Panic Disorder

Panic disorder is a anxiety disorder characterized by recurrent, unexpected panic attacks. This situation is an intense fear or discomfort that peaks within several minute. During Atak, individuals experience a sense that a catastrophe is one. According to DSM-IV, at least one of the following must be present for at least one month following the attacks to establish the diagnosis:

• Persistent concern about having additional panic attacks,
• Anxious expectations regarding the consequences of panic attacks (such as having a heart attack, losing control, etc.),
• Significant behavioral changes related to panic attacks (for example, avoiding going out alone, avoiding exercise, etc.).

Panic disorder may occur alone or in conjunction with agoraphobia (an anxiety disorder characterized by intense fear of being in places where escape might be difficult or help unavailable). When Agoraphobia accompanies it, individuals exhibit avoidance behaviors toward situations where escape would be difficult if they experience a panic attack.

The symptoms of panic attacks in panic disorder are suddenly onset and typically reach their peak within 10 minutes. At least four of the following thirteen symptoms must be present in individuals with this condition:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or a feeling of being smothered
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizziness, lightheadedness, feeling faint
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flashes

In some individuals, anticipatory anxiety develops after a panic attack; this leads to restriction of daily life due to fear of another attack. As a result, functioning may be impaired, social situations may be avoided, and emergency service visits may become recurrent.

_{A person experiencing a sudden panic attack in public. Image generated by artificial intelligence.}

• Lifetime prevalence: 1.5% – 3%
• It is observed 2 to 3 times more frequently in women than in men.
• The typical age of onset is often in the early 20s.
• Panic disorder is a significant mental health issue both in the general population and in healthcare utilization.
• Approximately 30% to 50% of individuals with panic disorder also have agoraphobia.
• The prevalence of panic disorder is higher among first-degree relatives (indicating genetic vulnerability).
• Patients with panic disorder frequently present to cardiology, pulmonary, and emergency departments with physical complaints.

^{Generated by artificial intelligence.}

The cause of panic disorder is not fully understood, but it is believed to involve a combination of biological, genetic, psychological, and environmental factors.

• Genetic predisposition: Risk is increased in individuals with first-degree relatives who have panic disorder.
• Neurotransmitter dysregulation: Abnormalities in serotonin, norepinephrine, and GABA systems underlie panic attacks.
• Carbon dioxide hypersensitivity: Increases in CO₂ levels can trigger panic attacks.
• Brain structures: Abnormal activity has been observed in the locus coeruleus, amygdala, and prefrontal cortex.

• Cognitive theories: Catastrophic misinterpretation of bodily sensations (for example, interpreting palpitations as a heart attack) is a key trigger.
• Classical conditioning: Learned fears may be associated with situations previously linked to panic attacks.
• Early life experiences such as childhood separation anxiety and other life events can be influential.

Before diagnosing panic disorder, other medical and psychiatric conditions that may present with similar symptoms must be ruled out:

• Cardiovascular diseases (e.g. arrhythmias, ischemic heart disease)
• Endocrine disorders (e.g. hyperthyroidism, pheochromocytoma)
• Respiratory diseases (e.g. asthma, COPD)
• Neurological disorders (e.g. epilepsy, vestibular disorders)
• Substance and medication use (e.g. amphetamines, caffeine, steroids)

• Generalized anxiety disorder
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Somatoform disorders
• Substance-induced anxiety disorder