Discrete periods of intense fear or discomfort in which at least four of the symptoms below develop abruptly and reach a crescendo within ten minutes. Typically ten minutes, these attacks may recur repeately, rapidly and may leave severe anxiety in its wake lasting for hours. Must occur unexpectedly or spontaneously in the absence of specific or environmental triggers (e.g. elevators). Four attacks over a four week period or one attack followed by one month of fearful anticipation of more. Subtypes include with or without agoraphobia (phobic avoidance).


 shortness of breath – smothering sensation
 dizziness, faintness or unsteady feeling
 accelerated heart rate
 trembling or shaking
 depersonalization or derealization
 hot flashes or chills
 chest pain
 fear of dying
 fear of going crazy or being out of control


Etiology is largely unknown at present. Medical or biochemical disturbances are suspected. Empirical clinical evidence suggests trumatic experiences and anger management problems may have a relationship. There is a significant correlation of people who have difficulty identifying, expressing or releasing anger and panic attacks.
Physicals ruling out thyroid, heart or other medical problems is routinely recommended.


 Behavioral Therapy – graduated exposure aimed at reducing avoidance and anticipatory anxiety
 Cognitve Therapy – cognitive restructuring of maladaptive thought processes
 Relaxation Therapy – biofeedback or breathing retraining
 Pharmacologic – medications