Panic attacks are extremely frightening. They may appear to come out of the blue, strike at random and make people feel powerless, that they are losing control and about to die.

A panic attack is really the body’s way of responding to the “flight or fight” response system getting triggered without the presence of an actual external threat or danger. There are a number of different physical and emotional sensations that may affect people during a panic attack. These may include;

• very rapid breathing or feeling unable to breathe
• palpitations, pounding heartbeat
• chest pain
• dizziness, light-headed or faint
• sweating
• ringing in the ears 
• hot or cold flushes 
• fear of losing control
• fear of dying

Panic Disorder is diagnosed by recurrent unexplained panic attacks, and often followed by one (or more) of the following :

• persistent concern about having future attacks
• worry about consequences of the attack (e.g. losing control)
• behaviour related changes as a result of the attack
• not related to a medical condition or substance induced
• presence/absence of Agoraphobia

Many people with panic disorder develop intense anxiety between episodes, worrying when and where the next one will strike. 

How common is Panic Disorder?

Not everyone who experiences panic attacks will develop panic disorder. However, panic disorder is very common, occurring in 1 out of 75 people worldwide. About 20% of adults will experience at least one panic attack at some time in their lives. Panic disorder is inclined to have a sudden onset, occurs “out of the blue” and first episodes are remembered vividly.

Panic disorder and Agoraphobia

People begin to associate particular places/situations with having a panic attack. In doing so, they attempt to avoid another attack by avoiding these places/situations where attacks have occurred previously. 

Another reason that people develop avoidance of feared situations is that they see themselves being unable to control a panic in that situation. This can put increasing restrictions on a person’s social or occupational functioning with the possibility of the development of agoraphobia or social phobia.

Agoraphobia

Prolonged Panic Disorder can lead to agoraphobia, a condition defined by anxiety/fear about being in situations from which escape might be difficult or embarrassing in the event of suddenly developing a panic attack or panic-like symptoms, or where help is not readily available. Examples of such situations include:

• Going outside of home alone
• Crowded public places, e.g. department stores, restaurants 
• Public transportation, e.g. trains, planes, buses
• Enclosed or confined spaces such as tunnels, lifts

In turn there may also be abnormal (excessive) worry about loss of control, socially inappropriate behaviour and physical illness such as a heart attack, fainting and of dying. 

People’s anxiety levels rise from anticipating that they might be stuck in a situation where they would panic. 

This results in a whole range of situations and day-to-day activity being avoided, and in some cases, people may become housebound.