Some medical conditions, like thyroid abnormalities and anemia, as well as certain medications, can produce severe anxiety. Examples of such medications include stimulants like methylphenidate (Ritalin) or amphetamine salts (Adderall), diabetes medications like metformin (Glucophage) and insulin, antimalarial medications like quinine, as well as corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron). As individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP), this possibility should be investigated by a doctor since MVP may dictate the need for special precautions when the individual is being treated for any dental problem. While the development of panic attacks has been attributed to the use of food additives like aspartame, alone or in combination with food dyes, more research is needed to better understand the role such substances may have on this disorder.
Your heart beats fast, and your breathing speeds up. Your chest may feel tight, and you might start to sweat. If you've ever felt it, you know that anxiety is just as much a physical state as a mental state. That's because there's a very strong biological chain reaction that occurs when we encounter a stressful event or begin to worry about potential stressors or dangers in the future. Other physical symptoms include sweating, headaches, and insomnia. Psychological symptoms may include feeling restless or irritable, feeling tense, having a feeling of dread, or experiencing ruminative or obsessive thoughts.
Panic attacks are common among all anxiety disorders but what sets panic disorder apart is that panic attacks are unexpected and occur "out of the blue" without an obvious trigger (American Psychiatric Association, 2013; Craske & Barlow, 2007). These unexpected panic attacks must be associated with a significant change in behavior or be followed by at least one month of persistent worry about having another attack or about what will happen if you have another panic attack.

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]


Often, a combination of psychotherapy and medications produces good results in the treatment of panic disorder. Improvement is usually noticed in about two to three months. Thus, appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency, bringing significant relief to 70%-90% of people with the illness. More than 18% of people who are assessed but not treated for this condition tend to relapse in less than two years. As these statistics indicate, access to appropriate mental health care is key to a positive prognosis for people who suffer from panic attacks. Therefore, it is imperative to alleviate the well documented economic and racial disparities that exist in having and using access to care. Combating other social disparities, like educational, employment, housing, and criminal justice, is also seen as being important to improving the prognosis for recovering from panic attacks and other health problems.

Carbonell compares the type of breathing you’ll need with the breathing of infants, whose bellies rise and fall with each inhale and exhale. When an anxiety attack starts, exhale deeply, loosen your shoulders, and focus on some longer, deeper inhales and exhales that let your belly rise and fall. Place one hand on your belly if you need to feel this happening.

Cognitive behavioral therapy (CBT), is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. According to the National Association of Cognitive Behavioral Therapists the benefit of this therapy is that we can change the way we think to feel and act better even if the situation does not change. CBT focuses on determining the thought and behavior patterns responsible for sustaining or causing the panic attacks. CBT is a time-limited process (treatment goals—and the number of sessions expected to achieve them—are established at the start) that employs a variety of cognitive and behavioral techniques to affect change.


Many people use the terms anxiety attack and panic attack interchangeable, but in reality, they represent two different experiences. The DSM-5 uses the term panic attack to describe the hallmark features of panic disorder or panic attacks that occur as a result of another mental disorder. To be considered a panic attack, four or more of the symptoms outlined in the DSM-5 must be present.
Psychologically, people who develop panic attacks or another anxiety disorder are more likely to have a history of what is called anxiety sensitivity. Anxiety sensitivity is the tendency for a person to fear that anxiety-related bodily sensations (like brief chest pain or stomach upset) have dire personal consequences (for example, believing that it automatically means their heart will stop or they will throw up, respectively). From a social standpoint, a risk factor for developing panic disorder as an adolescent or adult is a history of being physically or sexually abused as a child. This is even more the case for panic disorder when compared to other anxiety disorders. Often, the first attacks are triggered by physical illnesses, another major life stress, or perhaps medications that increase activity in the part of the brain involved in fear reactions.
If you’ve ever experienced a sudden surge of overwhelming anxiety and fear then you’re familiar with the feeling of having a panic attack. Your heart pounds, you can’t breathe, and you may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With the right treatment and self-help, you can reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life
About 12% of people are affected by an anxiety disorder in a given year and between 5-30% are affected at some point in their life.[49][50] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[10][49] The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[49]
"These techniques take some getting used to,” says Dave Carbonell, PhD, an anxiety therapist in Chicago, but learning how to cope with anxiety attacks is important so that fear of having another won't keep you at home or limit your activities. A study in Alternative Therapies in Health and Medicine in 2013 found that multiple approaches to managing anxiety, including strategies like breathing and journaling, can help. 
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
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