Panic disorder is an anxiety disorder characterized by unexpected and recurrent panic attacks. Panic attacks are episodes that begin with sudden and intense fear or discomfort, peaking within a few minutes. During these attacks, physical and cognitive symptoms such as palpitations, sweating, trembling, shortness of breath, chest pain, dizziness or fear of dying may occur. For a diagnosis of PD, the individual must experience persistent concern about having another attack or worry about the consequences of the attacks (for example, having a heart attack, losing control) after at least one of them.

PD can significantly impair quality of life. It may cause disruptions in daily functioning, social withdrawal and the development of secondary psychiatric conditions such as agoraphobia.

DSM-5 Diagnostic Criteria for Panic Disorder

According to DSM-5, the diagnosis of panic disorder requires the following conditions:

• The presence of recurrent, unexpected panic attacks.
• At least one attack has been followed by one month or more of one or more of the following:
  • Persistent concern about having additional attacks.
  • Worry about the implications or consequences of the attacks (for example, having a heart attack or “going crazy”).
  • A significant maladaptive change in behavior related to the attacks (for example, avoidance behaviors).

In addition, the symptoms must not be attributable to substance use, a medical condition or another mental disorder.

Panic Disorder Sypmtoms

Symptoms of panic attacks can be both physical and cognitive. Attacks usually begin abruptly and peak within 10 minutes. Four or more of the following symptoms may occur during a panic attack:

• Palpitations or accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or feelings of smothering
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizziness or lightheadedness
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flushes

These symptoms may lead the individual to believe they are in imminent danger, resulting in frequent visits to healthcare facilities or avoidance of social activities.

What Causes Panic Disorder?

The exact cause of panic disorder is not fully understood, but it is thought to arise from the interaction of biological, genetic and environmental factors.

Genetic predisposition may play a role. Individuals with a family history of panic disorder or other anxiety disorders may have increased risk. Neurobiologically, brain regions such as the amygdala, hypothalamus and brainstem have been implicated in anxiety responses. Hyperactivity in these structures may heighten threat perception.

Dysfunctions in neurotransmitter systems including serotonin, norepinephrine and GABA may increase vulnerability to panic attacks. In particular, increased norepinephrine release in the locus coeruleus has been linked to panic responses.

Environmental factors such as early life trauma, acute stressors (for example sudden job loss, divorce) and substance use (especially caffeine and stimulants) may also contribute to the onset of panic disorder.

Risk Factors

Several individual and environmental risk factors for panic disorder have been identified:

• Genetic predisposition (first-degree relatives with panic disorder)
• Female gender (prevalence may be twice as high in women compared to men)
• Stressful life events (divorce, bereavement, trauma)
• Substance use (caffeine, cocaine, amphetamines)
• History of depression or other anxiety disorders
• Tendency toward hyperventilation (habit of frequent, deep breathing)

Having one or more of these factors may increase the likelihood of developing panic disorder, though their presence does not guarantee its occurrence.

How Is Panic Disorder Diagnosed?

Diagnosis of panic disorder requires a detailed psychiatric evaluation. During the clinical interview, DSM-5 criteria are applied. Differential diagnosis must exclude cardiac, endocrine or neurological conditions. Disorders such as mitral valve prolapse, hyperthyroidism, hypoglycemia and epilepsy may mimic panic attack symptoms. Therefore, physical examination and laboratory tests may be necessary.

In some individuals, panic attacks may occur together with agoraphobia. This leads to avoidance of situations such as crowded areas or being alone, complicating the clinical course.

Panic Disorder Treatment

Panic disorder can be managed with an appropriate and comprehensive treatment approach. Treatment often involves a combination of pharmacotherapy and psychotherapy.

1. Pharmacotherapy

The following classes of medication are commonly used in the treatment of anxiety disorders:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Considered the first-line pharmacological option. They help regulate serotonin levels and reduce anxiety symptoms over time.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): May be prescribed when response to SSRIs is inadequate, as they also target norepinephrine pathways.
• Benzodiazepines: Can be used for short-term relief during acute anxiety episodes but are not recommended for long-term use due to the potential for tolerance and dependence.

Pharmacological treatment should always be supervised by a psychiatrist and individualized according to the patient’s clinical profile and treatment response.

2. Psychotherapy

Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), is highly effective in panic disorder. CBT helps individuals identify and restructure maladaptive beliefs about panic attacks. Relaxation techniques, breathing exercises and exposure therapy may further reduce anxiety.

3. Lifestyle Modifications and Support

Healthy lifestyle habits can support coping with panic disorder:

• Maintaining regular sleep patterns
• Reducing caffeine and alcohol intake
• Engaging in regular exercise
• Developing stress management skills

Psychoeducation programs for patients and their families may improve understanding of the disorder and treatment adherence.

Impact on Daily Life

Panic disorder may cause severe restrictions in social, occupational and personal domains. Individuals may avoid social situations, have difficulty commuting or attending work due to fear of attacks, leading to isolation and functional loss.

Panic disorder may co-occur with depression, other anxiety disorders or substance use disorders. Such comorbidities complicate treatment and further impair quality of life.

For some individuals, panic attacks may be so intense that they believe they suffer from a physical illness, leading to repeated medical interventions and “medicalization.”

In conclusion, panic disorder is a serious but manageable mental health condition. With early diagnosis, effective treatment and sustainable support strategies, individuals’ quality of life can be significantly improved.