The panic attack, the core feature of panic disorder, is a period of intense fear or discomfort that strikes suddenly, often in familiar places where there is seemingly nothing to be afraid of. But when the attack comes, it comes as if there were a real threat, and the body reacts accordingly. A combination of symptoms erupt—the heart races, breathing gets shallower and faster, and the whole nervous system signals:

DANGER!

Panic attacks are usually classified as being part of panic disorder if they occur more than once and are accompanied by at least four of the following symptoms:

• Sweating
• Shortness of breath
• Heart beating very rapidly
• Chest pain
• Feeling unsteady
• Choking or smothering sensations
• Numbness or tingling
• Hot or cold flashes
• Faintness
• Trembling or shaking
• Nausea or stomach pains
• Feelings of unreality
• Fears of losing control, dying, or "going crazy"

The discomfort and sense of danger the attacks bring is so intense that people may think they are having a heart attack or stroke.

Unfortunately, once the first panic attack begins to fade, many often believe it was a fluke. Consequently, many don’t seek treatment, which can result in the emergence of three serious side effects:

Avoidance. A person may discontinue any activities that seem to be triggers, for example, going to the park, driving, or riding in elevators, or doing anything that brings on frightening bodily sensations. While avoidance may help temporarily with the fear of the attack and its accompanying loss of control, it makes a normal home and work life nearly impossible. And it doesn’t keep the attacks from happening.

Anticipatory anxiety. Anxiety that is triggered by merely thinking about the possibility of having a panic attack is called anticipatory anxiety. Once this develops, it could even cause the person to become reclusive, opting to endure the attacks alone rather than in the open where there’s no chance of escape and little chance of help.

Agoraphobia. Often coupled with panic disorder, agoraphobia is the fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of a panic attack. It can drive people with panic disorder to avoid public places, crowds, or traveling by bus or plane. This pattern may progress to the point where the person will not leave his or her home.

Two main treatment options are available for people with panic disorder: medication and cognitive behavioral therapy. A number of medications that are used to treat depression also help from 75% to 90% of patients with panic disorder. Cognitive behavioral therapy consists of five key elements:

• Learning. In the first stage, the therapist explains the illness, teaches the patient
  to identify the symptoms, and outlines the treatment plan.

• Monitoring. The patient keeps a diary to monitor panic attacks and record
  anxiety-inducing situations.
  
• Breathing. The therapist teaches breathing relaxation techniques to combat the
  physical reactions of a panic attack.
  
• Rethinking. The therapist helps the patient change his or her interpretation
  of physical symptoms from catastrophic to realistic.
  
• Exposing. The therapist helps the patient encounter situations that evoke
  frightening physical sensations at levels of gradually increasing intensity.

These treatments are equally effective and can be chosen on the basis of each patient’s preference.

Effective treatments and ongoing re-search have brought new hope of recovery to people with panic disorder. And continuing medical education is helping more and more physicians recognize the disorder and get patients the help they need. Earlier detection is significantly reducing the complications of untreated panic disorder. With appropriate psychiatric treatment, up to 90% of people who experience panic disorder will recover and return to normal life activities.