Symptoms:

A panic attack begins suddenly, and most often peaks within 10 - 20 minutes. Some symptoms may continue for an hour or more. A panic attack may be mistaken for a heart attack.

Panic attacks may include anxiety about being in a situation where an escape may be difficult (such as being in a crowd or traveling in a car or bus).

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

People with panic disorder have at least four of the following symptoms during an attack:

• Chest pain or discomfort
• Dizziness or faintness
• Fear of dying
• Fear of losing control or impending doom
• Feeling of choking
• Feelings of detachment
• Feelings of unreality
• Nausea or upset stomach
• Numbness or tingling in the hands, feet, or face
• Palpitations, fast heart rate, or pounding heart
• Sensation of shortness of breath or smothering
• Sweating, chills, or hot flashes
• Trembling or shaking

Panic attacks may change behavior and function at home, school, or work. People with the disorder often worry about the effects of their panic attacks.

People with panic disorder may have symptoms of:

• Alcoholism
• Depression
• Drug abuse

Panic attacks cannot be predicted. At least in the early stages of the disorder, there is no trigger that starts the attack. Recalling a past attack may trigger panic attacks.

Signs and tests:

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

The health care provider will perform a physical examination, including a psychiatric evaluation.

Blood tests will be done. Other medical disorders must be ruled out before panic disorder can be diagnosed. Disorders related to substance abuse should be considered, because symptoms can mimic panic attacks.