You may be diagnosed with panic disorder after several unexpectedpanic attacks and if you continue to fear having another attack. These panic attacks can have mild to severe symptoms and usually last from 5 to 20 minutes but may last even longer, up to a few hours.

A first panic attack often starts without warning during an ordinary activity such as shopping or walking down the street. You may become confused and think you are "going crazy" or that something terrible is going to happen. You may feel a strong need to leave the area and go to a place that feels safe, such as your car or home. You may also experience physical symptoms such as shortness of breath, a pounding heart, or chest pain. The intensity of these symptoms usually peaks within 10 minutes. It is common to think you are experiencing a heart attack and to seek treatment in a hospital emergency room.

Panic attacks may be triggered by a specific action, such as drinking too much caffeine, or by a situation, such as being in a large crowd. Panic attacks may also start suddenly without a known trigger. You may greatly fear having another panic attack (anticipatory anxiety) and avoid all social situations (agoraphobia). As many as half of people who have panic disorder also have agoraphobia.¹ Isolating yourself and avoiding social situations can interfere with your ability to work and your relationships, especially with your family members and close friends.

Other characteristics that are common in panic disorder include:

• Fearing sleep and feeling exhausted from lack of sleep.
• Using drugs or alcohol (to numb your fears or give you a false sense of courage to face feared situations).
• Having depression.
• Having irrational fears (phobias).
• Experiencing other anxiety disorders, such as post-traumatic stress disorder.
• Having difficulty relating to other people in social settings due to intense feelings of anxiety.

Although the first panic attack may occur during a routine activity, for many people it happens at the same time during their life when there is a lot of stress, such as a life-threatening illness or accident, the loss of a relationship, or separation from family. Sometimes an initial panic attack may occur after giving birth.

It is also possible for a first panic attack to occur as the result of a drug reaction or a reaction to nicotine or caffeine. But after the situation that caused the first panic attack is resolved, attacks may continue. Experts believe these stressful circumstances may start the cycle of panic attacks in people who are already prone to panic disorder.⁷

Recurrent panic attacks can be mild to severe and continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur).⁸ You may have long periods of time without panic attacks and other periods of time when attacks occur frequently.

You may need longer or different treatment if you have both panic disorder and agoraphobia. You may also experience other conditions associated with panic disorder and panic attacks such as drug or alcohol problems, depression, or other mental health disorders. You will need treatment for all these conditions.

Panic disorder may last a lifetime, but its symptoms can be controlled with treatment. Most people with panic disorder get better with treatment. They are able to get back to a normal lifestyle, although relapse can occur, especially if treatment is discontinued too soon.^{2, 1}