Panic Disorder

You’re waiting in line at the bank. You’re running late, you have a million other errands to run and the child at the back of the line won’t stop screaming. Suddenly you start feeling strange. Your heart starts racing. You start to feel dizzy, nauseous and sweaty. After a minute, it feels so bad that you get the overwhelming feeling you’re going to die. It’s hard to breathe and your hands and feet start to tingle. You are absolutely terrified. Within a few minutes, the terror slowly starts to subside. Your heart rate and breathing start to return to normal. This is what a panic attack feels like.

On this Page: Panic Disorder What is it? Who does it affect? Could I have a panic disorder? What can I do about it? Where do I go from here?

You start to experience panic attacks more often, often usually out of nowhere. Now you’re always scared about having another one. You think that this might be a sign that you’re having a heart attack or stroke, even though the doctor has ruled those out. You might start avoiding the places or situations where you’ve had attacks before. Or maybe you are scared to be in public because you’re embarrassed that people might see you have an attack. This is what panic disorder feels like.

What is it?

Panic disorder is a type of anxiety disorder that causes repeated, unexpected attacks of intense fear, along with fear of having more attacks. If you have panic disorder, you are probably also scared that bad things will happen to you because of the attacks. While up to a third of adults may have a panic attack in any given year, only 1–2% of Canadians in that same year would experience panic disorder. About 4% of Canadians will experience panic disorder in their lifetime.

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Who does it affect?

While panic disorder can affect anyone, there are certain groups of people that it affects more often than others.

• Women: Like most other anxiety disorders, women are twice as likely as men to experience panic disorder.
• Young adults: Panic disorder usually appears in your mid-twenties, although it can happen at any age. Three quarters of people with panic disorder experienced the onset before the age of 33. Although it can exist in kids, it’s often not diagnosed until they’re older.
• People with a chronic illness: Three quarters of people with panic disorder report having at least one other diagnosed chronic physical or mental illness like diabetes or depression.
• Family history: People with a family history of anxiety or depression are at greater risk for developing panic disorder.

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Could I have panic disorder?

Recognizing a panic attack

Panic disorder involves repeated panic attacks, so it’s important to know what a panic attack feels like. Here is a list of signs that you’re having a panic attack:

• I feel like something terrible is going to happen
• I’m having trouble catching my breath
• My heart is pounding
• My body/hands are shaking
• I’m breaking out into a sweat
• I feel lightheaded or dizzy
• I have goose bumps or ‘chills’
• I feel tingling in my hands and feet
• I feel disconnected from reality
• I feel nauseous

If the first symptom plus several of the others come on suddenly, you may be experiencing a panic attack. Panic attacks usually peak within a few seconds or a few minutes, although it can take some time for all the symptoms to settle. Panic attacks can happen at any time and while they are sometimes triggered by a stressful life event, they can often appear to be triggered by nothing at all.

It’s important to know that having a panic attack doesn’t mean you have panic disorder. A third of adults will experience a panic attack in their lifetime and most of them will not develop panic disorder or need help. You might have a panic attack when you are feeling stressed about a life event, but on its own, this doesn’t mean you have panic disorder. Panic attacks can also be a symptom of other anxiety disorders, like phobias or post-traumatic stress disorder. For example, someone with post-traumatic stress disorder might have a panic attack when they revisit the place where the trauma happened. In this case the person is afraid of their trauma and not of the panic attack itself, so this would not be a sign of panic disorder.

Recognizing panic disorder

Here’s a list of signs that your panic attacks might mean something more, like a panic disorder:

• My panic attacks come on unexpectedly
• My panic attacks are happening more often—such as several a day, a week or a month
• I have a lot of fear of having another attack
• I’m worried about bad things that might happen because of the attack such as being embarrassed in public, or going ‘crazy’ or fear I might die because of them
• I am avoiding physical activities (e.g., exercise, sex), foods (e.g., spicy dishes), or beverages (e.g., caffeine, alcohol) because I’m afraid they might trigger panic-like symptoms
• I avoid certain places or situations unless I have a friend or family member with me, or have items like medications with me
• I find myself sitting near exits or bathrooms so that I can escape easily if I have an attack

If one or more of these sound like you, it’s important to talk to your doctor. You may also want to try our online anxiety self-tests,* which you can print out and take to your doctor. See www.heretohelp.bc.ca/screening-self-tests

*available in English, French and Traditional Chinese

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Panic Disorder with Agoraphobia Up to 50% of people with panic disorder also experience agoraphobia. Agoraphobia is an extreme fear of being in situations or places that would be difficult to escape from if you have a panic attack. For example, you might be scared of being in crowded places because it would be hard to find help if you have an attack. In rare cases, these fears can cause some people stay in their homes for long periods of time. Some people may experience agoraphobia without panic disorder.

What can I do about it?

There are a few different things you can do that have been shown by research to help the most:

• Counselling: Many people with anxiety disorders benefit from a form of counselling called cognitive-behavioural therapy or CBT. A mental health professional trained in the CBT approach can help you work through the thoughts, emotions, behaviours and triggers contributing to your panic disorder. They can also teach you coping skills. Part of CBT may involve slowly introducing you to things that may more easily trigger your panic until you feel more comfortable. Although CBT is usually a short-term treatment, practicing the skills you learn both during and after treatment can help you manage your symptoms for a long time to come.
• Medication: Anti-anxiety medications and antidepressants can be used in combination with counselling to reduce your body’s response to anxiety.
• Support groups: You are not alone. Anxiety disorder support groups, including for panic disorder, are a great way to share your experiences and learn from the experiences of others.
• Self-help: During and after treatment, there are some things you can do on your own to help keep you feeling better. Regular exercise, eating well, managing stress, spending time with friends and family, spirituality, and monitoring your use of alcohol and other drugs can help keep anxiety from getting worse or coming back. Talking to your doctor, asking questions, and feeling in charge of your own health are also very important. Always talk to your doctor about what you’re doing on your own.

Although there are many other alternative therapies for anxiety, there is less evidence that they actually work. Some people find that herbal remedies help reduce their body’s response to anxiety. Remember that even herbal remedies can have side-effects and may interfere with other medications. Dosages can also vary depending on the brand you use. Talk about the risks and benefits of herbal or other alternative treatments with your health care providerand make sure they know all the different treatments you’re trying.

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Where do I go from here?

The best first step is always to talk to your doctor. They can help you decide which, if any, of the above treatments would be best for you.

Other helpful resources are:

AnxietyBC

Visit www.anxietybc.com or call 604-620-0744 for community resources and lots of helpful information about panic disorder and other anxiety disorders, including strategies to try at home.

Canadian Mental Health Association, BC Division

Visit www.staging.cmha-bc.flywheelsites.com or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver) for information and community resources.

BC Partners for Mental Health and Addictions Information

Visit www.heretohelp.bc.ca for info sheets and personal stories about (illness). You’ll also find more information, tips and self-tests to help you understand many different mental health problems

Resources available in many languages:

*For the service below, if English is not your first language, say the name of your preferred language in English to be connected to an interpreter. More than 100 languages are available.

HealthLink BC

Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you’re worried about, or talk with a pharmacist about medication questions.