The primary characteristic of panic disorder is the presence of recurring, unexpected panic attacks, defined as distinct periods of extreme fear or terror. There’s a period of at least 1 month’s duration after the attack in which the client experiences extreme concern about having more attacks, worries about the consequences of the attack, or manifests behavioral changes related to these attacks. The panic attacks aren’t due to the physiologic effects of a substance or to a general medical condition. The usual age of onset is the late 20s, and about twice as many women as men are affected. Clients with panic disorder may concurrently experience a depressive disorder or a psychoactive substance use disorder, with dependence on alcohol or anxiolytics commonly occurring.
An unexpected panic attack is one that isn’t related to a situational trigger; it occurs spontaneously. Some people have situationally predisposed attacks associated with exposure to a specific circumstance. These attacks tend to be less common than the spontaneous type.
A panic attack lasts minutes, is usually unexpected, and doesn’t occur in response to typical anxiety-provoking stimuli. The symptoms that accompany it mimic signs of severe cardiac or respiratory distress. An attack begins with an intense feeling of apprehension and impending doom. During the attack, the person feels powerless to control the developing symptoms. After several panic attacks, clients may begin to associate certain situations such as driving a car with an attack: because the same situation may not always precipitate an attack, clients also typically endure fear about the unpredictability of panic disorder.