Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Panic Disorder vs. Situationally Bound Anxiety
Our brains elicit a fight or flight response when faced with anxiety-provoking events. This evolutionary biological development is designed to protect our well-being by alerting us and helping us respond to, threatening external stimuli. Whilst the somatic symptoms of panic are considered part of the broad continuum of human reactions, panic disorder is not.
Panic disorder may be differentiated from normal fear reactions as it does not only involve situation-specific responses. Individuals with the condition experience the recurrent occurrence of panic attacks, persistent worry surrounding the probability or inevitability of future panic attacks, changes in behavior (for instance, avoidance), and misappraisal of somatic symptoms. Collectively, the symptoms of panic disorder lead to significant deficits in day-to-day functioning. Furthermore, panic attacks may be differentiated from situationally-bound anxiety due to the attacks’ rapid peak, unexpected onset, and intense severity.
What is Panic Disorder?
Panic disorder is a debilitating mental health condition characterized by repeated, unexpected, discrete fear, anxiety and apprehension. Panic disorder can be differentiated from other anxiety disorders as its symptoms are primarily somatic/physiological. These occurrences are dubbed “panic attacks”. Hallmarks of panic attacks include heart palpitations or increased heart rate, sweating, trembling, chest pain, lightheadedness, dizziness, hot flushes, derealization and depersonalization, and fear of dying.
Individuals who misconstrue these somatic anxiety symptoms often arrive at emergency care centres to undergo unnecessary assessments. For example, individuals experiencing shortness of breath may perceive they are suffocating; individuals who experience a racing heart may fear an impending heart attack. Oftentimes, panic attacks surface spontaneously and rapidly, giving almost no warning. A hallmark of a panic disorder is an immense fear of the recurrence of another impending panic attack.
Further, individuals may take drastic steps to avoid their recurrence. For instance, individuals who believe that a racing heart is indicative of a heart attack, or being out of breath is indicative of suffocation, may avoid exercise.
Collectively, the symptoms of panic disorder are detrimental to one’s day-to-day life and may lead to considerable distress and impairment across important life domains, interfering with functioning (social, occupational or otherwise). Normal functioning is typically only maintained through conscious exertion and additional effort.
Importantly, the symptoms of panic disorder are not better explained by another mental health condition, or medical disorder, and are not better attributed to the effects of a substance or medication on one’s central nervous system. Further, these symptoms are not attributable to withdrawal.
For a comprehensive list of panic disorder symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside panic disorder include but are not limited to:
- Other anxiety disorders (including social anxiety disorder, generalized anxiety disorder, and agoraphobia)
- Mood disorders such as depression and bipolar disorder
- Substance use
Development and Course
Herein we present research findings as reported within the ICD-11. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Most individuals who have panic disorder begin experiencing symptoms in their late 20s.
- The condition follows different courses. While some individuals may experience recurrent panic attacks followed by long periods of remission, others may consistently experience severe and debilitating attacks.
- The presence of comorbidities has been associated with diminished success in long-term course trajectories. Specifically, individuals who have agoraphobia generally experience more severe symptoms and have a poorer long-term prognosis.
There are variations in the way this condition presents. Below, we present findings reported within the ICD-11.
- The condition is rare in young children who have not developed the cognitive capacity for catastrophizing.
- Panic Disorder is more common amongst adolescence and in early adulthood.
- Adolescents experiencing panic disorder are at a more significant risk of developing other mental health conditions including depressive disorders (including suicidality, substance use and conditions that may be attributed to substance use)
Gender and Sex-Related Differences
- Panic Disorder is twice as common amongst females compared to males
- To date, gender differences in clinical features of the condition have not been observed.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis and outcome are not definitively based upon the presence of one, or even several, of the variables.
Temperamental or personality factors
- Anxious tendencies
- Depressive tendencies
- Poor interpersonal sensitivity
Hereditary or genetic predisposition
- Although hereditary rates vary across studies, panic disorder is more prevalent amongst individuals who have close relatives with the condition.
- A recent genome-wide study estimated the condition’s heritability to reach 40%.
- Studies have implicated a “fear network”, suggesting panic disorder is the product of several brain regions. This includes the interaction of the amygdala (the part of our brain involved in threat processing) and our prefrontal cortex (involved in higher-order processing).
- Neurotransmitter imbalances
- Insecure parental attachment style
- Adverse childhood experiences (including a history of abuse)
- Traumatic life experiences (such as the loss of a loved one)
Previous studies have found that many individuals with panic disorder have a markedly lower quality of life compared to community samples. Whilst not everyone experiencing this condition will experience functional disruptions, studies have highlighted various associated correlating consequences. Individuals with panic disorder have been observed to be at heightened risk for:
- Diminished well-being
- Avoidance of social situations, and consequent decline in social support
- Compromised health
- Frequent dependency upon medical services
- Lower occupational attainment
- Financial dependency
- Marital strife
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Recommended Readings
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Panic Disorder: 6B01
Craske, M., Farchione, T., Allen, L., Barrios, V., Stoyanova, M., & Rose, R. (2007). Cognitive behavioral therapy for panic disorder and comorbidity: More of the same or less of more?. Behaviour Research And Therapy, 45(6), 1095-1109. doi: 10.1016/j.brat.2006.09.006
Meuret, A., Kroll, J., & Ritz, T. (2017). Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annual Review Of Clinical Psychology, 13(1), 209-240. doi: 10.1146/annurev-clinpsy-021815-093044
Kaczkurkin, A., & Foa, E. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues In Clinical Neuroscience, 17(3), 337-346. doi: 10.31887/dcns.2015.17.3/akaczkurkin