Panic disorder

Key points about panic disorder

  • A panic attack is a sudden feeling of intense fear that starts and finishes quickly.
  • They are common and can happen anytime, anywhere and without warning. 
  • Panic disorder is a common type of anxiety disorder involving frequent panic attacks
  • The exact cause is unclear. However, there is some evidence of a family/whānau tendency and a link with major life events and stresses.
  • If you think it possible that you or someone you care about has panic disorder, see your healthcare provider.
  • Most people get better with treatment that involves talking therapy and medication.
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Panic disorder affects 2–3% of the population each year. It usually begins during your teens or early twenties and is twice as common in women than men. Sometimes it starts when you are under a lot of stress

It involves recurrent, unexpected panic attacks. You may also feel physical symptoms, such as fast heartbeat, chest pain, breathing difficulty and dizziness.

You may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes.

Panic disorder can be associated with other anxiety disorders. Learn more about anxiety.

A panic attack is a sudden period of intense fear or discomfort, in which 4 or more of the following symptoms reach a peak within minutes:

  • palpitations, pounding heart or accelerated heart rate
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, lightheaded, or faint
  • feeling unreal or feeling detached from yourself
  • fear of losing control or going crazy
  • fear of dying
  • numbness or tingling sensations
  • chills or heat sensations.

At least one of these attacks is followed by one, or more, of the following, lasting a month or more:

  • worry about having more attacks or what the attacks might mean (eg, losing control, having a heart attack, “going crazy”)
  • a significant change in behaviour related to the attacks (eg, avoiding exercise).

Try this screening test: Panic disorder severity scale – self-reported(external link) Good Medicine, UK

The goal of treatment is to help you function well during everyday life. A combination of medication and cognitive-behavioural therapy (CBT) works best. 


Four major classes of medications are used in the treatment of anxiety disorders:

  • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Fluox), sertraline (Zoloft) and paroxetine (Aropax)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • benzodiazepines, but these are used cautiously as they can cause dependence
  • tricyclic antidepressants.

Talking therapy

Cognitive behavioural therapy This helps you understand behaviours and ways of thinking that might lead to more panic attacks and change these patterns to help prevent future panic attacks.

Exposure therapy(external link) In this approach you gradually face the sensations or places that you have been avoiding so that that you can learn new ways of coping.

One of the best things you can do is educate yourself. Read about panic disorder and the many things you can do to help yourself, such as getting enough sleep. The following things also help:

Eat well

Eat at regular times, choose healthier foods and reduce or avoid caffeine, certain cold medicines and stimulants.

Exercise regularly 

Many people with panic disorder avoid doing aerobic exercise as the increase in heart rate and faster breathing may remind you of panic symptoms. Through facing the symptoms and sensations that you fear (interoceptive exposure) you can gradually start increasing the amount of exercise you do. This is an important part of stress management. Aim for 3 sessions of exercise per week, choosing activities that you enjoy and varying the type of exercise so that you are able to establish and maintain a routine.

Some people find yoga, tai chi or meditation to be helpful from an exercise and relaxation perspective.

Relaxation training

Relaxation is the voluntary letting go of tension. This tension can be physical tension in the muscles or it can be mental (or psychological) tension. When you physically relax, the impulses arising in the various nerves in your muscles change the nature of the signals sent to your brain. This change brings about a general feeling of calm, both physically and mentally. Muscle relaxation has psychological benefits as well as physical.

Constant tension makes people over-sensitive and they respond to smaller and smaller events as though they were threatening.

By learning to relax, you can reduce general levels of arousal and tension, and gain control over these feelings of anxiety. View these practical techniques for managing stress(external link) from Computer Assisted Learning for the Mind, University of Auckland.

You can also reduce anxiety with a slow breathing technique. 

  • Take a regular breath (through your nose) and hold it for 6 seconds (use a watch). 
  • When you get to 6, breathe out and say the word ‘relax’ to yourself in a calm, soothing manner.
  • Breathe in and out in a 6-second cycle (in for 3, out for 3).
  • Continue breathing in this way until the anxiety symptoms of over-breathing have gone.
  • Find a relaxation tape or CD to assist.

Expose yourself to things you fear

Do this gradually. Write a list of things you avoid because of your anxiety and start to slowly reintroduce these activities into your life. Be kind to yourself and set achievable goals. Start with the things you feel least anxious about and move up the stepladder over time to face some of the things you feel more anxious about. 

Reward yourself for success even if it didn’t go as well as you had hoped. For example, a person who is afraid of driving because of their anxiety may set a goal to be able to drive to an unknown suburb 20 km away. They might start with short trips in familiar areas and gradually increase the distance from home and explore unknown places.

It's important to feel some anxiety during the exposure exercises and to ‘stay with’ the anxiety until it reduces.

If after trying this for a few weeks, if you are still experiencing panic attacks and/or avoiding situations, see your family doctor for referral to a psychologist.

Do a course or get support

Just a Thought(external link) is an organisation in Aotearoa New Zealand providing free online courses to improve your mental health through learning how to interact differently with thoughts and identify behaviours that enhance wellbeing. Read more about their course on overcoming panic(external link) and see the support section below for other options.

There are a range of organisations that can provide support and advice.


The following links provide further information about panic disorder. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Panic attacks and panic disorder(external link)  Ministry of Health, NZ
Find out how to tell if someone is struggling with their mental health(external link) BBC, UK, 2021
Panic disorder(external link)  Mental Health Foundation, NZ, 2014
Don’t panic!(external link) Book by Dr Andrew Page
Small Steps(external link) NZ


Panic disorder and agoraphobia(external link) Royal Australian and NZ College of Psychiatrists, 2005
Understanding anxiety and panic attacks (external link)Mind UK, 2015
Anxiety and how to handle it (external link)Mental Health Foundation, NZ, 2018


  1. Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Gorman JM, Papp LA. Multicenter collaborative Panic Disorder Severity Scale(external link) American Journal of Psychiatry 1997;154:1571-1575

The following information is from: generalised anxiety disorder in adults(external link) BPAC, NZ, 2009


When assessing someone with a possible anxiety disorder, there are a wide range of presentations. For some, anxiety or stress are dominant features, while for others physical symptoms such as poor sleepheadache, dizziness, gastrointestinal disturbance or other vague symptoms stand out.

Some medical conditions to consider include: hyper- and hypothyroidism, angina, asthma, depression and substance misuse eg, caffeine, amphetamines, cannabis, cocaine. Also consider medications such as anticholinergics, digoxin toxicity and some social drugs or alcohol withdrawal.

Discussion around the following points may be helpful:

  • the start of the anxiety symptoms (many patients delay seeking treatment for years)
  • associations with life events or trauma
  • the nature of the anxiety (e.g. worry, avoidance or obsession)
  • the impact of anxiety on daily function
  • medication use
  • alcohol, caffeine and cannabis intake

An algorithm can be used to determine which anxiety disorder is most likely. 

Other clinical resources

Principles of care for people with panic disorder(external link) National Institute for Healthcare and Excellence (NICE), UK, 2019
Practice guidelines for the treatment of patients with panic disorder(external link) American Psychological Association (APA), US, 2010

Continuing professional development

Healthier breathing for anxiety and panic

In this series of 4 short videos, Karen Fraser explains what healthier breathing is and how it can be used to help clients with anxiety and panic. View these videos here



Panic disorder and agoraphobia

Royal Australian and NZ College of Psychiatrists, 2005

anxiety and how to manage it

Anxiety and how to handle it

Mental Health Foundation, NZ, 2018

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Kirsty Furness clinical psychologist, Auckland

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