Question: What Are the Symptoms of Panic Disorder?
Answer: Panic disorder is characterized by repeated but unexpected panic attacks along with ongoing anxiety about having panic attacks and what additional problems the attacks might cause. Without the panic attack, there is no panic disorder, so it's first necessary to understand the symptoms of a panic attack.
The Panic Attack
For the symptoms of a panic attack, we look to the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, the book used by mental health professionals as a basis for diagnosing psychiatric disorders.It's important to remember that you might have a symptom not listed here that your doctor still would categorize as part of your panic disorder. Or, on the other hand, you may be having a symptom listed here, but you are describing it differently. (For example, you may be experiencing heart "flutters" rather than palpitations.) Discuss it with your doctor and be sure to share your concerns.
For the attack to be considered a "panic attack," it must have four or more of the following symptoms. If you have fewer symptoms but still experience the sudden onset and brief duration that characterizes a panic attack, then you may be having a "limited symptom attack." The symptoms below are from the DSM-IV, but in parentheses are similar symptoms described by people with panic disorder:
- Palpitations, pounding heart, or fast heart rate (may also feel like heart flutters or skipped beats)
- Sweating
- Trembling or shaking (may also feel like jitteriness)
- Shortness of breath or smothering sensations (may also feel like difficulty breathing or taking in a full breath)
- Choking feelings (may also feel like a lump in the throat or difficulty swallowing)
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizziness, unsteadiness, lightheadness, faintness (may feel like you're going to pass out)
- Derealization (feelings of unreality) or depersonalization (a feeling of being detached from oneself)
- Fear of going crazy or losing control
- Fear of dying
- Numbness or tingling sensations (also known as "paresthesias," this may be described as "pins and needles" and may be felt in various parts of the body, most notably extremities such as the hands and feet but the lips and face are common areas as well.)
- Chills or hot flushes
- The 10-minute guideline is an estimate or an average. Every individual may expect variations.
- For the attack to be considered a "panic attack," it must have at least four of the symptoms described above. You may be experiencing a period of above-average anxiety that lasts for hours or longer, but it may not be a full-blown panic attack.
- You may be experiencing more than one attack and really not noticing as each attack peaks and then slows down.
Panic Disorder
For a person to have panic disorder, the panic attacks must not result from another disorder (such as another anxiety disorder); a physical illness (such as hyperthyroidism); or substance use (whether drug abuse or a medication). The attacks generally are followed by ongoing anxiety that there will be more attacks. There may be anxiety about the consequences of the attacks (such as worries about having a heart attack or going crazy). And the person may begin to change behaviors and routines based on these anxieties. For a diagnosis to be made, according to the DSM-IV, the person must have one or more of these types of anxieties for at least one month following a panic attack.Agoraphobia
Panic disorder is diagnosed as "panic disorder without agoraphobia" or "panic disorder with agoraphobia." While agoraphobia may occur without panic disorder, generally it is a disorder that may progress from panic disorder. About one in three people with panic disorder will go on to develop agoraphobia, according to Psychiatric Disorders in America: The Epidemiologic Catchment Area Study.There is a range of severity of agoraphobia, and less severe agoraphobia frequently progresses to more severe agoraphobia. The DSM-IV states that agoraphobia may be categorized by an anxiety about being in places or situations where it may be difficult (or embarrassing) to escape (or leave) or where help might not be available if the person has a panic attack or panic-like symptoms. These types of fears generally fall into categories. Some examples are:
- Leaving home alone, leaving home at all, being at home alone
- Driving -- driving in general or in certain situations such as over bridges, through tunnels, on highways, or beyond certain distances from home
- Shopping situations -- grocery store lines, large (bright) stores, shopping malls
- Public transportation
It is important to know the difference between agoraphobic fears and specific phobias, as well as social phobias. Specific phobias are fears limited to a specific object or situation. The fear is of that object or situation and not of being trapped during a panic attack. With social anxiety or phobia, the fear is limited to social situations. While you may experience agoraphobia in crowds, for example, the fear is, again, of being trapped during a panic attack and not a fear of the social situation itself.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Association, 1994.
Robins, Lee N., and Darrel A. Regier. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
