinician will want to determine if any co-existing conditions exist (e.g. depression, anxiety, etc.). If you have not had a physical check-up since your panic symptoms began, you will be referred to a physician to rule out medical illness.Some of the following techniques may be used to help you alleviate your symptoms and overcome your attacks:

  • Identifying your physical stress symptoms

  • Replacing catastrophic interpretations of bodily sensations with healthy, accurate thoughts

  • Learning how to recognize and reduce anxiety through progressive muscle relaxation, diaphragmatic breathing, and mindfulness meditation techniques

  • Gradual exposure to environments that cause panic

  • Problem-solving how to reduce life stress

To learn more about treatment or to set up an appointment, contact Dr. Fazzari today.

You can also view a video clip of a physical therapist demonstrating and describing diaphragmatic breathing below (