Panic Disorder

Common symptoms of panic attacks

Panic attacks involve a combination of physical and psychological symptoms that occur suddenly and intensely. According to the DSM-5, a panic attack includes four or more of the following symptoms:

Physical symptoms include:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or sensations of smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizziness, lightheadedness, or feeling faint
• Chills or hot flashes
• Numbness or tingling sensations (paresthesias), particularly in fingers or toes

Psychological symptoms include:

• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or “going crazy”
• Fear of dying

In children and adolescents, panic attacks may be expressed differently, often manifesting as extreme crying spells, temper tantrums, clinging to caregivers, or refusal to separate from parents.

Understanding panic disorder vs. isolated panic attacks

It is important to distinguish between experiencing a panic attack and having panic disorder. Many people experience a panic attack at some point in their lives without developing panic disorder. Panic disorder is diagnosed when panic attacks are recurrent and unexpected, and when they are followed by at least one month of:

• Persistent worry about having additional panic attacks or their consequences (such as losing control, having a heart attack, or “going crazy”)
• Significant changes in behavior to avoid situations where panic attacks might occur
• Development of agoraphobia, which involves fear and avoidance of places or situations where escape might be difficult or help unavailable if a panic attack occurs

How panic disorder affects daily life

The impact of panic disorder extends far beyond the panic attacks themselves, often creating significant limitations in multiple areas of life.

In work and academic settings, panic disorder can impair attendance, performance, and career advancement. Individuals may avoid meetings, presentations, or work travel due to fear of having a panic attack in front of colleagues or in situations where escape feels difficult. Students may miss classes, avoid exams, or struggle with concentration due to anticipatory anxiety.

In social and interpersonal relationships, panic disorder can create isolation and strain. Individuals may avoid social gatherings, restaurants, theaters, or other public places where they fear having a panic attack. Partners and family members may feel frustrated or confused, unsure how to provide support. The need for reassurance or accompaniment to feared situations can create dependency and tension in relationships.

In independence and mobility, panic disorder combined with agoraphobia can severely restrict daily life. Individuals may avoid driving, using public transportation, shopping, or leaving their homes. This restriction can lead to loss of employment, social isolation, and dependence on others for basic needs.

In emotional and mental health, the constant fear of panic attacks can be exhausting and demoralizing. Many individuals with panic disorder also experience depression, generalized anxiety, or substance use as they attempt to manage symptoms. The unpredictability of panic attacks can create a sense of helplessness and loss of control over one’s life.

When to seek professional help for panic disorder

If you have experienced recurrent panic attacks or if fear of panic is limiting your life, it is important to seek professional support. Research consistently shows that panic disorder responds very well to CBT and exposure-based treatment.

Consider seeking help if you:

• Experience recurrent, unexpected panic attacks
• Worry persistently about having another panic attack or its consequences
• Avoid situations or places due to fear of having a panic attack
• Notice that fear of panic is affecting your work, school, or relationships
• Have developed agoraphobia or significant restrictions in your daily activities
• Experience physical symptoms that have been medically evaluated and attributed to anxiety
• Feel that your life is becoming smaller due to avoidance

A diagnostic evaluation can help clarify whether your symptoms meet criteria for panic disorder and rule out other medical conditions that may cause similar symptoms.

How Renewed Freedom Center treats panic disorder

At Renewed Freedom Center, treatment for panic disorder is grounded in Cognitive Behavioral Therapy (CBT), which has strong research support as the most effective treatment for panic disorder. CBT for panic focuses on understanding the panic cycle, challenging catastrophic interpretations of bodily sensations, and using exposure strategies to reduce fear and avoidance.

Treatment is personalized based on symptom severity, the extent of avoidance, and individual goals. For some, weekly CBT sessions provide appropriate support. For others experiencing severe panic disorder with agoraphobia or significant life disruption, our Intensive Outpatient Program (IOP) offers a more structured approach with multiple sessions per week and intensive exposure practice. Group therapy can also be beneficial, providing skills training, peer support, and normalization of experiences.

Our approach includes:

• Psychoeducation about the nature of panic attacks and the panic cycle
• Cognitive restructuring to challenge catastrophic interpretations of physical sensations
• Interoceptive exposure to practice tolerating feared physical sensations in a safe, controlled way
• In vivo exposure to gradually face avoided situations and places
• Breathing and relaxation techniques to manage symptoms and reduce hyperventilation
• Relapse prevention planning to maintain progress and navigate future challenges

For individuals whose panic disorder co-occurs with OCD or other anxiety disorders, integrated treatment addresses both conditions simultaneously. When appropriate, family involvement can help reduce accommodation patterns and support exposure practice. Learn more about family-focused treatment on our about page.