Are you experiencing treatment-resistant depression or other mood disorders? Outpatient services are available. Find out more

Navigating Panic Disorder:  Understanding, Coping and Supporting

We regularly encounter stressful and challenging situations that can heighten our anxiety or fear. But sometimes, an experience can be particularly overwhelming, and our bodies react instinctively with a physical and emotional intensity that kickstarts our fight-or-flight response. Because of intrusive thoughts, it’s suddenly hard to breathe; we feel our heart racing or that we’re having chest pains and start sweating. Detached from our surroundings, while consumed by racing thoughts and a sense of impending doom, we feel like we’ve lost control. Panic attacks are highly distressing and disruptive.

When panic attacks begin to occur repeatedly, however, the person experiencing them might start to be consumed with worry about the potential and unpredictable nature of future episodes, so much so that the fear of that possibility begins to affect their behaviour and lifestyle significantly. This is known as panic disorder. In these situations, where a pattern of recurring panic attacks develops, it is essential to seek professional help.

In this article, we’ll look at the concept of a panic attack versus panic disorder. Not everyone who experiences a panic attack will have panic disorder, but those with panic disorder will often experience repeated panic attacks. Panic attacks can occur with any anxiety disorder as well as other mental disorders (e.g., PTSD, substance use disorders, depressive disorders) and some medical conditions (e.g., cardiac, gastrointestinal, respiratory, vestibular). We’ll explore the relationship with agoraphobia, discuss some treatment options and coping strategies that can help support someone with greater empathy and understanding. From there, we’ll also address how veterans can be at increased risk of developing panic disorder and share resources that are essential to creating a supportive environment and helping to destigmatize mental health concerns.

What is panic disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic disorder can be diagnosed when someone frequently experiences recurring and unexpected panic attacks and is persistently worried about having more panic attacks or changes their behaviour in maladaptive ways because of the panic attacks (e.g., avoidance of exercise or of unfamiliar locations). (1) Panic disorder is not the same as an anxiety or a panic attack, though both can be elements of this type of mental health condition.

AnxietyPanic AttackPanic Disorder
Feeling uneasyA sudden, intense surge of fear  Repeated, unexpected, and unpredictable panic attacks.
Constant worry about having future panic attacks can heighten anxiety.
Intense and overwhelming feeling of losing control.Persistent fear that something terrible will happen during a panic attack.  
Example: You might feel anxious before taking a test or making an important decision.    Example: You might experience a panic attack if you are afraid of heights and go on a Ferris wheel.Example: You might be experiencing panic disorder if, during a panic attack, you feel intense physical and emotional symptoms. Your pulse might start pounding so intensely that you begin to think you are having a heart attack. It could lead to waves of successive or simultaneous panic attacks where you start to feel short of breath and dizzy or begin to sweat and have abdominal pain.   You may be unable to determine the cause of your panic attacks because no obvious danger could have triggered them.   You will often start to worry about when the next attack will happen. There could be more today, this week, or this month.
 

Panic disorder can make daily life challenging and can affect a person’s comfort with social interaction. They may prefer to stay within what they determine to be a safer environment where they are close to exits and have ways to escape a situation if a panic attack does happen. There may be a lot of pre-planning for outings, so they feel prepared by having medication or trusted friends and family members nearby.  What someone with panic disorder is experiencing is real and should never be thought of as an overreaction.

It’s important to note that not everyone who has experienced anxiety or had a panic attack will go on to develop panic disorder. It’s estimated that:

  • While up to 1/3 of Canadian adults may have a panic attack, about 4% of them will experience panic disorder in their lifetime (2)
  • Up to 11% of people in the US experience a panic attack (3)
  • Approximately 2-3% of them have panic disorder (4)
  • Onset often occurs in the late teens and early twenties (5)
  • It often affects women more than men (6)

Signs and Symptoms

Panic attacks can vary in their abrupt peak of intense fear or intense discomfort and peak in intensity within a few minutes. (7) People can experience physical symptoms like:

  • Racing heart
  • Shortness of breath
  • Trembling
  • Chest pain
  • Dizziness
  • Sweating

Emotionally, someone may feel intense fear, impending doom or like they have lost control. It’s important to note that for the person going through a panic attack, their perception of time can be distorted, making the experience feel much longer.

With panic disorder, frequency, intensity, and duration help determine different degrees and classifications of symptoms: (8)

Type 1Type 2Type 3Type 4
A single panic attack.Frequent panic attacks (without depression).Regular and recurring attacks with the gradual development of additional symptoms such as anticipatory anxiety, general anxiety, or agoraphobia.Recurring panic attacks with additional symptoms, including depression.

The Relationship with Agoraphobia

Agoraphobia is intense anxiety because of thoughts about being in situations or places where it can be difficult to leave or get help. The spaces are usually either open “such as parking lots, marketplaces, bridges) or enclosed, “such as tunnels, small rooms and elevators,” as well as “supermarkets, shopping malls and other crowded places,” including public transportation and unfamiliar environments. (9) People experiencing agoraphobia can feel trapped, helpless, or embarrassed as the worry that they may experience a panic attack overwhelms them. In some cases, someone experiencing panic disorder with agoraphobia “may not be able to leave the house.” (10) While symptoms of agoraphobia can exist without experiencing a panic attack, with panic disorder, there is no apparent reason for the agoraphobia to be present.

Veterans and Panic Disorder

Veterans can be at increased risk of developing panic disorder and substance use disorder due to the nature of their roles and exposure to combat, traumatic experiences and heightened general stress they experience during deployment. Programs like the Guardians Program, https://homewoodhealthcentre.com/treatment-programs/guardians-program/, at the Homewood Health Centre can offer specialized mental health support for veterans.

Treatment Options

There are a few treatment approaches that are effective to help with panic disorder. Working with a doctor is the best place to start, as they can help you understand what might work well and consider combinations that could provide relief more rapidly.

PsychotherapyMedicationComplementary and Alternative Therapies
Cognitive-Behavioural Therapy (CBT)Helps identify symptoms and triggers, plus develop ways to cope and change behaviours.   Exposure Therapy Helps address associations between fears and bad outcomes to help manage anxious feelings.  Depending on which medications your doctor might recommend, relief can happen within a few weeks. Some medicines may take longer to see improvements. Your doctor will discuss possible side effects and work to find a medication that works.Art therapy Breath training   Both types of treatment can be helpful. Because they help reduce stress, plus develop calm and healthy mindfulness and self-regulation techniques when you practice them.   Sometimes, these methods are easier for people to use to help them complete any ‘homework’ from psychotherapy treatment.

Coping Strategies

Meditation and lifestyle choices such as prioritizing better sleep, regular exercise, a balanced diet and limiting alcohol intake, plus maintaining social connections, are always good ways to cope with life’s stressful situations. Some specific techniques can be helpful to try when experiencing anxiety or panic attacks:

  • Breathing and relaxation techniques can help regulate the body’s stress response by introducing a rhythm that helps calm our automatic nervous system responses and reduce anxiety.
  • The 555 breathing technique involves inhaling for a count of 5, holding the breath for a count of 5 and then exhaling for a count of 5.
  • Box breathing is similar in that it involves inhaling for a specific count, holding the breath for the exact count, and exhaling for the same count. With box breathing, you add a counted pause before starting the cycle. Practitioners sometimes suggest envisioning a box shape to complete the technique.
  • Mindfulness practices that help focus on sensory awareness and offer grounding can also help during a panic attack and promote overall well-being. These exercises can help shift attention away from anxious thoughts.
  • The 333 sensory awareness technique involves identifying and acknowledging three things you can see, three things you can hear, and three things you can touch in your immediate surroundings.
  • The 54321 technique is similar but includes even more sensory awareness. You focus on naming five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste.

How to Support Someone During a Panic Attack

  1. Understand the nature of a panic attack and remember you are there to support someone experiencing one.
  2. Remain calm and provide reassurance, emphasizing that the panicked feelings will pass. Talk using short sentences.
  3. Encourage the person to use coping strategies that they may have learned in therapy or that you are aware of, like mindful breathing and grounding techniques. Even simply helping them count slowly aloud to ten can help slow their heart rate and make them more responsive.

Developing awareness and understanding of panic disorder is crucial to fostering compassion, being supportive and eliminating stigma around mental health. Knowing some signs and symptoms can help all of us create a better sense living in a supportive community.

References:

1. American Psychiatric Association. (2013). Anxiety disorders. Retrieved January 12, 2024 from Diagnostic and statistical manual of mental disorders (5th ed.).

2. Canadian Mental Health Association – British Columbia Division (n.d.). Panic Disorder. CMHC BC. Retrieved January 1, 2024 from https://bc.cmha.ca/documents/panic-disorder-2/

3. Cleveland Clinic (medically reviewed) (2023 Feb 12). Panic Attacks & Panic Disorder. Cleveland Clinic. Retrieved January 1, 2024 from https://my.clevelandclinic.org/health/diseases/445…

4. Ibid.

5. Burke D., and Collins D. (medically reviewed) (2022 Feb 23). A guide to Panic Attacks and Panic Disorder. healthline. Retrieved January 1, 2024 from https://www.healthline.com/health/panic-disorder

6. Ibid.

7. American Psychiatric Association. (2013). Anxiety disorders. Retrieved January 12, 2024 from Diagnostic and statistical manual of mental disorders (5th ed.).

8. Takeuchi, T. et al. (2022 March). Four clinical types of panic disorders – Abstract. National Library of Medicine. Retrieved January 1, 2024 from https://pubmed.ncbi.nlm.nih.gov/1635333/#:~:text=T…

9. Antony, M. Ph.D. (2002). Panic Disorder and Agoraphobia. St. Joseph’s Healthcare Hamilton. Retrieved January 1, 2024 from https://www.stjoes.ca/health-services/mental-healt…

10. Ibid.

Welcome to Homewood Health
Homewood Health Centre is a fully accredited, physician-led, medically-based inpatient treatment facility offering several specialized programs and extensive services to treat a wide range of mental health issues including trauma, addiction, anxiety, depression as well as co-occurring mental health and addiction issues.
Therapy@Home

Relax, Thrive, Persevere, and more. Transform your life with affordable and convenient virtual therapy from the comfort of your home.

Related resources for friends and family

Featured Articles