Panic Disorder

What is it?

Panic disorder causes a person to experience recurrent panic attacks and persistent concern about having future attacks. A panic attack is a brief period of intense fear or discomfort accompanied by distinct symptoms like heart palpitations, shortness of breath, dizziness, and an intense urge to flee the situation. An attack usually ends gradually on its own and rarely lasts beyond 10 minutes. These symptoms, which feel very real to the person, likely reflect the body’s intense response to a strong “fight or flight” signal that is beyond the person’s conscious control. Panic disorder is rare in childhood but may manifest in adolescence. Unlike the occasional, mild worries that children often experience, panic disorder may dramatically affect a child’s life by interrupting his or her normal activities when an episode occurs or when he becomes preoccupied with worry about possible future panic attacks. Some individuals with panic disorder avoid places where they think panic attacks might occur, or worry about being trapped in places where help might be unavailable if an attack occurred (a condition called agoraphobia). In some cases, a child may be so fearful, she will not go outside the house for fear of a recurring attack.

Signs and Symptoms

Panic disorder is characterized by panic attacks and concern about their return. The attacks are frightening and very stressful, both for the person having the attack and those watching it. If your child has panic attacks, she may describe heart attack-like symptoms, a sudden and overwhelming fear of death or losing control, and an intense desire to flee, as well as physical symptoms such as dizziness, nausea, sweating, and shortness of breath.  After an attack, she may have an intense fear of another one. She may avoid situations or activities she thinks would trigger another attack, which may limit her functioning.

Diagnosis and Treatment

Diagnosis of panic disorder occurs after medical explanations, as well as other psychiatric disorders—including OCD and PTSD—have been ruled out. A professional can diagnose panic disorder if attacks are recurrent, unexpected, and if one attack is followed within a month by other signs including: a preoccupation with the possibility of further attacks; fear of the effects of an attack, including the feeling of having a heart attack or “going crazy;” and a considerable behavioral change following the attacks, such as avoiding places associated with them.

Treatment for panic disorder usually consists of both therapy and medication. Cognitive behavioral therapy can reduce avoidance-based behavior; exposure therapy, which gradually exposes the child to situations associated with attacks, is also successful. Effective medications to treat the effects of panic attacks include antidepressants and benzodiazepines (Xanax, among others) are also used, though these drugs carry a risk of dependence.

What are the risk factors for children?

A family history of anxiety disorders, bipolar disorder, and/or depression is a risk factor for development of panic disorder. Respiratory problems like asthma may increase risk, as does a history of panic-like episodes that don’t meet the criteria for a panic attack. People with panic disorder are also at risk for substance abuse, as well as depression.