"All of a sudden, I felt a tremendous wave of fear for no reason at all. My heart was pounding, my chest hurt, and it was getting harder to breathe. I thought I was going to die."

"I'm so afraid. Every time I start to go out, I get that awful feeling in the pit of my stomach and I'm terrified that another panic attack is coming."

As described above, the symptoms of a panic attack appear suddenly, without any apparent cause. They may include:

• Racing or pounding heartbeat
• Chest pains
• Dizziness, lightheadedness, nausea
• Difficulty breathing
• Tingling or numbness in the hands
• Flushes or chills
• Dreamlike sensations or perceptual distortions
• Terror--a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
• Fear of losing control and doing something embarrassing
• Fear of dying

A panic attack typically lasts for several minutes and is one of the most distressing conditions that a person can experience. Most who have one attack will have others. When someone has repeated attacks, or feels severe anxiety about having another attack, he or she is said to have panic disorder.

What is Panic Disorder?

Panic disorder is a serious health problem in this country. At least 1.6 percent of adult Americans, or 3 million people, will have panic disorder at some time in their lives. The disorder is strikingly different from other types of anxiety in that panic attacks are so sudden, appear to be unprovoked, and are often disabling.

Once someone has had a panic attack--for example, while driving, shopping in a crowded store, or riding in an elevator-- he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where the individual with panic disorder may be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus panic disorder can have as serious an impact on a person's daily life as other major illnesses--unless the individual receives effective treatment.

Is Panic Disorder Serious?

Yes, panic disorder is real and potentially disabling, but it can be controlled with specific treatments. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for heart disease or some other life-threatening medical illness. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions.

Medical personnel generally attempt to reassure the panic attack patient that he or she is not in great danger. But these efforts at reassurance can sometimes add to the patient's difficulties: If the doctors use expressions such as "nothing serious," "all in your head," or "nothing to worry about," this may give the incorrect impression that there is no real problem and that treatment is not possible or necessary.

What is the Treatment for Panic Disorder?

Thanks to research, there are a variety of treatments available, including several effective medications, and also specific forms of psychotherapy. Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time--about 6 to 8 weeks. Thus appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency-bringing significant relief to 70 to 90 percent of people with panic disorder.

In addition, people with panic disorder may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. Recent research also suggests that suicide attempts are more frequent in people with panic disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself. Tragically, many people with panic disorder do not seek or receive treatment.

What Happens if Panic Disorder is Not Treated?

Panic disorder tends to continue for months or years. While it typically begins in young adulthood, in some people the symptoms may arise earlier or later in life. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. There may be periods of spontaneous improvement in the disorder, but it does not usually go away unless the person receives treatments designed specifically to help people with panic disorder.

What Causes Panic Disorder?

According to one theory of panic disorder, the body's normal "alarm system"--the set of mental and physical mechanisms that allows a person to respond to a threat-tends to be triggered unnecessarily, when there is no danger. Scientists don't know exactly why this happens, or why some people are more susceptible to the problem than others. Panic disorder has been found to run in families, and this may mean that inheritance (genes) plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Often the first attacks are triggered by physical illnesses, a major life stress, or perhaps medications that increase activity in the part of the brain involved in fear reactions.

Where Can I Get More Information?

For more information about panic disorder and other anxiety disorders, write:

The Anxiety Disorders Education Program, National Institute of Mental Health
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663

Or call 301-443-4513.

Publications and other information are also available online from the NIMH Website at http://www.nimh.nih.gov or by calling toll-free 1-88-88-ANXIETY (1-888-826-9438).