Q1. What is panic disorder?

Ans: Panic disorder is a specific anxiety disorder where people have repeated, sudden, and intense panic attacks. They witness these physical surges of discomfort or fear, along with a persistent sense of fear about attacks in the future.

Q2. How is a panic disorder and panic attack different?

Ans: A panic attack is one episode of intense anxiety and fear. On the other hand, panic disorder is diagnosed when you keep having these recurring, unexpected, and sudden attacks, with subsequent and persistent worry about future attacks.

Q3. What are the common physical symptoms of panic attacks?

Ans: Some of the common symptoms include a pounding/racing feeling or palpitations, tightness or pain in the chest, shortness of breath, sweating, dizziness, shaking, and numbness in the hands and feet.

Q4. How do the psychological symptoms of panic disorder feel like?

Ans: Most people facing panic disorder often experience overwhelming and sudden feelings of any upcoming doom or negative developments. There is a strong fear of losing control, dying, going crazy, etc.

Q5. What can trigger a panic attack?

Ans: Many attacks may be triggered suddenly or unexpectedly in panic disorder, without any immediate or clear/specific reason/trigger. However, factors like fatigue, particular environmental aspects, and chronic stress may contribute to the same.

Q6. How long do panic attacks usually last?

Ans: Most panic attacks usually arrive suddenly and peak within about 10 minutes. They may last between 5â20 minutes on average. However, some attacks may last up to an hour.

Q7. Who is at risk of developing panic disorder?

Ans: It may appear in early adulthood or even late adolescence. Some of the risk factors include being female, a family history of anxiety attacks/disorders, and chronic stress.

Q8. Are panic attacks physically dangerous?

Ans: A panic attack may feel like a life-threatening scenario or medical emergency. However, it is not fatal or physically dangerous. It does not lead to any permanent physical damage to the body.

Q9. Why do many people facing panic disorder first consult cardiologists?

Ans: For many people, the symptoms of panic attacks usually mirror those seen during cardiac emergencies, i.e. a rapid heartbeat, chest pain, etc. Hence, many of them visit cardiologists first and panic disorder can go undiagnosed in general medical environments.

Q10. What is the role of agoraphobia in panic disorder?

Ans: Agoraphobia is the fear of being in a situation where escaping may be hard or help may be unavailable. It is a common complication seen for those with panic disorder. A large percentage of those with panic disorder may also experience agoraphobia.

Q11. What are the usual treatments for panic disorder?

Ans: Some of the usual treatments for panic disorder include psychotherapy (like cognitive behavioral therapy) and medication (such as SSRIs prescribed by psychiatrists).

Q12. Do any lifestyle changes help with panic disorder management?

Ans: You can manage panic disorder better through proper stress management, routine physical exercise, deep breathing, and meditation techniques. You can also consider lowering your caffeine intake and getting proper sleep.

Q13. Are the medications for panic disorder addictive in nature?

Ans: Psychiatrists may prescribe SSRIs for the treatment of panic disorder and they are non-habit-forming in nature. Benzodiazepines may be given for relief in the short term, although they are monitored stringently to avoid any dependency.

Q14. Is it possible to fully cure panic disorder?

Ans: While it is a chronic problem or episodic issue for some people, it is still manageable. Consistent medication, therapy, and lifestyle management may help many people recover significantly. Several individuals can drastically lower or eliminate symptoms and get back to leading fully normal lives.

Q15. How can I find help for panic disorder?

Ans: You can consult a clinical psychologist or a psychiatrist. Verified mental health professionals can be found through various platforms like the IAPP (Indian Association of Private Psychiatry) directory. You may also consult your primary care physician for the first referral.

Panic Disorder: Causes, Types & Effects

What is Panic Disorder?

Panic disorder is a specific type of anxiety disorder and it usually involves multiple and unexpected panic attacks. One key feature of these attacks is how they often happen without any warning and do not often require any obvious trigger. But what you should note is that not everyone who experiences a panic attack will develop panic disorder.

Panic attacks are quite common worldwide. Those with a family history of panic disorder are at higher risk of developing the condition. Environmental aspects like stress, abusive relationships, etc., may also contribute to the same.

How Common are Panic Disorders in India?

Panic disorder is one of the commonest debilitating anxiety disorders in India. In the National Mental Health Survey (2016) for India, the lifetime weighted prevalence (for PD) stood at 0.5% (95% confidence interval 0.49-0.52). It also stood at 0.3% for current weighted prevalence (95% confidence interval 0.28-0.41). Higher odds with current PD were seen for urban metro, elderly, and the separated/married cohorts. The treatment gap for current PD also stood at 71.7% according to this report.

The WHO (World Health Organization) states that mental health conditions are among the biggest causes of disability across the globe. It was estimated in 2021 that about 11 in 100 people in India were living with a mental disorder.

Symptoms of Panic Disorder

Panic disorder is not just about feeling scared or anxious. Its a medical condition where recurrent panic attacks can happen suddenly. Such attacks tend to cause strong physical and psychological changes in an individual which may feel similar to a heart attack.

Early Warning Signs	Advanced Symptoms
Sudden episodes of overwhelming fear without a clear reason. Rapid heartbeat or sensation in the chest. Feeling short of breath despite normal breathing. Excessive sweating during stressful or calm situations. Trembling or shaking hands. Persistent worry about experiencing another panic attack. Avoiding places where previous panic attacks occurred. Feeling detached from surroundings. Difficulty concentrating because of constant fear. Mild dizziness or light-headedness during anxious moments.	Recurrent unexpected panic attacks lasting several minutes. Intense chest pain that may resemble a cardiac event. Severe breathlessness or choking sensation. Fear of losing control. Feeling that death is imminent during an attack. Numbness or tingling in the hands, feet or face. Strong urge to escape crowded spaces. Avoiding travel, shopping centres or public transport because of fear of another attack. Sleep disturbances caused by nocturnal panic attacks.

Early Warning Signs

Advanced Symptoms

Sudden episodes of overwhelming fear without a clear reason.
Rapid heartbeat or sensation in the chest.
Feeling short of breath despite normal breathing.
Excessive sweating during stressful or calm situations.
Trembling or shaking hands.
Persistent worry about experiencing another panic attack.
Avoiding places where previous panic attacks occurred.
Feeling detached from surroundings.
Difficulty concentrating because of constant fear.
Mild dizziness or light-headedness during anxious moments.

Recurrent unexpected panic attacks lasting several minutes.
Intense chest pain that may resemble a cardiac event.
Severe breathlessness or choking sensation.
Fear of losing control.
Feeling that death is imminent during an attack.
Numbness or tingling in the hands, feet or face.
Strong urge to escape crowded spaces.
Avoiding travel, shopping centres or public transport because of fear of another attack.
Sleep disturbances caused by nocturnal panic attacks.

Related Diseases Comparison

There are various human disorders that may be mistaken for panic disorder due to symptoms like chest pain or difficulty breathing. Here’s table highlighting difference among all of them.

Basis of Comparison	Panic Disorder	Panic Attack	Social Anxiety Disorder
When it Happens?	Happens when a person has repeated panic attacks and keeps worrying about having more attacks.	Happens suddenly and may occur without warning or after a stressful situation.	Happens before or during social situations where a person fears being judged or embarrassed.
Location	Can happen anywhere, such as at home, work, while travelling or even during sleep.	Can happen anywhere, depending on the situation or trigger.	Mostly happens in social settings, such as meetings, classrooms, parties or public speaking.
Associated Symptoms	Repeated panic attacks, constant fear of another attack and avoiding places linked to previous attacks.	Fast heartbeat, chest pain, shortness of breath, sweating, shaking, dizziness and intense fear.	Fear of talking to people, blushing, sweating, shaking, difficulty speaking and avoiding social situations.
Severity	A long-term condition that can affect daily life if left untreated.	A short episode that is very intense but usually goes away within a few minutes.	Can be mild or severe and may affect work, studies and relationships.
Can it be Reversed?	Yes. Most people improve with counselling, medicines or both.	Yes. The attack usually passes on its own, but frequent attacks should be checked by a doctor.	Yes. Most people improve with counselling, medicines and gradual practice in social situations.

Medicines Used to Treat Panic Disorder

Medicines for panic disorder are usually combined with psychological therapies such as Cognitive Behavioural Therapy (CBT) to achieve better long-term outcomes. Listed below are some of the common medicines prescribed:

Escitalopram
Sertraline
Paroxetine
Fluoxetine
Venlafaxine Extended Release
Clonazepam
Alprazolam

Note: These medicines should only be taken on the advice of a registered medical practitioner.

Living with Panic Disorder in India: Daily Challenges & Caregiving

Living with panic disorder can affect many aspects of everyday life. While effective treatment is available, managing the condition often requires support from family and healthcare professionals.

Daily Challenges It is common for many people to be fearful of experiencing another panic attack when they are engaged in daily activities like going to work, meeting people, or even shopping. Such fears often make them avoid going to public places and thus lack confidence.
Financial Considerations The cost of psychiatric consultations, counselling sessions and prescription medicines can become a long-term financial commitment, particularly when treatment continues for several months. Those living in smaller towns may also need to travel to larger cities for specialist mental health services, increasing overall healthcare expenses.
Lifestyle Changes Maintaining regular sleep, limiting caffeine intake, avoiding recreational drugs and practising stress-management techniques can reduce the frequency of panic attacks for some people.
Home Modifications A calm and predictable home environment can help reduce anxiety. Family members can minimise unnecessary stress by maintaining regular routines, encouraging open communication and creating quiet spaces where the individual can practise relaxation exercises during periods of increased anxiety.
Caregiver Support Rather than seeing panic attacks as overthinking, caregivers should realise that these symptoms are real and can cause great distress. Non-judgmental emotional support also aids in the process of recovery.

Panic Disorder Treatment Cost in India

The cost of treating panic disorder varies depending on the severity of symptoms, the type of treatment recommended and the city where care is received. People requiring long-term treatment or combined psychotherapy may have higher overall costs than those with mild symptoms of panic disorder.

Treatment Type	Estimated Cost
Psychiatric Consultation	₹800 to ₹3,000
Therapy Session	₹1,500 to ₹5,000
Full Treatment Program (Sessions, Assessment, and Medication Management)	₹20,000 to ₹80,000

Note: Treatment costs are indicative and may differ based on the care required and the hospital or clinic chosen.

Causes of Panic Disorders

It’s still unknown as to why some people experience panic attacks or develop panic disorders. Of course, your nervous system and brain have a vital role to play in how you perceive and tackle anxiety and fear.

Risk Factors of Panic Disorders

The risks of panic disorders may increase in case you have:

Family history: If one of your first-degree relatives like biological siblings, parents, or children has the condition.
Mental health conditions: If you have a mental health condition, i.e. depression, anxiety disorders, etc., it may increase the risks of panic disorders.
ACEs: The risks are higher if you have any adverse childhood experiences or ACEs, which mostly happen between 1-17 years of age (and are usually traumatic in nature).
Environmental aspects: If you're living in a mentally stressful environment with ample triggers to deal with regularly.

When Should I See My Healthcare Provider?

You should immediately reach out to your healthcare provider if you notice any of the following:

Chronic or stubborn anxiety that hinders your daily life.
Concentration issues.
Huge irritability.
Fear of leaving the home or agoraphobia.
Sleep issues.
Symptoms of panic attacks that last more than 15 minutes.
Chest pain.
Breathing trouble.
Loss of consciousness.

How Are Panic Disorders Diagnosed?

To find out whether you have panic disorder, your healthcare provider will usually examine various aspects. They include:

Medical History and SymptomsThe provider will check your medical history for confirmation, along with examining any specific symptoms.
Physical ProblemsThere will be checks to see whether any other physical problem is leading to your symptoms. These may include physical examinations, blood tests (for thyroid issues and other conditions), heart health tests, etc.
Panic Disorder TestIf necessary, you may be asked to go through a panic disorder test to confirm the diagnosis. In many cases, you may be referred to mental health providers for panic disorder tests or other psychological evaluations.

How Are Panic Disorders Treated?

Some panic disorder treatment methods may include:

Psychotherapy
Psychotherapy or talk therapy, as it is known, encompasses several treatments that help you identify and change unhealthy thoughts, behaviors, and emotions. Some of the common treatments in this category may include:
- CBT (Cognitive behavioral therapy): Here, you will discuss your feelings and emotions with your licensed psychologist or counselor. He/she will help you identify the specific triggers for your panic attacks and help you change your behavior/reaction likewise.
- Exposure therapy: It is a specific therapy type where gradual and repeated exposure (imagination/reality) to your panic attack triggers is the remedy. Over time, you will gain more control over these events/scenarios. Breathing exercises and other relaxation techniques are also taught to help you manage your anxiety better across this process.
Medications
Some medications that may help treat panic attacks and panic disorders include:
- Antidepressants: Specific antidepressant medications may help bring down the frequency or severity of panic attacks. Some providers may prescribe SNRIs (serotonin-norepinephrine reuptake inhibitors) or SSRs (serotonin-selective reuptake inhibitors).
- Anti-anxiety medications: Benzodiazepines may be prescribed for treating and combating panic attacks (should be taken with caution and only with medical advice).

What is the Outlook for Panic Disorder?

With proper treatment and support, most people experiencing frequent panic attacks or panic disorder will get better. Without treatment, there are risks of unhealthy/negative thoughts and behaviors, suicidal ideation, and lower quality of life due to impaired social functions.

Can Panic Disorders be Prevented?

Your healthcare provider/counselor may help you identify the specific triggers that bring on panic attacks. During psychotherapy, you will learn more strategies to manage these events and combat attacks.

Some other tips include:

Avoiding alcohol.
Reducing your caffeine intake.
Cutting down on/quitting smoking.
Exercising regularly (improves mood and reduces tension and stress).
Getting proper sleep each night.
Consuming a balanced and healthy diet.
Talking to your healthcare provider before taking any medication (some substances may increase your anxiety).

How Can You Stop a Panic Attack?

There is no instant method to stop a panic attack in case it begins. Yet, you can still follow a few steps to manage the symptoms until the attack resolves.

Deep breathing: Deep breathing may help you reduce the panic symptoms during attacks. Try breathing in slowly, deeply, and gently through your nose, while breathing out slowly through the mouth.
Acknowledgement: You should acknowledge that you're having a panic attack- not a dangerous health condition. You can manage anxiety better, knowing that it's only temporary and will pass soon.
Muscle relaxation: Anxiety/panic attacks may get your muscles tense and stiff; try to relieve and relax one muscle group at a time.
Mindfulness: You may suddenly feel disconnected from your body or even from reality. Practicing mindfulness helps immensely, letting you stay in the present.

How Long Does a Panic Attack Last?

A panic attack may usually last for anything between 5 to 20 minutes. However, some individuals have reported attacks that last for up to an hour.

Does Health Insurance Cover Panic Disorder?

Yes, health insurance in India covers panic disorders. As per the Mental Healthcare Act (2017) and the directives of the IRDAI (Insurance Regulatory and Development Authority of India), insurers have to legally treat mental illnesses at par with physical disorders. The usual coverage inclusions are in-patient hospitalization for severe attacks and pre and post-hospitalization (tests, evaluations, medications).

*Note that coverage for regular therapy/counseling and standalone psychiatrist consultation depends on the specific OPD benefits in your policy.

How Much Health Insurance Is Needed for Panic Disorder Treatment?

Adequate health insurance coverage for panic disorder depends on your city/location, the type of treatments, and your particular symptoms. On average, the treatment costs start from about ₹35,000 and can go up significantly, depending on the nature of the problem and the number of sessions. A high sum assured is recommended, since you may have to cover therapies, tests, medications, and even in-patient hospitalization in some scenarios.

FAQs

Q1. What is panic disorder?

Ans: Panic disorder is a specific anxiety disorder where people have repeated, sudden, and intense panic attacks. They witness these physical surges of discomfort or fear, along with a persistent sense of fear about attacks in the future.
Q2. How is a panic disorder and panic attack different?

Ans: A panic attack is one episode of intense anxiety and fear. On the other hand, panic disorder is diagnosed when you keep having these recurring, unexpected, and sudden attacks, with subsequent and persistent worry about future attacks.
Q3. What are the common physical symptoms of panic attacks?

Ans: Some of the common symptoms include a pounding/racing feeling or palpitations, tightness or pain in the chest, shortness of breath, sweating, dizziness, shaking, and numbness in the hands and feet.
Q4. How do the psychological symptoms of panic disorder feel like?

Ans: Most people facing panic disorder often experience overwhelming and sudden feelings of any upcoming doom or negative developments. There is a strong fear of losing control, dying, going crazy, etc.
Q5. What can trigger a panic attack?

Ans: Many attacks may be triggered suddenly or unexpectedly in panic disorder, without any immediate or clear/specific reason/trigger. However, factors like fatigue, particular environmental aspects, and chronic stress may contribute to the same.
Q6. How long do panic attacks usually last?

Ans: Most panic attacks usually arrive suddenly and peak within about 10 minutes. They may last between 5–20 minutes on average. However, some attacks may last up to an hour.
Q7. Who is at risk of developing panic disorder?

Ans: It may appear in early adulthood or even late adolescence. Some of the risk factors include being female, a family history of anxiety attacks/disorders, and chronic stress.
Q8. Are panic attacks physically dangerous?

Ans: A panic attack may feel like a life-threatening scenario or medical emergency. However, it is not fatal or physically dangerous. It does not lead to any permanent physical damage to the body.
Q9. Why do many people facing panic disorder first consult cardiologists?

Ans: For many people, the symptoms of panic attacks usually mirror those seen during cardiac emergencies, i.e. a rapid heartbeat, chest pain, etc. Hence, many of them visit cardiologists first and panic disorder can go undiagnosed in general medical environments.
Q10. What is the role of agoraphobia in panic disorder?

Ans: Agoraphobia is the fear of being in a situation where escaping may be hard or help may be unavailable. It is a common complication seen for those with panic disorder. A large percentage of those with panic disorder may also experience agoraphobia.
Q11. What are the usual treatments for panic disorder?

Ans: Some of the usual treatments for panic disorder include psychotherapy (like cognitive behavioral therapy) and medication (such as SSRIs prescribed by psychiatrists).
Q12. Do any lifestyle changes help with panic disorder management?

Ans: You can manage panic disorder better through proper stress management, routine physical exercise, deep breathing, and meditation techniques. You can also consider lowering your caffeine intake and getting proper sleep.
Q13. Are the medications for panic disorder addictive in nature?

Ans: Psychiatrists may prescribe SSRIs for the treatment of panic disorder and they are non-habit-forming in nature. Benzodiazepines may be given for relief in the short term, although they are monitored stringently to avoid any dependency.
Q14. Is it possible to fully cure panic disorder?

Ans: While it is a chronic problem or episodic issue for some people, it is still manageable. Consistent medication, therapy, and lifestyle management may help many people recover significantly. Several individuals can drastically lower or eliminate symptoms and get back to leading fully normal lives.
Q15. How can I find help for panic disorder?

Ans: You can consult a clinical psychologist or a psychiatrist. Verified mental health professionals can be found through various platforms like the IAPP (Indian Association of Private Psychiatry) directory. You may also consult your primary care physician for the first referral.

Panic Disorder