Panic Disorder: Causes, Symptoms, and Treatment

Written by Rachel De La Merced and reviewed by Board Certified Psychiatric Nurse Practitioner Kate Filippelli, PMHNP who specializes in evidence-based psychiatry practices with personalized treatment plans for all mental health challenges, including psychiatric medication management, research-based supplements and behavioral interventions for major depressive disorder, bipolar disorder, anxiety, panic, OCD, ADHD and eating disorders.

 

Have you ever experienced a sudden wave of overwhelming fear that seemed to come out of nowhere? Maybe your heart started racing, you could not catch your breath, your chest felt tight, and you became convinced something was seriously wrong. 

A panic attack can feel frightening, especially the first time it happens. Many people think they are having a heart attack or another medical emergency. At Remedy Psychiatry, we often see patients who initially present to emergency or urgent care settings believing they are experiencing a cardiac event, only to later learn their symptoms are related to panic attacks. While panic attacks themselves are not dangerous, recurring attacks may be a sign of panic disorder, a common and highly treatable anxiety disorder. [1,2] 

If you have been asking yourself, “Why am I always anxious?” or worrying about when your next panic attack might happen, understanding panic disorder can be the first step toward finding relief.

What Is Panic Disorder?

Panic disorder is a mental health condition characterized by recurrent, unexpected panic attacks followed by ongoing fear about having another attack or changes in behavior to avoid one. [1]

A panic attack is an intense surge of fear or discomfort that usually reaches its peak within minutes. Unlike anxiety that gradually builds over time, panic attacks often appear suddenly – even when there is not an obvious danger.

After experiencing one panic attack, many people begin worrying about when the next one will happen. Some avoid exercising, traveling, driving, crowded places, or unfamiliar situations because they are afraid of triggering another episode. Over time, this fear can become just as disruptive as the panic attacks themselves.

What Does a Panic Attack Feel Like?

Panic attacks can affect both the mind and body, and symptoms often appear very quickly.

Common symptoms include:

• A racing or pounding heartbeat
• Chest pain or discomfort
• Shortness of breath
• Sweating
• Trembling or shaking
• Feeling dizzy or lightheaded
• Nausea or stomach discomfort
• Chills or hot flashes
• Tingling or numbness
• Feeling detached from yourself or your surroundings
• Fear of losing control
• Fear of dying [1]

Because these symptoms closely resemble those of certain medical emergencies, it is common for people experiencing their first panic attack to visit an emergency department believing they’re having a heart attack. [2]

Some people also experience nocturnal panic attacks, which wake them suddenly from sleep with the same intense physical symptoms and fear. These nighttime episodes affect about ¼ to ⅓ of people with panic disorder and are often associated with more severe symptoms. [1]

What Causes Panic Disorder?

Panic disorder does not have one single cause. Instead, researchers believe it develops through a combination of genetic, biological, psychological, and environmental factors.

Genetics

Panic disorder tends to run in families. Studies estimate that nearly half of a person’s risk may be influenced by genetics, meaning having a close family member with general anxiety disorder or mood disorder can increase the likelihood of developing panic disorder. [1,2]

However, genetics alone do not determine whether someone will develop the condition.

Brain and Nervous System Changes

Researchers have found that people with panic disorder may have an unusually sensitive “fear system” in the brain.

Certain brain regions involved in detecting danger appear to become overactive, causing the body to react as though it is facing a life-threatening situation – even when it is actually safe. [1]

Some people also have increased sensitivity to carbon dioxide (CO₂). Small changes in breathing or carbon dioxide levels that most people would not notice may trigger intense fear and physical symptoms in individuals who are vulnerable to panic disorder. [1,4,5]

Psychological and Environmental Factors

Life experiences also play an important role.

Stressful life events, ongoing life changes, childhood adversity, smoking, and certain personality traits can all increase the risk of developing panic disorder. [6]

Many people first experience panic attacks during particularly stressful periods, although panic attacks can eventually occur without any obvious trigger.

Panic Disorder vs. Everyday Anxiety

Understanding stress vs anxiety can help explain why panic disorder feels so different from everyday nervousness.

Most people feel anxious before a presentation, important exam, or major life event. There is even social anxiety where people fear being judged or embarrassed in social situations. Those feelings usually improve once the situation has passed. 

Panic disorder is different. Panic attacks often occur unexpectedly and may not be connected to a specific stressful event. In between attacks, many people continue worrying about when another attack might happen, making it difficult to fully relax.

In our experience at Remedy Psychiatry, we often see that avoidance behaviors, such as limiting travel or avoiding exercise can significantly reinforce panic symptoms and reduce overall quality of life if not addressed early in treatment.

Can Panic Disorder Cause Physical Symptoms?

Absolutely. Panic disorder is a mental health condition, but its symptoms are often intensely physical.

Many people experience chest tightness, dizziness, rapid breathing, muscle tension, or digestive symptoms during a panic attack. If you have wondered, can anxiety cause nausea?, the answer is yes. Anxiety and panic commonly affect the digestive system through the gut-brain connection, leading to nausea, stomach discomfort, or other gastrointestinal symptoms.

Because these physical symptoms feel so real, many people do not initially realize anxiety is the underlying cause. Fortunately, recognizing panic disorder is the first step toward effective treatment.

How Is Panic Disorder Diagnosed?

There is not a blood test or brain scan that can diagnose panic disorder. Instead, a psychiatric provider will review your symptoms, medical history, and how panic attacks are affecting your daily life.

To diagnose panic disorder, providers look for recurrent, unexpected panic attacks followed by at least one month of persistent worry about having another attack or changes in behavior because of the attacks, such as avoiding certain places or activities. [1]

Because panic attacks can mimic other medical conditions, it is also important to rule out causes such as thyroid disorders, heart rhythm abnormalities, asthma, medication side effects, or substance use before confirming the diagnosis. [1,2]

Some providers may also use questionnaires, such as the Panic Disorder Severity Scale (PDSS), to better understand symptom severity and monitor progress during treatment. [2]

Treatment for Panic Disorder

The good news is that panic disorder is highly treatable. Many people experience fewer panic attacks – and often stop having them altogether – with evidence-based treatment.

Treatment usually includes psychotherapy, medication, or a combination of both, depending on the severity of symptoms and individual needs.

Psychiatric Medication Management

For people experiencing frequent or severe panic attacks, medication can be an effective way to reduce symptoms and lower the risk of future attacks.

Current treatment guidelines recommend selective serotonin reuptake inhibitors (SSRIs) – such as sertraline, escitalopram, citalopram, and paroxetine – and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine as first-line medications for panic disorder. [2,3]

These medications do not work immediately. While some people notice gradual improvement within a few weeks, full benefits often take several weeks to a few months. Continuing medication for at least six to twelve months after symptoms improve can help reduce the risk of relapse. [2]

Although benzodiazepines may provide rapid relief during acute anxiety, they are generally not recommended as first-line treatment because they carry risks of tolerance, dependence, withdrawal, and other long-term complications. [2-4]

 

Therapy and Self-Management

Cognitive behavioral therapy (CBT) is the most well-studied psychotherapy for panic disorder and is considered as effective as medication for many people. [2]

CBT helps people recognize the thoughts and behaviors that contribute to panic attacks while gradually reducing the fear associated with physical sensations through exposure-based techniques.

In addition to professional treatment, healthy daily habits can also support recovery. If you are looking to manage anxiety naturally, regular exercise, consistent sleep, mindfulness, breathing exercises, and stress-management techniques may help reduce overall anxiety levels. You can also read our guide on how to calm down for evidence-based strategies to use during moments of heightened anxiety.

When Should You Seek Help?

Many people wait months or even years before seeking treatment because they assume panic attacks will eventually go away on their own.

Consider speaking with a psychiatric provider if:

• You have experienced more than one unexpected panic attack.
• You are constantly worried about having another attack.
• You have started avoiding places, travel, exercise, or social situations because of panic.

If you have been experiencing recurrent panic attacks, you do not have to wait until symptoms become more severe before asking for help.

If you ever experience chest pain, difficulty breathing, or symptoms that could indicate a medical emergency, seek immediate medical care rather than assuming they are caused by anxiety.

You Do Not Have to Live in Fear of the Next Panic Attack

Panic disorder can make everyday life feel unpredictable. Many people begin organizing their lives around avoiding panic attacks, which can make anxiety even more limiting over time. In our experience at Remedy Psychiatry, patients often report that understanding the nature of panic attacks and receiving appropriate treatment helps restore confidence and allows them to re-engage in activities they had previously avoided. The good news is that panic disorder is highly treatable, and many people experience significant improvement with the right care. Whether you are dealing with panic disorder, nocturnal panic attacks, or other anxiety disorder symptoms, effective treatment is available. Understanding what is happening is the first step toward regaining confidence and control.

Disclaimer: This article is intended for educational purposes only and should not be considered medical advice. It is not a substitute for diagnosis or treatment from a qualified healthcare professional. Always consult a licensed healthcare provider regarding your individual health