What is Panic Disorder Course of Panic Disorder Agoraphobia
Treatment of Panic Disorder Recurrence after Treatment Coexisting Conditions


Between 3 and 6 million people in the United States alone will develop panic disorder at some time in their lives. Women in young adulthood are the most typical but the disorder can manifest itself to anyone regardless of age, sex and ethnicity.

There is hope for those who suffer: treatment can benefit virtually everyone with panic disorder and is becoming more widely available. It is critical for panic suffererers to learn as much as they can about their condition and treatment options and seek help



Panic disorder is a chemical inbalance of the brain in which distinct episodes of acute fear are accompanied by multiple physical symptoms. These panic attacks occur repeatedly and unexpectedly and have no discernable threat. They appear to occur when the brain's normal threat reaction is inappropriately aroused. This is called the "fight or flight" response

Symptoms of panic vary from individual to individual but typically include chest pain, heart palpatations, choking sensations, disorientation, nausea, headaches, upset stomach, dizziness, difficulty breathing, numb or tingling hands, trembling, flushes or chills, insomnia, feelings of unreality, sense of impending doom, and the fear that you are going crazy or dying.

Panic attacks usually take a person by complete surprise and it is this unpredictability that makes them so devastating. Those who have never had a panic attack might assume that panic is just the familiar feeling of being nervous or anxious. However, feelings experienced during an attack are so overwhelming and terrifying that the sufferer is convinced disastrous consequences will occur, even if their symptoms are not obvious to others.



Typically, the first panic attack seems to come "out of the blue" and occurs while a person is engaged in some ordinary activity such as driving a car or shopping in a grocery store. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms including terror, a sense of unreality and a fear of losing control. These symptoms can last for several seconds to several minutes and gradually fade over the course of about an hour. Most often, people experiencing their first panic attacks seek help at a hospital emergency room, convinced they have been stricken with a life-threatening emergency.

Initial panic attacks may occur when people are under considerable mental or physical stress. An overload of work, the loss of a loved one, surgery, a serious accident, illness, or childbirth are all examples of possible situations that may trigger panic. Other triggers include an excessive consumption of caffeine and the use of cocaine or other recreational drugs as well as stimulant medicines such as those used in treating asthma.

Most people with panic disorder also develop a "fear of the fear". This fear can seriously interfere with a person's life even in the absence of an actual panic attack as phobias develop about places and situations where attacks have occured. These phobias may cause someone who has experienced panic while driving to develop an irrational fear about getting behind the wheel of a car again, even to drive around the block. Anticipatory anxiety and the resulting avoidance can lead to disability in panic disorder.

The fallout from the avoidance behavior is tremendous as limitations increase. Careers may suffer due to a person's inability to travel and relationships may become strained because of phobic behavior and the difficulty in getting a loved one to understand the severity of the disorder. Also, sleep may be disturbed due to nocturnal panic attacks and chronic anxiety. Panic attacks that awaken slumbering victims are so harrowing that those who have experienced them may fear going to sleep and suffer from exhaustion.

Many people with panic disorder continue to go to doctors or emergency rooms even after their diagnosis, convinced a life-threatening condition has been missed. Some sufferers visit a dozen doctors and go through multiple unnecessary tests in an effort to find out what is causing their symptoms.

Adding to this problem has been a lack of knowledge about panic disorder in the medical community which is slowly but surely becoming familiar with the cause, course and treatment. The statistics regarding misdiagnosed panic disorder are staggering as it is still considered a rule out rather than rule in condition. This means that unfamiliar doctors do not often recognize it in spite of all the tell-tale symptoms. And sometimes when doctors do recognize the disorder, it is often downplayed as nerves or stress which can be disheartening to a worried patient with recurring symptoms. They need to be reassured that panic disorder is very real and that there are many effective treatments.


Agoraphobia occurs when panic disorder advances to the stage where a person fears being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. It affects about a third of all people with panic disorder.

Typically, agoraphobics are afraid of being in crowds, standing in line, going to malls or large stores, and riding in cars or public transportation. Often, they create a "safety zone" and restrict themselves to their homes or neighborhood. Leaving this zone causes them increased anxiety. Sometimes they can travel only if they accompanied by their "safe person"- usually a family member or friend. Even when restricted to "safe" situations, most agoraphobics have panic attacks at least a few times a month.

Agoraphobia can be a serious disability with those afflicted leading lives of extreme discomfort and dependency. Sufferers are typically unable to work and rely heavily on others for shopping, errands, and other appointments. They also need to be accompanied in the event that necessity forces them to travel outside of their "safety zone".


Panic Disorder is highly treatable, bringing significant relief to almost 90% of patients. Early diagnosis and treatment is critical to keeping the disorder from progressing to agoraphobia.

Even if panic disorder is diagnosed, patients should undergo a thorough medical examination to rule out all other possible causes of their symptoms before treatment. This is necessary because other conditions, including thyroid disease, epilepsy, and cardiac arrhythmias, can cause symptoms resembling those of panic disorder.

Effective treatments available for panic disorder and agoraphobia include cognitive-behavioral therapy and many different forms of medications. Individual needs and patient preferences should be considered in selecting treatment with reassessment being necessary if significant effects are not produced within 6 to 8 weeks.



Panic disorder is often a chronic condition. For many people, panic goes into remission and then suddenly relapses after many years. These recurrences are not a reflection on the person with panic disorder or their initial treatment. Panic disorder can be treated as effectively in a recurring episode as it was the first time around.

Actually, the coping skills that a person learns in dealing with panic disorder initially can assist them in possible future setbacks. Many people who have overcome panic disorder find themselves better able to deal with recurring problems. In spite of the occasional panic attack, they are no longer at the mercy of their disorder and do not allow panic to control their lives or the lives of their loved ones.


Panic disorder patients should be carefully evaluated for other conditions that may run concurrent with panic as these may influence the choice of treatment. Listed are the most common conditions experienced in patients also diagnosed with panic disorder.

These are irrational fears of specific events or situations. A person who has experienced an attack crossing a bridge, for example, may fear doing so as he associates the bridge with the anxiety. These fears can be addressed and resolved through exposure to the phobia inducing situations, while involved in cognitive-behavioral therapy.

This fear is associated with situations involving the possible scrutiny of the anxious person by others. This exposure causes persistent anxiety as the person feels he will act in an embarrassing or humiliating manner. Social phobia can be treated effectively with cognitive-behavioral therapy, medications or a combination of the two.

Almost 50% of panic disorder patients will experience an episode of clinical depression at some point in their lifetime. Symptoms of major depression include persistent sadness or feelings of emptiness, a sense of hopelessness, feelings of guilt, loss of interest or pleasure in ordinary activities, fatigue or decreased energy, loss of appetite, and difficulty concentrating, remembering and making decisions. Depression can be treated effectively with antidepressant drugs or even cognitive-behavioral therapy, depending on its severity.




What is derealization?
A change in an individual's experience of the environment, where the world around him/her feels unreal and unfamiliar. Terms commonly used to describe derealization include: spaciness, like looking through a grey veil, a sensory fog, spaced-out, being trapped in a glass bell jar, in a goldfish bowl, behind glass, in a Disney-world dream state, withdrawn, feeling cut off or distant from the immediate surroundings, like being a spectator at some strange and meaningless game, objects appear diminished in size, flat, dream-like, cartoon-like, artificial; objects appear to be unsolid, to breathe, or to shimmer; 'as if my head were inside a Coke bottle and I'm viewing the world through the thick glass at the bottom'.

What is depersonalization?
Depersonalization is a change in an individuals self-awareness such that they feel detached from their own experience, with the self, the body and mind seeming alien. Terms commonly used to describe depersonalization include: unreal, disembodied, divorced from oneself, apart from everything, unattached, alone, strange, weird, foreign, unfamiliar, dead, puppet-like, robot-like, acting a part, like a lifeless, two dimensional, 'cardboard' figure', made of cotton-wool, having mechanical actions, remote, automated, a spectator, witnessing ones own actions as if in a film or on a TV program, not doing ones own thinking, observing the flow of ideas in the mind as independent.

Anxiety Symptoms

Shortness of breath Racing heart Chest Pain Derealisation
Difficulty swallowing Skin losing color Sweating Pain in the face or jaw
Symptoms of urinary infection Numbness Gastric emptying Hyperactivity
Flu like Symptoms Indigestion Skin rashes Hallucinations
Weakness in body Shock feeling Dry mouth Agoraphobia
Increase in sexual feelings Losing control Depression Sore eyes
Pins & needles sensations Shaking Distorted vision Insomnia
Disturbed hearing Hormone problems Headaches Aggression
Increased sensitivity      

It is not important to try and understand the physiology of the human body but it is important to remember that each of the anxiety symptoms you experience can be explained. Do not dwell on what you are feeling, instead, project yourself into more useful subjects, do something constructive, exercise, learn a skill or craft and escape the body trap.

The following list of anxiety symptoms includes the most common ones reported by actual anxiety sufferers. Whilst the list is fairly comprehensive, there may be symptoms that you experience that are not listed; this does not mean that you are more ill or suffering from something else, we are all biologically different in many ways and some people simply react differently during anxiety. If you have any symptoms to add to this list, please email them to me with a description of the sensations you experience.

Anxiety Symptom

Smothering sensations and Shortness of breath
These sensations are amongst the more distressing anxiety symptoms. Sometimes it feels as if your chest will not expand to accommodate the air your body needs, other times it feels as if someone is pushing a pillow into your face. The one thing to remember should you experience this is that it is only a sensation caused by exaggerated nerve impulses. These symptoms will not and cannot harm you; you will not stop breathing, pass out or suffocate.

Racing heart, slow heart beat, palpitations
Anxiety releases adrenaline into the blood stream making the heart race and feel as if it is missing beats, (palpitations). This is perfectly natural and will not and cannot harm you in any way. Later I will discuss methods you can use to help stop these feelings. A slow heart beat is also a common feature of anxiety, again it does not mean that your heart will stop beating, it may feel odd and alarming but again do not give it any credibility and it will go away.

Chest Pain
Caused by muscle tension, chest pains can make you feel very scared. The initial reaction of anyone with anxiety who gets pains in their chest is that they are dying of a heart attack. This is not true. Heart pain is very different to this pain and very often does not start in the chest. Deep breathing and relaxation exercises are a very effective way of diminishing these unpleasant symptoms. If you can get somebody to massage your upper back, shoulders and chest, it will help to relax tired and achy muscles.

Lump in throat & Difficulty swallowing
Globus Hystericus is the correct term for this symptom. It is caused by the muscles in the throat contracting due to anxiety or stress. Sometimes it feels like you cannot swallow anything and trying to makes it worse. This is another example of a symptom, which will improve if you give it no credibility. It is totally harmless and will not cause you to stop breathing, eating or drinking, it is just very unpleasant.

Skin losing color (blanching)
As blood is diverted to the muscles during the ‘flight or fight’ response, the fine blood vessels in your skin that gives the skin that pink, healthy colour receive reduced blood flow and the skin loses some of its colour. It is not dangerous and will return to normal as the body starts to normalise after an attack. Some people with generalised anxiety can look a little pale most of the time, again this is quite normal and will return to normal.

Sweating is a normal bodily reaction and is designed to reduce the body temperature. As the body heats up sweat is released onto it through sweat glands. As the sweat evaporates it takes heat with it, cooling the body. During periods of anxiety the body is preparing itself for either flight or fight and releases sweat to cool the impending exertions. As the anxiety subsides sweat levels return to normal.

Shaking or shivering (Visibly or internally)
We all shake or shiver when we are nervous or cold. Shaking is a normal reaction to fear and/or a drop in body temperature. Shaking occurs when the muscles spasmodically contract creating friction between muscles and other body tissues. This friction creates heat which raises body temperature. During anxiety it is quite normal to experience shaking or shivering. It will pass.

Neck & shoulder pain & numbness in face or head
The blood vessels and nerves, which supply the face and head, originate in the neck and shoulders. Many of these nerves and blood vessels are routed across the head to the face. When the body is under stress these areas of the body are usually the first to become tense. Facial numbness can be very disturbing but is usually nothing to worry about and is usually the result of this tension.

Rapid gastric emptying
This can be a very unpleasant side effect of both anxiety and tranquilliser use. This condition causes the sufferer to feel full very early on in a meal, sometimes making them feel as if they cannot breathe. Then soon after eating they can experience diarrhea and feel as if their whole digestive system is emptying very quickly indeed.

Indigestion, heartburn, constipation and diarrhea
During periods of anxiety the body diverts blood from various parts of the body to the muscle tissues in order to supply them with the oxygen needed by them during the flight or fight response. One of the main areas where blood is used most is around the digestive tract. Blood is sent there to absorb nutrients from the food we eat. As blood is diverted away from the stomach during anxiety, the digestion slows and the muscles around the stomach can become knotted. This can cause indigestion, heartburn and diarrhea or constipation. Sexual Dysfunction Impotency, or failure to achieve or maintain an erection, effects many men for many reasons, sometimes there is a physical reason for this but more often than not there is a psychological element.

Symptoms of urinary tract infection
Medication can have many and some times quite obscure side effects including the symptoms of a urinary tract infections. It is always advisable to get these things checked out by your doctor but even if you do have an infection it can be easily treated. Drinking plenty of water is always advisable to maintain good, general health but even more so when the body is under stress.

Skin rashes
Skin rashes, spots or dryness are all very common symptoms of anxiety and stress. It is quite common to get an eczema like rash around the nose, cheeks and forehead. They are nothing to worry about and usually disappear when you start to feel better.

Weakness in arms & tingling in the hands or feet
The flight or fight response is an intense reaction and causes many systems of the body to react. Circulation, blood oxygen and blood carbon dioxide levels change and muscle tension is altered in preparation for action. All of these bodily changes have a profound effect on bodily sensations, feeling week in the extremities, (arms, hands, legs or feet) is one of these sensations. Tingling is usually caused by the pooling of blood carbon dioxide in the limbs, shaking the hands, arms, legs and feet can help increase circulation to these areas. These symptoms are not harmful and will return to normal. Light exercise is very helpful in reversing these sensations. THEY DO NOT MEAN YOU ARE EXPERIENCING A STROKE OR ANY OTHER NEUROLOGICAL CONDITION!!

Electric shock feeling anywhere in the body
The nervous system is a very complex network of electrically charged nerves which are found in every square centimeter of your body, around every organ, muscle and across your skin, the largest organ in the body. Abnormal nerve impulses due to anxiety can cause a vast array of strange sensations; although quite harmless these can be very disturbing.

Dry mouth
As fluids are diverted for use in other parts of the body during anxiety, the mouth becomes dry. Sip water or suck sweets to lubricate your mouth. In extreme cases your doctor can prescribe a liquid to do this but it is expensive. It cannot harm you and will go away after the anxiety subsides.

One of the more distressing effects of anxiety, insomnia is the inability to fall asleep or to remain asleep. It is important to regain regular sleep patterns as lack of sleep can lead to disturbing symptoms.
Dreams and nightmares tend to mimic what is going on in our daily lives. If we are relaxed and contented we have pleasant dreams and usually do not remember them. If we are disturbed or confused our dreams are more likely to be too. Nightmares are unpleasant but harmless, the more you master good sleep and practice breathing and relaxation exercises the better your dreams will become.

Fears of going mad or losing control
We all have a fear of going mad or losing control but rest assured you are not going mad. Going mad is not a conscious act; those who are suffering from severe mental illness are unaware of their journey into it. You are not going mad. Confused nervous messages to the brain along tired nerves in a tired body do not constitute madness. Thoughts are an unconscious product of brain activity. If you are anxious, angry, sad or stressed your thoughts are affected, not only by mood, but also by your physical body chemistry. Blood oxygen levels can affect brain activity and the central nervous system, as can many other bodily chemicals like adrenaline, hormones and even vitamins. These un-pleasant thoughts, emotions and totally irrational fears are not harmful to yourself or others. Any thoughts of harming yourself or other people are perceived only. As you body becomes more relaxed and less anxious your thought processes will return to normal.

Increased depression & suicidal feelings
Depression is a word that is commonly misused to describe a variety of conditions. I hear many people in every day life who say, “I am depressed, I feel terrible, I am so fed up”; this is, in most cases, not depression. Depression is a series of chemical imbalances that create a clinical illness that has strong links with anxiety disorders and can be a side effect of them. Anxiety has many features of depression and can mimic it quite strongly. When someone goes to the doctor complaining of feeling run down and fed up, it is all too easy to write a prescription for Prozac, Seroxat or another anti-depressant. I wonder how many people are on anti-depressants who just needed to reassess and restructure their lives.

When you feel tired, ill, fed up and held back by your condition you are bound to feel angry. One of the main causes of true anger is actually sadness. Think back to a situation that has made you feel anger, if you dissect that event you might find that the true reason for feeling so angry was a feeling of sadness. Aggression is a normal reaction to fear also, the fight or flight response prepares us to either run or fight, sometimes to fight may seem to be the best response.

Symptoms like 'flu'
Influenza causes the body to release anti-bodies into the blood stream to attack the virus. This combination of anti-bodies and infection makes the body feel weak, sweaty and painful. Anxiety can have a similar effect, weakening the muscles, making you clammy and achy. Believe it or not the more you do physically the better this will become.

Distorted vision
In order to prepare the body for impending danger, adrenaline release causes many physical changes. During the anxiety response the body prepares the eyes to notice any slight movements; it does this by dilating the pupils allowing more light to enter. This is why anxious people become more sensitive to bright light and often wear sunglasses to minimize the eyestrain it causes.

Disturbed hearing
This is called tinitus and is usually experienced as whistling or screeching noises in either or both ears.

Hormone problems
Anxiety can affect various systems of the body, one of which is the endocrine system. This system is responsible for balancing the glands, which secrete hormones in the body. Although these glands secrete the hormones needed by the body, they do not control the levels of these chemicals, this is done by the brain. Disturbed messages in the brain and nervous system can cause slight irregularities in the secretion of these chemicals. When anxiety levels return to normal so will the hormone levels. There are few examples where these hormones cause serious problems and if they do your doctor can correct them. Women may find that their menstrual cycle is temporarily effected and men may find that they have mood swings whilst testosterone levels are affected.

Headaches & feelings of having a tight band around head
As discussed earlier, tension in the neck and shoulders can cause immense discomfort, migraine and numbness. The feeling of having a tight band around your head is caused by muscular tension in the sheath of muscles covering the skull. Restricted blood vessels and nerves within this tissue can cause very severe symptoms including pain in the eyes, face and teeth

Sore eyes
Reduced lubrication in the eyes when body fluids are diverted elsewhere during anxiety causes the eyes to feel sore, dry and painful.

Agoraphobia is a natural response to anxiety and self-preservation. If we feel threatened we tend to retreat to somewhere safe, like a tortoise into its shell. In anxiety it is important to gain control of this response as soon as you feel it developing. Avoidance of situations is not an effective tool in the fight against agoraphobia.

Mostly experienced by people in withdrawal, hallucinations can be very frightening indeed if you do not understand what they are and where they come from. Hallucinations are another example of transient symptoms. If you are in withdrawal they will pass, if you are not in withdrawal consult your doctor, as they may be a side effect of the drugs that you have been prescribed.

Creeping or pins and needles sensations in the skin
The nerve endings in your skin are alive with electrical impulses, these can feel like creeping sensations, pins and needles or tickling, they are the result of confused nerve impulses and cannot harm you.

Increased sensitivity to light, sound, touch, and smell
All of these sensitivities are to prepare your senses to see, smell, hear and feel more when in impending danger during the fight or flight response. All of these feeling are unusual but not dangerous, they are temporary and will return to normal as your anxiety levels reduce.

Hyperactivity is a way of describing a range of symptoms that cause you to feel as if you need to talk faster and do things faster. It can make you feel confused and irrational and can make you do things that you would not usually do. This is a common feature of anxiety and drug withdrawal and will pass in time.

Dramatic increase in sexual feelings
As the brain copes with disturbed and confused messages from all around the body, some of the mind’s thought processes can become a little distorted or exaggerated. Sexual thoughts and emotions are typically very strong even when in good health, they are what drive the attraction mechanism when we meet people we find attractive and create the sexual feelings we feel for some people.

Pain in the face or jaw that resembles a toothache
The term “face ache” comes from this feature of anxiety. Most of this symptom is caused by tension, not only in the face, neck and shoulders, which can refer pain to the jaw and teeth, but also in the jaw itself.

Derealisation and depersonalisation
These are both symptoms, which affect the way you experience yourself. Derealisation is the sensation that you and everything around you is not real or dreamy, as if you are seeing everything through a fog or some kind of filter. It has been noticed that people experience both depersonalisation and derealisation during panic. It seems that some people dissociate first which then causes panic and derealisation.

It is not important to try and understand the physiology of the human body but it is important to remember that every symptom you experience can be explained. Do not dwell on what you are feeling, instead, project yourself into more useful subjects, do something constructive, exercise, learn a skill or craft and escape the body trap.

Tips For Coping With Panic


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