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Patients with panic disorder may experience panic attacks in a variety of different patterns. Panic attacks occur suddenly, with symptoms following rapidly and reaching a peak within 10 minutes. Symptoms of panic attack include:

• Palpitations (rapid or pounding heartbeat)
• Heavy perspiration
• Shortness of breath or feeling of suffocation
• Chest pain
• Dizziness or lightheadedness
• Tightness in the throat
• Nausea or abdominal cramping
• Chills or hot flashes
• Tingling and numbness in the hands
• Trembling
• Sensation of choking
• Feelings of unreality or being detached from oneself
• Fear of losing control or “going crazy”
• Fear of dying

A person who experiences four or more of these symptoms could be having a panic attack. As these symptoms multiply, the individual may feel an impending sense of doom or a loss of control. Gradually, these feelings and symptoms will subside. Once the attack has passed, a feeling of fatigue may set in.

In some cases, patients diagnosed with panic disorder may experience panic attacks that occur regularly and frequently. In other cases, patients may have short periods in which they experience many attacks followed by periods of relative calm.

In addition, people with panic disorder are likely to experience many attacks in which just a handful of symptoms appear. These are known as limited-symptom attacks. They may also experience full panic attacks, in which many more symptoms appear.

Patients with panic disorder may have disturbed sleep patterns because of panic attacks that occur at night. Sleep may also be disrupted because of chronic, panic-related anxiety.

Patients with panic disorder are likely to experience symptoms in between attacks. These are chiefly psychological and involve worrying about future attacks and the potential consequences of such attacks. Their behavior may change dramatically as they take steps to avoid any situation that might trigger an attack. This can become so significant that the patient eventually is diagnosed with agoraphobia, which is an unwillingness to venture beyond comfortable surroundings due to fear of intense anxiety. Symptoms of agoraphobia may come and go in tandem with the incidence of panic attacks, or agoraphobia may be chronic and constant.

In many cases, panic disorders are associated with other mental disorders. For example, panic disorder is closely associated with major depression. Other conditions associated with panic disorder include agoraphobia, post-traumatic stress disorder and phobias (e.g., social phobias, specific phobias).

In some patients, the overwhelming feelings of fear may be accompanied by various symptoms of sympathetic nervous system arousal, such as sweating, palpitations, diarrhea, and often, an angina-like chest pain resembling a heart problem. However, detailed medical cardiac “workups” in patients with panic disorder typically show no abnormalities.