Panic disorder

Learn about panic disorder, signs to look for, how your doctor determines if you have panic attacks or panic disorder and treatment options.
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Found in: Mental Health Conditions
Date: September 2022

About panic disorder

People with panic disorder experience panic attacks (sometimes called anxiety attacks) – feelings of severe fear or anxiety that start and finish quite suddenly and come with physical symptoms such as palpitations, sweating, trembling, dizziness or feeling hot and cold.  

If you have panic disorder, these panic attacks happen repeatedly. They can be extremely distressing and change the way you live day-to-day. During a panic attack, the feelings and sensations can be so intense that you may think you are about to die, collapse or lose control of your mind. You may have a strong urge to immediately escape the situation you are in or to find help.

All of these feelings and sensations are a normal part of human life, and you would naturally experience them if your life was in danger, for example, if you were in the sea and a shark was swimming towards you. This is called the “fight-or-flight” response. It is a hardwired survival mechanism that protects us by helping us react quickly to danger. 

With panic attacks, though, the physical response is out of proportion to the danger. They may start for no obvious reason. Often, they happen in an everyday situation you have become anxious about, like being in a supermarket. Panic attacks are so unpleasant that most people are frightened of having another one. They often remember their first attack for the rest of their lives.

Many people experience a panic attack once or even a few times in their lives but do not receive a diagnosis of panic disorder. 

Panic disorder is when you experience recurrent panic attacks, followed by one month or more of fearing having more panic attacks. Your life will be seriously affected by this fear, causing you to change your behaviour and avoid places or situations that might cause an attack.

If you are experiencing panic attacks, you may feel generally unwell. You may sleep badly and feel anxious and exhausted, have trouble concentrating, and find it hard to relax and enjoy yourself. If you are severely affected, you might find it difficult to go out alone, even to do everyday activities like shopping or collecting children from school. Travel to new places may be impossible.

In severe cases, this means you cannot work or have a social life outside the home. You may lose touch with your friends.

It is important to seek help and information. There are very effective treatments for panic disorder. With support, it will be possible for you to live your normal life without feeling overwhelmed by fear of panic attacks. 

What causes panic attacks?

Panic attacks are common. Many people will have at least one attack during their lifetime. Panic disorder is also quite common. Women are affected twice as often as men. The problem usually starts between the late teenage years and the mid-30s. 

It's important to remember that it’s not your fault if you are experiencing anxiety or panic. There are many causes of panic. Most people experiencing panic disorder will have several of the following factors that contribute to an attack:

  • Panic disorder runs in families, so if either parent has panic attacks, it may mean you are more likely to experience them too.
  • Personality may play a part. Some people are more sensitive to the world around them, experiencing more intense emotional responses than others might in the same situation. Sensitivity is not a bad thing; in many ways, it can be a strength. But the downside is that highly sensitive people will be slightly more likely to have anxiety problems, including panic attacks. Again, this is not always the case. Some sensitive people never experience sudden panics, and some people who are less sensitive by nature will develop panic attacks.
  • Events and situations in your life can put you under stress and make you more likely to panic. Typically, events that make you feel unsafe or insecure or anxious may be causes. General stresses like poverty or relatives dying could increase the chance of panic attacks. They can also occur as part of another mental health condition, such as depression. 
  • Some common substances can cause or intensify panic. Caffeine, found in coffee and many soft drinks, is the most common. Tea has a similar but weaker effect. People who have panic attacks and panic disorder may be very sensitive to caffeine, and even small amounts may produce physical symptoms such as increased heart rate, shaking and light-headedness. Alcohol does not directly cause attacks, but as its effects wear off, you are more likely to have a panic attack. Cannabis is another drug that some people are sensitive to, and, for them, it can start panic attacks. The effects of cannabis are long-lasting, as the body takes weeks to get rid of it.  

For some people, panic seems to start out of the blue. There are often some symptoms of general anxiety, depression or phobias in the months before panic starts.

If you are having panic attacks following an extremely dangerous or distressing experience, like being assaulted or being in an accident, then it may be part of a different condition known as post-traumatic stress disorder or PTSD.


Signs to look for (symptoms)

The most obvious symptoms of panic disorder are the panic attacks themselves. These start suddenly, often in a few seconds, sometimes over five or 10 minutes. Panic attacks normally last for 10 or 20 minutes, but you may feel anxious or shaken up for some hours after.

As well as feelings of great anxiety, fear or terror, you may have many other symptoms, most of which are physical. In an attack, you may feel several of the following: 

  • shaking or trembling
  • sweating
  • choking feelings
  • racing or pounding heart
  • chest pain or tightness
  • nausea, stomach pain or diarrhoea
  • hot and cold feelings
  • shortness of breath or feeling smothered
  • dizziness or light-headedness
  • tingling or numbness, often in the fingers
  • feeling cut off from reality or detached from yourself
  • fear that people are judging you, that you are losing control of your mind or that you are going to die.

These are all symptoms of severe anxiety. Because many of them are physical sensations, you may think that there is something wrong with your body – that you are having a heart attack or stroke or that you are dying. People with panic attacks sometimes call an ambulance and are rushed to an emergency medical service. People do not die of panic attacks, even though they may feel that way during an attack.  

Panic disorder will affect you in different ways when you are not having a panic attack. You are likely to avoid places and situations that you think could cause an attack. You might avoid exercise, avoid being alone, or avoid situations where it would be difficult for you to leave quickly or get help if you had a panic attack.

These are all normal responses – it is natural to do all you can to avoid a highly distressing experience. Unfortunately, restricting your day-to-day life can actually make the symptoms of panic disorder more intense over time. That’s why it’s important to seek help from a health professional, who will guide and support you as you find new ways to manage and reduce attacks.

Panic disorder usually causes problems for a few months and then lessens. Some people may experience only one episode of panic disorder in their lifetime. Unfortunately, for others, panic disorder comes back again after a few months or years. Some people have distinct episodes of panic disorder with periods of no symptoms in between, while others may have persisting symptoms that vary in intensity depending on life events or stressors.

Most people who have not been treated for panic will still have some symptoms 10 years later. If you have been experiencing panic disorder for a long time, you may have also become depressed or started to overuse alcohol or other drugs as a way to cope with panic. You may feel an urge to hurt yourself or end your life.

With treatment, many people recover from panic disorder and find relief from panic attacks. 

How the doctor determines if you have panic attacks or panic disorder (diagnosis)

Many people with panic attacks, sooner or later, go to see their doctor or a counsellor. When you see your doctor, it’s important to tell them as much as you can about how you are feeling and what you are going through, especially if you experience any of the feelings listed above.

The doctor may do some tests to make sure there are no underlying medical conditions that are causing your symptoms. They may also refer you to a mental health professional if they suspect you have panic disorder.

Treatment options

There are effective treatments for panic disorder, including psychotherapy (sometimes called “talk therapy”), medication, or a combination of both.

Talking therapies

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment.  

This involves talking with a trained professional who uses clinically researched techniques to assess and help you understand what has happened, and to help you make positive changes in your life.  

Cognitive-behavioural therapy (CBT), a psychological therapy which largely focuses on overcoming unhelpful beliefs and behaviours, is the therapy of choice for panic disorder and has been proven to work well. 


Antidepressant medication, in conjunction with therapy, has proven effective in improving the symptoms of panic disorder. Anti-anxiety medication is also used sometimes, but doctors are cautious about prescribing this, as it can be very addictive.

Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication, you are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for and what their side effects (short and long-term) are
  • what the process of stopping taking them (withdrawal) could look like. 

If you are pregnant or breastfeeding, medication may still be an option. It’s best to talk to your doctor about what’s right for your circumstances.

Other strategies to support recovery


Education can be extremely important to help you, your family/whānau and your supporters to understand this disorder and help in the recovery.  Your doctor or mental health professional will give you information about panic disorder, suggest different ways to handle it, and discuss any complications which may occur.

There are also numerous books available that some people find to be really useful. They can teach you about some of the ways of dealing with panic attacks, and they can also get you used to reading about or discussing problems that you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have experienced panic attacks.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor. Being in good physical health will also help your mental health.

More strategies to support recovery

For people who have panic attacks or a panic disorder, the following strategies have been found to be important and useful. 

  • Tell family/whānau or friends about your concerns. If you find it difficult to let others understand how it feels for you, it may be helpful to find an article or book which explains panic attacks and ask them to read it. You will feel more comfortable if they know that you might have to stop to wait out an attack or that you might have to leave a place or situation. They might also be able to help you as you navigate treatment, e.g. by coming with you to appointments.
  • Peer support. Support groups, either in person or online, can be a source of advice and reassurance. Panic is common, and you will find many people who can share their strategies and experiences.
  • Avoid substances that aggravate panic including caffeine, alcohol and cannabis. You might want to experiment to see if alcohol and caffeine do affect you, but the safest plan is to stop. Do this gradually if you are taking them regularly.
  • Physical health. Make sure you eat good food, exercise and having a regular daily routine. These things are not treatments for panic disorder, but they can support your treatment by helping you feel better and more in control of your health.
  • Relax regularly. If you need to, learn a relaxation technique or find something to do with your family/whānau or friends that is relaxing and enjoyable. Exercise and sport are good as they help you relax and feel in control of yourself. Spending time in nature, or doing activities you enjoy (e.g. cooking, dancing), can help you feel relaxed and in the present moment. Sleep is the most important relaxation, so do not stay up late unnecessarily.

Try to remember that it’s your thoughts/anxiety that causes the feelings you have during an attack. If you do nothing, the attack will do you no harm and it will pass.  If you find yourself thinking catastrophic thoughts like “I am dying”, remind yourself that this is not true. Remember that you have survived previous attacks. If you can, you should resist leaving places or situations because of attacks. This is because if you leave or avoid places, you will find it increasingly hard to return there. 

Thanks to Natasha de Faria, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.