Panic Disorder

The first attack felt like a heart attack. By the second, you had started reorganising your life around avoiding the next one. The avoidance is often what makes it worse.

What Is Panic Disorder?

A panic attack is a sudden surge of intense fear, with strong physical symptoms, that peaks within minutes. In panic disorder, the attacks keep coming, often at unpredictable times and with no clear trigger.

After an attack, many people start to dread the next one. They begin avoiding places and situations they link to it, and life slowly gets smaller. Panic disorder is a medical condition. It is not weakness and it is not a flaw in character: the body’s alarm system is going off when there is no danger. It is treatable.

What It Looks Like

An attack comes on fast and feels like real danger. Many people think they are having a heart attack, or that they are about to die or lose control. Then the fear of the next one takes over.

How long it lasts. An attack peaks within minutes. Most last 5 to 20 minutes, and some last up to an hour. The fear of the next one can stay.

Chest pain and breathlessness can also have a medical cause, so they should be checked before you assume it is panic.

What Causes Panic Disorder?

Panic disorder is linked to an over-sensitive fight-or-flight response:

• A threat-response system that fires strongly even when there is no real danger
• Genetics and a family history of anxiety or panic
• A period of high stress, which often precedes the first attacks
• Triggers such as caffeine or stimulants in some people

How Panic Disorder Is Assessed

We first rule out medical causes of the physical symptoms. A racing heart, chest pain, and breathlessness can come from the heart, the lungs, or the thyroid, so they are checked before panic disorder is diagnosed.

Then comes a clinical conversation about your attacks: when they began, how long they last, what happens in your body, and what you now avoid. Screening questionnaires such as the GAD-7 are a starting point, not a diagnosis. A low score does not rule out panic disorder, so if attacks are affecting your life, book an assessment whatever the result.

Treatment Options

Treatment for panic disorder is well established. The main parts are:

• CBT with interoceptive exposure. Cognitive behavioural therapy is a first-line approach. Interoceptive exposure is systematic, graduated practice, guided by a therapist, with the physical sensations of panic, such as a fast heartbeat, so they become less frightening.
• Working on avoidance. Avoidance often keeps the fear going, so it is addressed directly, one step at a time.
• Medication. It is another established option, on its own or alongside therapy. The choice depends on how severe the attacks are, what you prefer, and your health, and is made with your clinician.
• Skills for the moment. Slow breathing and grounding can help some people get through an attack. Treatment is what reduces how often attacks happen.

Most people improve significantly within a defined course of treatment.

When to Get Help

Book an assessment if you have had more than one unexpected panic attack and have since been avoiding situations or worrying about the next one. Do the same if attacks are frequent or intense, last longer than usual, are affecting your work, school, or relationships, or if what you do to cope no longer works.

Left untreated, panic disorder can affect your quality of life and cause difficulties at work or school.

Get medical help now if you have chest pain, trouble breathing, or fainting that is new, feels different from your usual attacks, or does not settle. Also get medical help now if chest pain spreads to your arm, neck or jaw, or if it feels tight or like squeezing and your heart has not been checked. The same applies if you are having thoughts of harming yourself. Do not wait for an appointment. Call the Royal Oman Police on 9999 or go to your nearest emergency department.

Frequently Asked Questions

Are panic attacks dangerous?
They feel frightening and physical, but a panic attack itself is not physically dangerous. Understanding this is part of recovery. Chest pain and breathlessness should still be checked by a doctor first, because they can have other causes.

How do I know it is a panic attack and not a heart problem?
You cannot tell from how it feels, because the symptoms overlap. That is why chest pain and breathlessness are checked first. If it is new, feels different from your usual attacks, or does not settle, get urgent medical help. Once a medical cause has been ruled out and the attacks keep returning, panic disorder can be assessed.

Why do they come “out of nowhere”?
Attacks can appear without an obvious trigger because the body’s alarm system has become over-reactive. Treatment helps reset this.

Is one panic attack the same as panic disorder?
No. A single attack can happen to people who never develop the disorder. Panic disorder is diagnosed when attacks keep recurring, often with no clear trigger, you worry about the next one or change your life to avoid it for at least a month, and no medical condition or substance explains them. A clinician makes that call.

Is an anxiety attack the same as a panic attack?
People use both terms. “Panic attack” is the medical term for a sudden surge of intense fear with physical symptoms. “Anxiety attack” is an everyday phrase, not a diagnosis.

Will avoiding the places where I had an attack help?
It brings relief at first, but it tends to keep the fear going and make life smaller. That is why treatment works on avoidance directly, one step at a time.

What helps during an attack?
Slow breathing and grounding techniques can help some people in the moment; treatment reduces how often attacks happen.

Can panic disorder be treated?
Yes, and it responds very well to treatment, particularly psychological therapy.

Do I need a referral?
No. You can book a confidential assessment directly.

Sources: NHS (nhs.uk), Mind UK (mind.org.uk), NIMH (nimh.nih.gov)