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Panic disorder involves sudden episodes of intense fear—panic attacks—peaking within minutes and accompanied by physical (palpitations, dyspnea, chest pain, dizziness, diaphoresis) and cognitive (fear of losing control or dying, derealization) symptoms. Diagnosis requires recurrent unexpected attacks plus at least one month of persistent concern about additional attacks, worry about consequences, or maladaptive behavioral changes (avoidance, safety behaviors).

Onset commonly occurs in late adolescence to early adulthood. Risk factors include female sex, family history of panic/anxiety disorders, temperamental traits (neuroticism), significant life stressors, and certain medical or substance-related triggers (stimulants, thyrotoxicosis). Differential diagnosis should exclude cardiac, endocrine, respiratory, and neurologic causes and consider substance withdrawal.

Evidence-based treatment combines pharmacotherapy—selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), or short-term benzodiazepines—with cognitive behavioral therapy (CBT) emphasizing interoceptive exposure and cognitive restructuring.

Psychoeducation, breathing retraining, and gradual exposure reduce avoidance. Prognosis improves with early, sustained treatment; untreated cases often become chronic with increased comorbidity and functional decline. Monitor for suicidality, medication side effects, and co-occurring depression or substance misuse.