Symptoms:

With panic disorder, at least four of the following symptoms suddenly occur within 10 minutes. Attacks may be followed by at least 1 month of persistent fear of having another attack.

• Chest pain or discomfort
• Dizziness or faintness
• Fear of dying
• Fear of losing control
• Feeling of choking
• Feelings of detachment
• Feelings of unreality
• Nausea or upset stomach
• Numbness or tingling
• Palpitations or pounding heart
• Sensation of shortness of breath
• Sweating, chills, or hot flashes
• Trembling or shaking

There are often extreme changes in behavior at home, school, work, or with family. People with the disorder often worry about the significance of their panic attacks. They may think they are "going crazy" or having a heart attack.

A person with panic disorder often lives in fear of another attack and may be afraid to be alone or to be far from medical help.

Signs and tests:

A health care provider will perform a physical examination, including blood tests and a psychiatric evaluation. Medical disorders must be ruled out before panic disorder can be diagnosed.

Disorders related to substance abuse should also be considered, because some can mimic panic attacks. Substance abuse also can occur when people who have panic attacks try to cope with their fear by using alcohol or illegal drugs.

Cardiovascular, endocrine, respiratory, and nervous system (neurologic) disorders can be present at the same time as panic disorders. Specific tests will vary from person to person depending on the symptoms.

Many people with panic disorder first seek treatment in the emergency room, because the panic attack feels like a heart attack.