Behavioral choices can also significantly impact risk, as excessive tobacco or caffeine use can increase anxiety, whereas regular exercise can decrease anxiety. Specific temperament and personality traits also may confer risk of having an anxiety disorder. With regards to temperament, shyness and behavioral inhibition in childhood can increase risk of developing an anxiety disorder later in life. With regard to personality traits, the Five Factor Model of Personality consists of five broad trait domains including Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. An individual higher on trait Neuroticism or low on Conscientiousness is at a higher risk for all anxiety disorders, and an individual low on trait Extraversion is at a higher risk of developing social phobia and agoraphobia. Some more narrow personality traits have also been found to relate to risk for anxiety, including anxiety sensitivity, a negative or hostile attributional style, and self-criticism. Personality disorders have also been shown to relate to increased risk for anxiety disorders.
Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.

How do you know if you're having a panic or anxiety attack? Panic attacks and anxiety attacks share some symptoms, but they differ in intensity, duration, and whether or not there is a trigger. Some treatments are similar and include therapy, stress management, and breathing exercises. Learn more about the differences between a panic attack and an anxiety attack here. Read now


Many patients first report symptoms to their primary care physician. Primary care physicians (PCPs) will administer a thorough physical exam to rule out hormonal imbalances, side effects of medications, and certain illnesses. If the symptoms are not due to other conditions, the physician may diagnose the patient with anxiety and therefore refer the patient to a psychologist or psychiatrist. Physicians practice in hospitals, clinics and private practices.
Specialized coils that targetes deeper brain regions than rTMS. A patient wears a cushioned helmet (similar to the type of helmet worn during an fMRI). The coil used in dTMS was approved by the FDA in 2013 for treating depression but is currently being studied for the treatment of anxiety disorders such as OCD. The procedue is administered for 20 minutes for 4-6 weeks. Patients can resume their daily lives right after each treatment.
Humor and laughter, in addition to being fun and enjoyable, have many health benefits. Laughter can help people cope with stress, reduce anxiety and tension and serve as a coping mechanism. Humor may allow a person to feel in control of a situation and make it seem more manageable. By helping to reduce fear, anger and stress, humor can help minimize the potential harm they can have on the body over time.
If medications are prescribed, several options are available. Selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), and the benzodiazepine families of medications are considered to be effective treatment of panic disorder. SSRIs include sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). SSNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor). Clinical trials have shown SSRIs reduce the frequency of panic attack up to 75%-85%. SSRIs must be taken three to six weeks before they are effective in reducing panic attacks and are taken once daily.
Medications options for panic attacks typically include benzodiazepines and antidepressants. Benzodiazepines are being prescribed less often because of their potential side effects, such as dependence, fatigue, slurred speech, and memory loss.[57] Antidepressant treatments for panic attacks include selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and MAO inhibitors (MAOIs). SSRIs in particular tend to be the first drug treatment used to treat panic attacks. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants appear similar for short-term efficacy.[58] SSRIs carry a relatively low risk due to the fact that they are not associated with much of a tolerance or dependence, and are difficult to overdose with. TCAs are similar to SSRIs in their many advantages, but come with more common side effects such as weight gain and cognitive disturbances. They are also easier to overdose on. MAOIs are generally suggested for patients who have not responded to other forms of treatment.[59]
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.
When we’re anxious, the body produces a stress response. The stress response is designed to give us an extra ‘boost’ of awareness and energy when we think we could be in danger. The stress response causes a number of physiological, psychological, and emotional changes in the body that enhance the body’s ability to deal with a perceived threat – to either fight or flee, which is the reason the stress response is often referred to as the ‘fight or flight response.’

Many neurotransmitters are affected when the body is under the increased stress and anxiety that accompany a panic attack. Some include serotonin, GABA (gamma-aminobutyric acid), dopamine, norepinephrine and glutamate. More research into how these neurotransmitters interact with one another during a panic attack is needed to make any solid conclusions, however.
CBT is a short-term treatment designed to help patients identify inaccurate and negative thinking in situations that cause anxiety like panic attacks. CBT can be used in one-on-one therapy or in a group therapy session with people facing similar problems. CBT primarily focuses on the ongoing problems in a patient's life and helps them develop new ways of processing their feelings, thoughts and behaviors to develop more effective ways of coping with their life. In patients who suffer from PTSD, CBT can take on a trauma-focused approach, where the goal is to process and reframe the traumatic experience that lead to the symptoms. On average, the length of treatment is around 10-15 weekly one-hour sessions depending on the type and severity of symptoms.
Panic disorder is thought to have a psychobiological conceptualization (Craske & Barlow, 2007). This does not mean that panic attacks are due to a biological disease. What this does mean is that there are certain biological factors that may be inherited or passed on through genes, and thus may lead some people to be more likely than others to experience panic disorder symptoms. This is likely why panic disorder seems to run in families. In other words, if one family member has panic disorder, the other family members are more likely to experience panic symptoms or panic disorder compared to people without a family history of panic disorder. It is very important to note that just inheriting these vulnerabilities to panic does not make the onset of panic attacks inevitable or unalterable. In fact, it is possible to think and act in ways that prevent panic attacks.
A collection of activities focused in which an individual consciously produces the relaxation response in their body. This response consists of slower breathing, resulting in lower blood pressure and overall feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises.
Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.
Anxiety attacks can last anywhere between a few moments to 30 or more minutes. It’s also common for subsequent anxiety attacks to follow, causing the overall anxiety attack experience to last much longer as one episode is followed by another. Even though anxiety attacks eventually end, it’s common for the symptoms and after effects of an anxiety attack to linger for hours or even days, depending upon the severity of the attack and the level of stress your body is under.
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.

Panic disorder affects 2-3% of people every year in the United States and Europe, with varying rates depending on race and ethnicity. On average, Native American Indian populations experience panic disorder at higher rates than non-Latino white Americans. In contrast, African Americans, Latinos, Caribbean Blacks, and Asian Americans all experience the disorder at lower rates than non-Latino white Americans. In addition, it has been well established than females are twice as likely to be diagnosed with panic disorder than males (Asnaani, Gutner, Hinton, & Hofmann, 2009; McLean, Asnaani, Litz, & Hofmann, 2011). A number of factors (e.g., biological influences, temperament, exposure to stressors and trauma, cognitive factors, and environmental factors) have been identified as possibly influencing sex differences in rates of panic disorder (McLean & Anderson, 2009). However, no one theory has been determined so the underlying reason for sex differences in rates of panic disorder remains unknown.


Connect with others. Loneliness and isolation can trigger or worsen anxiety, while talking about your worries face to face can often make them seem less overwhelming. Make it a point to regularly meet up with friends, join a self-help or support group, or share your worries and concerns with a trusted loved one. If you don’t have anyone you can reach out to, it’s never too late to build new friendships and a support network.
The feared object/situation is avoided or endured with intense anxiety or distress. The avoidance, anticipation of, or distress of the phobic object/situation must cause significant distress or interferes with the individual's daily life, occupational, academic, or social functioning to meet diagnosis. The symptoms cannot be better accounted for by another mental disorder or be caused by substances, medications, or medical illness.
People who have had a panic attack in certain situations may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia.
Biological causes may include obsessive compulsive disorder, Postural Orthostatic Tachycardia Syndrome, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disturbances (labyrinthitis). Dysregulation of the norepinephrine system in the locus ceruleus, an area of the brain stem, has been linked to panic attacks.[13]
“I thought I would be smart, take care of myself, and not go out as much,” Sideman says. He managed to find ways to build his business without leaving his home office. After he had a panic attack on a freeway, he decided to avoid driving on the freeway — a tough stand to take in Los Angeles. He kept withdrawing from activities to try to avoid panic attacks, but that never solved the problem, he says, and after two and a half years, he realized the attacks were getting worse.

In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac. Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don't know they have a real and highly treatable disorder. It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.


People generally can overcome panic attacks faster if they seek help after the first one or two, says psychologist Cheryl Carmin, PhD, director of clinical psychology training at the Wexner Medical Center and a professor at Ohio State University in Columbus. When you do seek help, your doctor or therapist will ask about your symptoms and the situations in which they arise, and might also recommend additional medical testing to rule out other health concerns.

Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death.[63][64][65] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety;[66][67] the same is true for some sexual dysfunctions.[68][69] Conditions that affect the face or the skin can cause social anxiety especially among adolescents,[70] and developmental disabilities often lead to social anxiety for children as well.[71] Life-threatening conditions like cancer also cause anxiety.[72]
Hey I have a problem of socializing I was addicted to a PC game called DotA 2 from 7-8 years due to which I was not so social I use to avoid people and I use to avoid calls but from last 1 year I have suffering from anxiety I year ago I met with an anxiety attack ….coming to the problem I’m facing im unable to communicate with my friends.it feels like I have almost forgotten how to talk. I my breathing increase and im. Unable to look at someone and when I I’m able to look I end up staring at them with this happens at my home to please help me out. I want to live a life like others :(. I I’m trying to be social now but I’m unable to do it makes me panic full of anxiety need a help for this.
Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.
While the use of drugs in treating panic attacks can be very successful, it is generally recommended that people also be in some form of therapy, such as cognitive behavioral therapy. Drug treatments are usually used throughout the duration of panic attack symptoms, and discontinued after the patient has been free of symptoms for at least six months. It is usually safest to withdraw from these drugs gradually while undergoing therapy.[14] While drug treatment seems promising for children and adolescents, they are at an increased risk of suicide while taking these medications and their well-being should be monitored closely.[59]
To activate your parasympathetic nervous system, use this simple meditation technique: focus your gaze on an imaginary point in front of you; relax your focus and use your peripheral vision, as if you are trying to take in everything around you with soft focus. It signals to your brain to relax. The more you practice this technique – the faster it will help you to relax in any situation.
Anxiety disorders are characterized by a general feature of excessive fear (i.e. emotional response to perceived or real threat) and/or anxiety (i.e. worrying about a future threat) and can have negative behavioral and emotional consequences. Obsessive-compulsive and related disorders are characterized by obsessive, intrusive thoughts (e.g., constantly worrying about staying clean, or about one's body size) that trigger related, compulsive behaviors (e.g. repeated hand-washing, or excessive exercise). These behaviors are performed to alleviate the anxiety associated with the obsessive thoughts. Trauma- and stressor- related anxiety disorders are related to the experience of a trauma (e.g., unexpected death of a loved one, a car accident, or a violent incident) or stressor (e.g., divorce, beginning college, moving).
The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on the best treatment. Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have an illness that has effective treatments.
What happens, exactly? "We all physically respond to stress," says Barbara O. Rothbaum, PhD, psychiatry professor and director, Trauma and Anxiety Recovery Program, at Atlanta's Emory University School of Medicine. "You might feel anxious about work-related problems, taking a big exam, or making an important decision. But someone who suffers from panic disorder may react to those same moderate pressures with an exaggerated physical reaction-as if he or she were about to be attacked by a wild tiger or fall from a great height. It's full-on, adrenaline-pumping, fight-or-flight response."

I was 34 before I knew anxiety was real. I had lived my life with these feelings, never knowing that everyone else wasn’t experiencing the same thing. I was 35 when I reached out to a friend, who is a nurse practitioner, to ask about my symptoms. That is when I began taking medication. I am on the lowest dose of anxiety medication and I have been taking it for six months. It has changed my life.
2) If you suddenly feel your heart pounding or experience other physical clues that a panic attack is barreling for you, try this distraction suggested by Rob Cole, LHMC, clinical director of mental health services at Banyan Treatment Centers. Start counting backward from 100 by 3s. The act of counting at random intervals helps you to focus and override the anxious thoughts that are trying to sneak into your psyche. Better still keep loose change in your pocket. Add a dime to a nickel, then add two pennies and so on. By controlling your thoughts and focusing on something outside yourself you will being to feel calmer.
Humor and laughter, in addition to being fun and enjoyable, have many health benefits. Laughter can help people cope with stress, reduce anxiety and tension and serve as a coping mechanism. Humor may allow a person to feel in control of a situation and make it seem more manageable. By helping to reduce fear, anger and stress, humor can help minimize the potential harm they can have on the body over time.
Repeated and persistent thoughts ("obsessions") that typically cause distress and that an individual attempts to alleviate by repeatedly performing specific actions ("compulsions"). Examples of common obsessions include: fear that failing to do things in a particular way will result in harm to self or others, extreme anxiety about being dirty or contaminated by germs, concern about forgetting to do something important that may result in bad outcomes, or obsessions around exactness or symmetry. Examples of common compulsions include: checking (e.g., that the door is locked or for an error), counting or ordering (e.g., money or household items), and performing a mental action (e.g., praying).

This information is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. Always consult your doctor about your medical conditions. Vertical Health & PsyCom do not provide medical advice, diagnosis or treatment. Use of this website is conditional upon your acceptance of our User Agreement.
Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.
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