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).
But over time, you may find yourself experiencing more panic attacks, in a variety of circumstances. Most of these will not be entirely unexpected. Most subsequent attacks occur in response to various cues such as entering a crowded area; a traffic jam; or simply worrying about having a panic attack. But there may still be some surprises: for instance, you might have a nocturnal panic attack, which wakes you out of a sound sleep. Or you might find yourself experiencing odd feelings of depersonalization as you kill some time with friends or colleagues.
Panic attacks can happen during the day or night. Some people have one panic attack then don't ever experience another, or you might find that you have them regularly, or several in a short space of time. You might notice that particular places, situations or activities seem to trigger panic attacks. For example, they might happen before a stressful appointment.
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.

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.


Most treatment providers for anxiety-related disorders can be found in hospitals, clinics, private or group practices. Some also operate in schools (licensed mental health counselors, clinical social workers, or psychiatric nurses ). There is also the growing field of telehealth in which mental health workers provide their services through an internet video service, streaming media, video conferencing or wireless communication. Telehealth is particularly useful for patients that live in remote rural locations that are far from institutions that provide mental health services. Mental health providers that work in telehealth can only provide services to patients currently located in the state in which the provider is licensed.
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.

If you’re constantly dogged by worries, you might be diagnosed with generalized anxiety disorder (GAD). This mental illness is defined as excessive anxiety and worry with symptoms that are present most of the time and persist for more than 6 months. GAD is characterized by feelings such as nervousness, restlessness, fatigue, muscle tension, and difficulty concentrating and sleeping.
Those who experience anxiety attack disorder are not alone. It’s estimated that 19 percent of the North American adult population (ages 18 to 54) experiences an anxiety disorder, and 3 percent of the North American adult population experiences anxiety attack disorder. We believe that number is much higher, since many conditions go undiagnosed and unreported.

"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. 
Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:
Research is inconsistent as to whether nutritional deficiencies (for example, zinc or magnesium deficiency) may be risk factors for panic disorder. While food additives like aspartame, alone or in combination with food dyes, are suspected to play a role in the development of panic attacks in some people, it has not been confirmed by research so far.
There are several different anxiety-related disorders. Some symptoms overlap across many of these disorders, and others are more specific to a single disorder. In general, however, all anxiety-related disorders feature worry, nervousness, or fear that is ongoing, excessive, and has negative effects on a person's ability to function. It can be tricky to decide when anxiety is typical or linked to a disorder, which is why diagnoses should be made by licensed professionals, such as psychologists or psychiatrists.
The causes of anxiety attacks are not well understood. Some traumatic life events can set off anxiety attacks if the person is prone to depression or anxiety disorders. Also, medical conditions and some medications may trigger anxiety attacks. Many believe anxiety attacks run in families with a genetic predisposition. In other words, if your mom and her sister had anxiety attacks, it’s likely you will, too.

If you’re constantly dogged by worries, you might be diagnosed with generalized anxiety disorder (GAD). This mental illness is defined as excessive anxiety and worry with symptoms that are present most of the time and persist for more than 6 months. GAD is characterized by feelings such as nervousness, restlessness, fatigue, muscle tension, and difficulty concentrating and sleeping.
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."
Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses.[10] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.[10]
Prevention is more effective than treatment for panic attacks. Prevention involves stress management methods such as meditation and mindfulness to reduce your stress so that it doesn’t accumulate and eventually erupt into a panic attack. Prevention is not about stopping a panic attack just before it happens. The best you can do just before a panic attack is manage it.
Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short lived, present focused, geared towards a specific threat, and facilitating escape from threat; anxiety, on the other hand, is long-acting, future focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[17]
The typical course of panic disorder begins in adolescence and peaks in early to mid-twenties, with symptoms rarely present in children under the age of 14 or in older adults over the age of 64 (Kessler et al., 2012). Caregivers can look for symptoms of panic attacks in adolescents, followed by notable changes in their behavior (e.g., avoiding experiencing strong physical sensations), to help potentially identify the onset of panic disorder. Panic disorder is most likely to develop between the ages of 20-24 years and although females are more likely to have panic disorder, there are no significant sex differences in how the disorder presents (McLean et al., 2011).
We have all felt anxiety—the nervousness before a date, test, competition, presentation—but what exactly is it? Anxiety is our body's way of preparing to face a challenge. Our heart pumps more blood and oxygen so we are ready for action. We are alert and perform physical and emotional tasks more efficiently. (See also Test Anxiety for tips on dealing with tests.)
Anxiety cannot increase forever and you cannot experience peak levels of anxiety forever. Physiologically there is a point at which our anxiety cannot become any higher and our bodies will not maintain that peak level of anxiety indefinitely. At that point, there is nowhere for anxiety to go but down. It is uncomfortable to reach that peak but it is important to remember this anxiety will even out and then go down with time.
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, difficulty moving, and derealization. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety and forms a positive feedback loop.[10]

Most treatment providers for anxiety-related disorders can be found in hospitals, clinics, private or group practices. Some also operate in schools (licensed mental health counselors, clinical social workers, or psychiatric nurses ). There is also the growing field of telehealth in which mental health workers provide their services through an internet video service, streaming media, video conferencing or wireless communication. Telehealth is particularly useful for patients that live in remote rural locations that are far from institutions that provide mental health services. Mental health providers that work in telehealth can only provide services to patients currently located in the state in which the provider is licensed.
More than shyness, this disorder causes intense fear about social interaction, often driven by irrational worries about humiliation (e.g. saying something stupid or not knowing what to say). Someone with social anxiety disorder may not take part in conversations, contribute to class discussions or offer their ideas, and may become isolated. Panic attacks are a common reaction to anticipated or forced social interaction.
If you’re constantly dogged by worries, you might be diagnosed with generalized anxiety disorder (GAD). This mental illness is defined as excessive anxiety and worry with symptoms that are present most of the time and persist for more than 6 months. GAD is characterized by feelings such as nervousness, restlessness, fatigue, muscle tension, and difficulty concentrating and sleeping.
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Panic attacks, on the other hand, are short bursts of intense fear often marked by increased heart rate, brief chest pain or shortness of breath. Typically lasting fewer than 30 minutes, they could occur once or repeatedly — sometimes without reason. These episodes can send patients to the emergency room, as they are sometimes mistaken for a heart attack.
Seek medical follow-up. For those who are diagnosed with panic disorder, depression, or another form of anxiety disorder, the news is encouraging when treatment is received. These disorders are usually well controlled with medications. However, many people suffer the effects of these illnesses for years before coming to a doctor for evaluation. These conditions can be extremely disabling, so follow-up after the initial visit to the doctor is crucial so that diagnosis and treatment can continue.
People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.[18] However, panic attacks experienced by those with panic disorder may also be linked to or heightened by certain places or situations, making daily life difficult.[19]
Panic attacks cause a variety of distressing symptoms that can be terrifying for the individual experiencing the attack. Some people mistake panic attacks for heart attacks and many believe that they are dying. Others feel a mixture of self-doubt or impending doom. Some can also find the episodes extremely embarrassing and refrain from telling their friends, family, or a mental health professional.

Warren: So if you’re walking down a dark alley, you are probably thinking that there could be potential danger; that anxiety of anticipation, the feeling in your stomach, the elevated heart rate. But if you’re walking down that alley and somebody jumps out with a knife, then you’re likely to have a panic attack — an overwhelming urge to escape a situation that is dangerous.
Great questions. Unfortunately, there is usually no clear cut answer – and like many mental health disorders – it is likely caused by a combination of genetic, behavioral, and developmental factors. Anatomically speaking, Generalized Anxiety Disorder is most closely related to a disruption in the functional connectivity of the amygdala – the “emotional control center” of the brain – and how it processes feelings of fear and anxiety. Genetics also play a role in Generalized Anxiety Disorder. If you have a family member that also suffers from this disorder, your chances of suffering from it are increased, especially in the presence of a life stressor. Interestingly, long-term substance abuse also increases your chances of Generalized Anxiety Disorder, as the use of benzodiazepines can worsen your anxiety levels, as can excessive alcohol use. Tobacco use and caffeine are also both associated with increased levels of anxiety.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/. For additional resources, visit www.nimh.nih.gov/findhelp.
I had the biggest panic attack to date today, managed to get into the car with my friends to take my son for a hospital appointment, felt very unsafe and thought I was going to fall out of the car when it went around a corner. Talked to myself all through the journey telling myself I’d been round hundreds of corners and never fallen out out a car yet…got the hospital, got out the car, got half way across the carpark and had what I can only describe as the most hysterical panic/anxiety attack I have ever had. I,d dropped to the floor by now as I was with my friend Kay and I knew she wouldnt be able to run after me….I was screaming, pleading for help for what felt like forever, 2 paramedics came over and it took them a good 10 minutes to convince me I should stand up and go into A&E, I can only explain the whole thing as being hysterical, a Crisis nurse and doctor came to see my and gave me 4 diazepam, even after taking one – 5mg – I was hysterical and wouldnt then leave the hospital…I,m now at home and a lot calmer, the Crisis team are coming to see me between 10am and 1pm tomorrow to discuss meds, even the nurse said to the doctor ‘this isnt depression, this is severe anxiety..’ all I need is a tiny pinprick of light to look at to keep me hopeful. I honestly thought I could handle today but I didnt, I,m angry and disappointed with myself as this time a month ago I was fine
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.
When used in the appropriate person with close monitoring, medications can be quite effective as part of treatment for panic disorder. However, as anything that is ingested carries a risk of side effects, it is important for the individual who has panic attacks to work closely with the prescribing health care professional to decide whether treatment with medications is an appropriate intervention and, if so, which medication should be administered. The person being treated should be closely monitored for the possibility of side effects that can vary from minor to severe, and in some cases, even be life-threatening. Due to the possible risks to the fetus of a mother being treated for panic attacks with medication, psychotherapy should be the first treatment tried when possible during pregnancy and the risk of medication treatment should be weighed against the risk of continued panic attacks in regard to the impact of a developing fetus.
"Anxiety" is a general term that describes a variety of experiences, including nervousness, fear, apprehension, and worry, that are common in several mental health disorders. While most of us have anxiety at some time, this is completely different from an anxiety attack or anxiety disorder. Normal feelings of nervousness, worry, and fear often have a known trigger (a major exam, money issues, or seeing a bug). But when you're having a full blown panic attack or anxiety attack, the symptoms — chest pain, flushing skin, racing heart, and difficulty breathing — can make you feel as though you're going to faint, lose your mind, or die. The reality is, you won’t. The key to surviving is to learn all you can about anxiety attacks and practice the skills you need to get through them.
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
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