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While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder.

Signs and symptoms of panic disorder

While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.

You may be suffering from panic disorder if you:

  • Experience frequent, unexpected panic attacks that aren’t tied to a specific situation

  • Worry a lot about having another panic attack

  • Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:

Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.

Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.

                         

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.

If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.

For example, you may begin to avoid:

  • Crowded places such as shopping malls or sports arenas.

  • Cars, airplanes, subways, and other forms of travel.

  • Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.

  • Physical exercise in case it triggers panic.

  • Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.

  • Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.

                         

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.

Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:

  1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly

  2. Hyperthyroidism (overactive thyroid gland)

  3. Hypoglycemia (low blood sugar)

  4. Stimulant use (amphetamines, cocaine, caffeine)

  5. Medication withdrawal

Source: https://www.helpguide.org/articles/anxiety/panic-attacks-and-panic-disorders.htm