Panic Disorder
Basics
Description
- A classic panic attack is characterized by rapid onset of a brief period of sympathetic nervous system hyperarousal accompanied by intense fear.
- In panic disorder, multiple panic attacks occur (including at least two without a recognizable trigger). Patients experience at least 1 month of worried anticipation of additional attacks and/or maladaptive (e.g., avoidance) behaviors.
Epidemiology
Incidence
Median age of onset is 24 years. Prevalence significantly decreases after age 60 years; predominant sex: female > male (2:1)
Prevalence
Lifetime prevalence: 4.7%
Etiology and Pathophysiology
Patients resist the initial surge of adrenaline which exacerbates the symptoms—in essence, they get anxious about being anxious.
Genetics
There is a higher incidence of panic disorder among family members.
Risk Factors
- Life stressors of any kind can precipitate attacks, including history of sexual or physical abuse.
- Substance abuse, smoking, bipolar disorder, major depression, obsessive-compulsive disorder (OCD), and simple phobia
General Prevention
- Healthy lifestyle, including healthy diet, regular exercise, and stress-reduction techniques (such as mindfulness), are useful.
- The USPSTF now recommends screening children and teens for anxiety in ages 8 to 18. In September 2022, the USPTF made a draft recommendation to screen adults aged ≤64 years.
Commonly Associated Conditions
- Other psychiatric diagnoses: PTSD, social phobia, simple phobia, major depression, bipolar disorder, substance abuse, OCD, separation anxiety disorder
- More common in patients with asthma, migraine headaches, hypertension, mitral valve prolapse, reflux esophagitis, interstitial cystitis, irritable bowel syndrome, fibromyalgia, nicotine dependence
- Panic disorder increases the risk of suicide attempts and ideation.
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Citation
Domino, Frank J., et al., editors. "Panic Disorder." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688736/all/Panic_Disorder.
Panic Disorder. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688736/all/Panic_Disorder. Accessed October 7, 2024.
Panic Disorder. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688736/all/Panic_Disorder
Panic Disorder [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688736/all/Panic_Disorder.
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