The occurance of panic attacks that often seem to come "out of the blue" and the persistant worry or anxiety of having another attack for at least 1 month or the development of maladaptive behaviors.

More common in women than men

Commonly develop between ages of 23-34

Symptoms of Panic Disorder 

(Experience 4 of 13)

1. Accelerated heart rate
2. sweating
3. thrembling or shaking
4. sensations of shortness of breath
5. feelings of chocking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy or faint
9. chills or hot sensations
10. parethesias (numbness of tingling)
11. derealization or depersonalization 
12. fear of losing control or "Going Crazy"
13. fear od dying

Can be cued or uncued fear responses that essentially has physical symptoms and some cognitive symptoms, but occurs when there is no real clear or present danger.

Can occur with multiple anxiety disorders

Can occur nocturnally 

Peaks in about 10min and lasts usually 20 to 30min but rarely longer than an hour

• Anxiety and/or avoidance of specific situations (public transportation, open spaces or enclosed spaces)
• The reason for avoidance is that it would be emberrassing or hard to obtain help in these places in the event of a panic attack 
• Extreme agoraphobics may become housebound
• Occurs in 50 -75% of people with panic disorder

1. Marked fear or anxiety about 2 or more of the following situations
• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone
2. The situations are avoided because the person fear they will not be able to get help or will be embarrassed if a panic attack occurs

3. The situation feared most always provokes anxiety

4. The situation feared is actively avoided

5. The fear or anxiety is out of proportion to the actual danger posed by the situation

6. Avoidance lasts for 6 months or more

7. The fear and avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• 1st panic attack often follows stressful life event, loss of a job, important relationship, or family memeber
• Later panic attacks come "out of the blue" taking hold in the person on their own autonomous way
• Not everyone who experiences panic attacks develops panic disorder

• Cognitive Theory of Panic --> Panic becomes a consciouse thought pattern that envokes physiological symptoms and is then translated as catastrophic thus to panic and becomes an endless cycle
• Learning Theory of Panic --> Panic is a conditioned reaction learned by initial panic attacks that become associated with neutral internal cues such as heavy breathings or sweating and then when those cues occur they are unconsciously interpreted as panic and envoke a panic attack

• Anxiety sensitivity
• Safety behaviors and persistence of panic
• cognitive biases and maintenance of panic 

• Amygdale - core emotional brain region, part of the "fear network"
• Increased sensitivity = diathesis
• May be inherited of learned or both
• Hyperventilation/suffocation theory (over breathing)
• Trait, or...
• Result of acute event, argument or exercise 
• Decreased blood CO² 
• Patients cannot hold breath as long as controls 
• feeling of "suffocation"
• hyperventilating escalates problem

• Medications, anxiolytics (Xanex and Klonopin) are usually very fast acting (30-60min) and antidepressants (SSRIs and SNRIs)
• Prolonged exposure therapy
• Interoceptive exposure (internal physical cues that trigger panic are exposed in a controled enviornment)
• Cognitive restructuring techniques