A panic disorder diagnosis is given to a person who has recurrent unexpected panic attacks. A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes. During this time, four or more of the following symptoms occur:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or feeling smothered
• Feeling choked
• Chest pain or discomfort 
• Nausea or abdominal distress
• Dizziness, light-headedness, or feeling faint 
• Chills or heat sensations
• Numbness or tingling sensations
• Feelings of unreality or of being detached from oneself
• Fear of losing control or “going crazy”
• Fear of dying

A diagnosis of panic disorder requests that at least one of the attacks be followed by 1 month or more of one or both of the following:

• Persistent concern or worry about additional panic attacks or their consequences
• A significant maladaptive change in behavior related to the attacks, such as avoiding exercise or unfamiliar situations

Moreover, the disturbance cannot be explained by the physiological effects of a substance (e.g., drug of abuse or medication), another mental condition (e.g., hyperthyroidism or cardiopulmonary disorders), or another mental disorder, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD).

Panic Attack / Panic Disorder Epidemiology

• The lifetime prevalence of the panic disorder is in the 1 to 4 percent range.
• Women are two to three times more likely to be affected by panic attacks than men, although the underdiagnosis of panic disorder in men may contribute to this difference.
• The only social factor identified as contributing to panic disorder is a recent history of divorce or separation.
•  The panic disorder most commonly develops in young adulthood at the mean age of 25. However, panic disorder and agoraphobia can develop at any age.

Panic Attack / Panic Disorder Comorbidity

• Of patients with panic disorder, 91 percent have at least one other psychiatric disorder. About one-third of individuals with panic disorders have major depressive disorder before the panic disorder onset. About two-thirds first experience panic disorder during or after the onset of major depression.
• Of patients with panic disorder, 15 to 30 percent also have a social anxiety disorder or social phobia, 15 to 30 percent have a generalized anxiety disorder, 2 to 20 percent have a specific phobia, 2 to 10 percent have post-traumatic stress disorder (PTSD), and up to 30 percent have obsessive-compulsive disorder (OCD). Other common comorbid conditions include hypochondriasis or illness anxiety disorder, personality disorders, and substance-related disorders.
• Various studies also indicate that 40 to 80 percent of all panic disorder patients suffer from depression.

Psychodynamic Themes in Panic Attacks / Panic Disorder

The psychodynamic theory considers the interplay of conscious and unconscious factors that may develop through interpersonal relationships and during childhood. Psychodynamic themes often seen in patients with the panic disorder include:

• Difficulty tolerating anger
• Physical or emotional separation from significant persons both in
• childhood and adult life
• Situations of increased work responsibilities
• Perception of parents as controlling, frightening, critical, and demanding
• Perception of relationships involving sexual or physical abuse
• A chronic sense of feeling trapped

Panic Attack Disorder vs. Medical Disorders

The panic disorder must be differentiated from a number of medical conditions that produce similar symptoms. These include cardiovascular diseases, pulmonary diseases, neurological diseases, and endocrine diseases.

What are treatments for Panic Attacks or Panic Disorder?

The two most effective treatments for panic attacks/panic disorder are medications and cognitive behavioral therapy. Family and group therapy may also help patients and their families.

Pharmacotherapy
In general, selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil) are shown to be more effective and better tolerated than benzodiazepines, monoamine oxidase inhibitors, and tricyclic and tetracyclic drugs. Some reports suggest a role for venlafaxine (Effexor) and buspirone (BuSpar). Venlafaxine is approved for the treatment of generalized anxiety disorder and may help in patients with both panic disorder and depression.

Cognitive & Behavior Therapies
Cognitive and behavioral therapies are effective treatments for panic disorder. Several studies have found that the combination of cognitive or behavioral therapy with pharmacotherapy is more effective than either approach alone.