Panic disorder is an anxiety disorder defined by recurrent unexpected panic attacks — sudden surges of intense fear or discomfort peaking within minutes — followed by persistent worry about more attacks or significant behavioral change to avoid them. Lifetime prevalence is roughly 2-3% in US adults (NCS-R) and 4-5% globally, with women affected twice as often as men.
Panic disorder (ICD-10: F41.0) is defined in DSM-5-TR by recurrent unexpected panic attacks plus at least one month of persistent concern about additional attacks, worry about their implications, or significant maladaptive behavioral change (such as avoidance of activities or places that might trigger an attack). A panic attack is a discrete period of intense fear or discomfort that develops abruptly and peaks within 10 minutes, with four or more of thirteen DSM-defined symptoms (palpitations, sweating, trembling, shortness of breath, choking sensation, chest pain, nausea, dizziness, derealization, fear of losing control, fear of dying, paresthesias, chills or hot flushes). Panic attacks must not be attributable to substance effects or medical conditions, and must not be explained better by another mental disorder. Agoraphobia frequently accompanies panic disorder — about 30-50% of patients develop avoidance of places or situations where escape would be difficult or help unavailable.
The key symptoms of Panic Disorder are: Sudden surge of intense fear or discomfort that peaks within 10 minutes — the defining feature of a panic attack., Palpitations, pounding heart, or accelerated heart rate, often the first symptom noticed and frequently mistaken for cardiac disease., Sweating, trembling, or shaking that may continue for 20-30 minutes after the peak of the attack., Shortness of breath or feelings of smothering, often with rapid shallow breathing that compounds the physiologic arousal., Chest pain or discomfort that can closely mimic angina and is the most common reason for emergency department presentation., Nausea or abdominal distress, sometimes with diarrhea or urgency during severe attacks., Dizziness, lightheadedness, or feeling faint — common but rarely progressing to actual syncope..
Diagnosis follows DSM-5-TR criteria after clinical interview that documents the presence of recurrent unexpected panic attacks, persistent worry about additional attacks or maladaptive behavioral change for at least one month, exclusion of substance and medical causes, and exclusion of other mental disorders that better explain the symptoms. Validated rating scales support diagnosis and severity tracking: the Panic Disorder Severity Scale (PDSS) provides a 7-item clinician or self-report measure of severity, and the Beck Anxiety Inventory or GAD-7 capture co-occurring anxiety. Suicide risk should be assessed at every visit (C-SSRS or equivalent) given the comorbid depression prevalence of 50-60%. The medical workup excludes contributors that mimic or trigger panic: TSH and free T4 (hyperthyroidism), 12-lead ECG (cardiac arrhythmia), urine toxicology in suspected substance involvement, and selected tests guided by clinical features (24-hour metanephrines if pheochromocytoma is suspected, echocardiography only if cardiac signs persist). Brain imaging is reserved for atypical presentations or focal neurological signs. Differential diagnosis includes generalized anxiety disorder (persistent worry without discrete attacks), social anxiety disorder (fear of social scrutiny), specific phobias, post-traumatic stress disorder (panic following trauma cues), obsessive-compulsive disorder, major depressive disorder, hyperthyroidism, pheochromocytoma, and substance-induced panic. Agoraphobia is identified by asking about avoidance of public transport, open spaces, enclosed places, crowds, or being outside home alone. Patients often present first to cardiology, gastroenterology, or the emergency department before psychiatric assessment, contributing to diagnostic delay of 2-5 years on average.
Prognosis with appropriate treatment is favorable. Response rates with CBT or SSRI reach 60-80% at 12 weeks, and combined treatment improves outcomes for severe or treatment-resistant cases. Sustained remission is achievable in roughly 50% of patients with consistent treatment, though chronic course persists in about 30%. Without treatment, panic disorder tends to become chronic with episodes lasting years and high relapse rates between symptomatic periods. Agoraphobia, comorbid depression, substance use, and chronic medical illness worsen prognosis. The most robust predictor of long-term outcome is completion of evidence-based CBT, which produces durable benefit beyond medication. Lifetime suicide risk in panic disorder is roughly 7-12% in pooled data, driven primarily by comorbid depression and substance use; integrated treatment of comorbidities is essential. Decisive prognostic factors include early treatment, adherence to CBT and medication, absence of substance use, social support, and integrated management of comorbid depression.
A psychiatrist or specialist mental health team should be involved when first-line SSRI plus structured CBT fails to produce remission after 12-16 weeks, when panic disorder coexists with severe depression or substance use, when suicide risk is moderate to high, in pregnancy or postpartum, and when agoraphobia severely limits functioning. Primary care manages most uncomplicated panic disorder effectively with stepped care.
Find specialists →Benzodiazepines produce relief within hours to days but are limited to short-term or breakthrough use. SSRI or SNRI response emerges over 4-8 weeks with full effect at 12 weeks. CBT shows meaningful symptom reduction at 4-6 weeks and full benefit at 12-16 weeks. Sustained remission typically requires 12 months of continued treatment after symptoms remit; many guidelines recommend 2-3 years of maintenance for recurrent or severe panic disorder. Functional recovery (returning to avoided activities) often takes longer than symptomatic improvement and is supported by graded exposure work.
Aim for 150-300 minutes weekly of moderate aerobic activity, ideally including outdoor activity for daylight exposure. Exercise has a consistent anxiolytic effect and is part of evidence-based panic disorder management. Start gently if exertion has been a panic trigger — graded exercise is itself a form of interoceptive exposure that builds tolerance to physical arousal.
Look for a clinician or therapist with formal CBT training and experience with panic disorder including interoceptive exposure, access to internet-delivered CBT programs as alternative or adjunct, and integration with primary care for medical comorbidity. Continuity matters more than prestige — panic disorder treatment is typically a 1-3 year relationship including maintenance.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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