What is panic disorder?

Panic is a “fight or flight” reaction. It is a sudden surge of fear. When panic attacks happen repeatedly, without warning, it is called panic disorder. These attacks can happen many times every week.

Panic disorder (PD) may last for a short time or may continue for many years. With treatment, most people improve in less than a year.

What is the cause?

The exact cause of this disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Certain parts of the brain and nervous system cause the emotional and physical surge of fear. A stressful event may trigger the panic. But often panic begins with no identified stressful event.
• PD tends to run in families. If a parent has panic disorder, children are more likely to have it. However, more than half of those with panic disorder do not have a relative with a history of this disorder.

Many people with PD also have agoraphobia, which means they avoid going places or doing things because they are afraid they will panic and have no help. It is common to have depression along with panic disorder.

Panic disorder usually starts in the teen or young adult years. Children who were often scared when separated from their parents are more likely to develop PD later.

What are the symptoms?

Panic attacks tend to come on suddenly. Children or teens with PD may:

• Cry in fear
• Tremble or shake
• Be short of breath or feel like they are being smothered
• Feel like they are being choked or have trouble swallowing
• Sweat
• Feel their heart pounding or feel like something is pressing on their chest
• Feel they are going to die or that they are going crazy
• Feel very helpless to stop the attacks

Along with these main symptoms, children or teens may:

• Be on guard all the time or startle easily
• Eat very little or become very picky eaters
• Have trouble concentrating due to worry
• Not do as well as they could in school
• Have frequent headaches or stomachaches
• Have trouble falling or staying asleep, or have nightmares

These feelings start suddenly and get very strong, usually within 10 minutes. Symptoms usually last from 20 to 30 minutes. The attacks happen without warning.

If your child has a panic disorder, these symptoms come repeatedly. Panic attacks may happen at certain times of day, such as bedtime, or with daily events, for example, going to school. When this is the case, the child often worries as these times approach. The child feels helpless to prevent the attacks.

How is it diagnosed?

Your child’s healthcare provider or a mental health therapist will ask about the child’s symptoms, medical and family history, and any medicines the child is taking. He or she will make sure that your child does not have a medical illness or drug or alcohol problem that could cause the symptoms.

A mental health therapist who specializes in working with children and teens may be best qualified to diagnose PD.

How is it treated?

Cognitive behavior therapy (CBT) helps children learn what causes them to feel panic and how to control it. CBT teaches skills for managing the fear and the worrisome thoughts about whether an attack is coming.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Several types of medicines can help treat panic disorder. Medicines used to treat PD in adults may not work best for children and young teens. Your child’s healthcare provider will work with you to select the best medicine. Your child may need to take more than one type of medicine.

How can I help my child?

• Support your child. Let your child talk about the scary feelings if he feels ready. Do not force the issue if your child does not feel like sharing his thoughts. Do not criticize your child for acting younger than his age. Let your child know that he is safe and protected. The support and understanding that you provide can help children deal with scary emotions.

  Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax, for example take up a hobby, listen to music, play, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that your child takes.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child or teen has ideas of suicide, harming himself, or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-NIMH (6464)
  http://www.nimh.nih.gov
• Mental Health America
  800-969-NMHA (6642)
  http://www.mentalhealthamerica.net/