Panic disorder, one of the anxiety disorders, is characterized by repeated and unexpected attacks of intense fear and anxiety.

Panic attacks are usually not related to a particular situation (although attacks in patients with social and specific phobias are usually expected or "cued" to a recognized or specific stimulus) and typically "peak" within ten minutes of their onset.

Agoraphobia refers to a fear of being in places where escape might be difficult, or where help might be unavailable in case of a panic attack.

The development of agoraphobia may involve learned behavior, since it reflects a fear of experiencing panic attacks in unprotected settings. Sometimes the association of panic attacks occurs with areas where they have happened.

Studies have reported lifetime prevalence rates of 1.5 to 5% for panic disorder. Panic disorder can occur in children, but the average age of onset is 25 years old. Panic disorder affects middle-aged and older adults as well. Studies have shown that women are 2 to 3 times more likely to be affected.

• Shortness of breath
• Dizziness or faintness
• Palpitations
• Trembling
• Sweating
• Choking
• Nausea or other abdominal distress
• Numbness or tingling
• Chest pain or discomfort
• Hot flushes or chills
• Fear of dying
• Fear of being out of control
• Fear of going insane

Symptoms of agoraphobia include:

• Anxiety about being in places where escape might be difficult
• Situations are avoided or endured with marked stress or anxiety about having a panic attack
• Fear of being alone
• Fear of losing control in a public place
• Becoming house bound for prolonged periods
• Feelings of detachment or estrangement from others
• Feelings of helplessness and dependence on others

A physical examination and a psychological evaluation are performed to arrive at a diagnosis. People with undiagnosed panic disorder may truly feel as if they are dying, so they often go to emergency rooms or other urgent care centers because they feel as if they are having a heart attack.

Given the physical nature of symptoms and the possibilities for misdiagnosis, it is critical that any underlying medical disorders are ruled out. Cardiovascular, endocrine, respiratory, neurologic, and substance abuse disorders may be suspected and can coexist with panic disorders. Diagnostic tests will done depending on the symptoms.

Antidepressant medications are effective treatments for many people with panic disorder -- selective serotonin reuptake inhibitors (SSRIs), such as Paxil, have become the primary medication. Antianxiety medications may also be prescribed.

Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive behavioral therapy to restructure distorted and potentially harmful interpretations of the experience of severe anxiety.

Other psychological counseling and therapy techniques may be helpful to help individuals gain an understanding of the illness and the specific factors that serve as protectors or "triggers" for them.

Although many people with this disorder may not be cured with treatment, all can expect improvement with drug or behavioral therapy. However, without early and effective intervention, the disorder may be long-standing and difficult to treat.

• Panic disorder may coexist with other anxiety disorders and/or depression
• Inability to function at work or in social situations
• Substance abuse (alcohol or other drugs) may develop, as individuals may attempt to "self-medicate"
• Feelings of isolation and/or loneliness, depression, suicidal thoughts or behavior

Call for an appointment with your health care provider if you are experiencing episodes that could suggest panic attacks.

If you are prone to panic attacks, early intervention is essential, particularly to prevent the development of agoraphobia which could significantly interfere with your ability to function at work and social situations outside the home.