What are the symptoms of Panic Disorder?

Panic Disorder involves recurrent, unexpected Panic Attacks. In between attacks, the individual persistently worries about having another attack and/or changes their behaviors or activities to avoid having an attack. Specific symptoms of a Panic Attack include:

Core Symptoms of a Panic Attack

  • Heart palpitations or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or sensation of being smothered
  • Choking feeling
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Dizziness, unsteadiness, light-headedness, or faintness
  • Chills or heat sensations
  • Numbness or tingling
  • Feeling detached from oneself or that things are not real
  • Fear of losing control or “going crazy”
  • Fear of dying

How is Panic Disorder diagnosed?

A child-adolescent psychiatrist may diagnose a child or teen with Panic Disorder after determining that their worries and/or avoidance behaviors are associated with a specific situation or place; they have difficulty controlling their thoughts or feelings related to their symptoms, the situation, or the event; their symptoms have been persistent, occurring for a period of at least one month; and their symptoms result in significant impairment in other aspects of everyday functioning (e.g., social, familial, academic, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child or teen and a caregiver in order to determine the specific nature of the child’s or teen’s distress and may add behavior and emotion rating form results to their clinical impression to support the diagnosis. The practitioner will also seek to determine that the child’s or teen’s distress is not related to something unforeseen.

Panic Disorder Facts

Worldwide frequency of the condition

Panic Disorder is estimated to be present in 2% to 3% of the world’s population. Anxiety Disorders, in general, are estimated to be present in 6.5% of the world's population. While there is no recent, specific epidemiological data for Greece, a recent review of European countries reported a 7.9% frequency of Anxiety Disorders.

Burden of the condition in Greece

Anxiety accounts for 9.8% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. It is the most prominent mental health condition adding to the health burden of the Greek child and adolescent population.

Gender ratio

Gender comparative data for Panic Disorder suggests that females are more likely to be diagnosed than males at a rate of 2:1.

Peak age of onset

The peak age of onset for Panic Disorder is estimated to be 15.5 years.

Proportion of the condition that emerges before age 18

According to recent data, 75.0% of individuals with Panic Disorder will have been diagnosed by the time they are 18 years old.

What are the associated factors for Panic Disorder?

Some common factors associated with Panic Disorder are:

  • Genetic and familial factors. Predisposition toward an anxiety disorder most likely results from a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • History of asthma.
  • Environmental factors. These include identifiable stressors in the months before a first Panic Attack (e.g., negative experiences with drugs, disease, death), adversity (e.g., exposure to previous trauma), low economic resources, and smoking.
  • Temperament. These include anxiety sensitivity, harm avoidance, and behavioral inhibition.

What other disorders co-occur with Panic Disorder?

Even though each child and adolescent is different, individuals who meet the criteria for Panic Disorder sometimes also struggle with other anxiety disorders, depression, and bipolar disorders.

How is Panic Disorder treated?

Panic Disorder is usually treated with psychotherapy or a combination of psychotherapy and medication. Caregivers and other family members are an important part of treatment, since they can help kids and teens practice the skills they learn in therapy.

There are multiple therapies that have been shown to effectively treat symptoms of Panic Disorder, but the one with the most evidence is a type of therapy called cognitive-behavioral therapy (CBT). CBT is an umbrella term that refers to a wide range of different cognitive and behavioral techniques. One technique is called interoceptive exposure. Using this technique, a therapist engages the child in exercises that mimic the somatic symptoms (e.g., hyperventilation, increased heart rate) that usually trigger anxiety or panic, beginning slowly and with small triggers. As the child becomes upset, the therapist teaches them ways to think about and handle their fear related to these symptoms. They repeat this process with bigger and bigger exercises. Other aspects of CBT focus on lessening the fear that causes kids to avoid situations that remind them of Panic Attacks. Over time, changing their behaviors can ease their anxiety.

Children and adolescents with GAD tend to respond well to certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, sertraline, citalopram, escitalopram, and paroxetine. Other medications called serotonin norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine, are also effective for reducing anxiety in children and adolescents. Benzodiazepines (e.g., clonazepam, diazepam) and tricyclic antidepressants (e.g., amitriptyline, clomipramine) are not effective in children and adolescents and should not be used. Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

The combination of CBT and SSRIs/SNRIs can also be considered, given some studies show evidence that the combination is better than either treatment in isolation in children and adolescents.

Where to find more information

If you need more information on panic, you can also go to "Panic Attacks" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list here:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Quick guide to panic disorder. https://childmind.org/guide/quick-guide-to-panic-disorder/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B01 Panic Disorder. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/56162827

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678–686. https://doi.org/10.1016/S2215-0366(18)30169-X
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381
  • Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02131-2
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Ayano, G., Betts, K., Maravilla, J. C., & Alati, R. (2021). The risk of anxiety disorders in children of parents with severe psychiatric disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 282, 472–487. https://doi.org/10.1016/j.jad.2020.12.134
  • Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159–168. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Lawrence, P. J., Murayama, K., & Creswell, C. (2019). Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 46–60. https://doi.org/10.1016/j.jaac.2018.07.898
  • Ye, G., Baldwin, D. S., & Hou, R. (2021). Anxiety in asthma: A systematic review and meta-analysis. Psychological Medicine, 51(1), 11–20. https://doi.org/10.1017/S0033291720005097

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Preti, A., Vrublevska, J., Veroniki, A. A., Huedo-Medina, T. B., Kyriazis, O., & Fountoulakis, K. N. (2018). Prevalence and treatment of panic disorder in bipolar disorder: Systematic review and meta-analysis. Evidence Based Mental Health, 21(2), 53–60. https://doi.org/10.1136/eb-2017-102858
  • Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. https://doi.org/10.1002/da.23113

Interventions

  • Allen, L. B., White, K. S., Barlow, D. H., Shear, M. K., Gorman, J. M., & Woods, S. W. (2010). Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome. Journal of Psychopathology and Behavioral Assessment, 32(2), 185–192. https://doi.org/10.1007/s10862-009-9151-3
  • Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A. J., & Powers, M. B. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1–21. https://doi.org/10.1080/16506073.2018.1560358
  • Correll CU, Cortese S, Croatto G, et al. Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry. 2021;20(2):244-275. doi:10.1002/wps.20881
  • Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15(3):245-258. doi:10.1002/wps.20346
  • Gosmann NP, Costa M de A, Jaeger M de B, et al. Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis. Patel V, ed. PLoS Med. 2021;18(6):e1003664. doi:10.1371/journal.pmed.1003664
  • Mahdi, M., Jhawar, S., Bennett, S. D., & Shafran, R. (2019). Cognitive behavioral therapy for childhood anxiety disorders: What happens to comorbid mood and behavioral disorders? A systematic review. Journal of Affective Disorders, 251, 141–148. https://doi.org/10.1016/j.jad.2019.03.041
  • Preti, A., Vrublevska, J., Veroniki, A. A., Huedo-Medina, T. B., Kyriazis, O., & Fountoulakis, K. N. (2018). Prevalence and treatment of panic disorder in bipolar disorder: Systematic review and meta-analysis. Evidence Based Mental Health, 21(2), 53–60. https://doi.org/10.1136/eb-2017-102858
  • Rabasco, A., McKay, D., Smits, J. A., Powers, M. B., Meuret, A. E., & McGrath, P. B. (2022). Psychosocial treatment for panic disorder: An umbrella review of systematic reviews and meta-analyses. Journal of Anxiety Disorders, 86, 102528. https://doi.org/10.1016/j.janxdis.2022.102528
  • Schwartz C, Barican JL, Yung D, Zheng Y, Waddell C. Six decades of preventing and treating childhood anxiety disorders: A systematic review and meta-analysis to inform policy and practice. Evid Based Mental Health. 2019;22(3):103-110. doi:10.1136/ebmental-2019-300096
  • Zhou X, Zhang Y, Furukawa TA, et al. Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis. JAMA Psychiatry. 2019;76(1):41. doi:10.1001/jamapsychiatry.2018.3070

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