Panic

Panic is a sudden, overwhelming surge of fear or discomfort that reaches a peak within minutes and is accompanied by physical symptoms such as heart palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, or abdominal distress. A panic attack is not itself a diagnosis; panic disorder is diagnosed when attacks are recurrent and followed by persistent worry about another attack or significant behavioral changes to avoid them.

There are two broad patterns of panic: attacks that are triggered by specific situations (expected) and attacks that occur unexpectedly without a clear trigger (unexpected). Nocturnal panic refers to attacks that wake a person from sleep. Panic can occur in the context of anxiety disorders, depression, medical conditions, or substance effects, but it can also appear on its own.

The symptoms reflect rapid activation of the body's sympathetic nervous system, involving the amygdala and other circuits in the limbic system. Neurotransmitters such as norepinephrine and GABA are involved, and genetic and environmental factors can contribute to vulnerability. Stressful life events and certain substances can increase risk.

In diagnostic terms, a panic attack is defined by four or more of thirteen possible symptoms reaching peak within about ten minutes. Panic disorder is diagnosed when attacks are recurrent and followed by at least one month of persistent concern about future attacks or significant behavioral changes to avoid them.

Treatment typically includes psychotherapy, especially cognitive-behavioral therapy with exposure components, and medications such as selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. Benzodiazepines may be used for short-term relief. Self-help strategies include paced breathing, grounding techniques, regular exercise, adequate sleep, and reducing caffeine and alcohol intake.