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Panic Disorder in Children and Adolescents

By Josephine Elia, MD

Panic disorder is characterized by panic attacks that occur at least once a week. A panic attack is a brief (5- to 20-minute) episode of intense fear that is usually accompanied by physical symptoms, such as rapid breathing, a rapid heart beat, sweating, chest pain, and nausea.

  • Panic disorder is diagnosed when children have panic attacks frequently enough to cause significant impairment or suffering.

  • Panic disorder is usually treated with a combination of drugs and behavioral therapy.

Panic disorder is much more common among adolescents than among younger children. Sometimes children have separation anxiety (see Separation Anxiety Disorder) or generalized anxiety (see Generalized Anxiety Disorder in Children) when they are younger and then develop panic disorder as they go through puberty.

Panic attacks (see Panic Attacks and Panic Disorder) can occur in any anxiety disorder, usually in response to the focus of that disorder. For example, children with separation anxiety may have a panic attack when a parent leaves. Children who fear being trapped in places with no way to escape easily (agoraphobia) may have a panic attack when they are seated in the middle of a row in a crowded auditorium. Many children who have panic disorder also have agoraphobia.

Physical disorders, such as asthma, can also trigger panic attacks, and panic attacks can trigger asthma.

Symptoms

During an attack, children feel great anxiety, which causes physical symptoms. The heart beats rapidly. Children may sweat profusely and feel short of breath. They may have chest pain or feel dizzy, nauseated, or numb. Children may feel like they are dying or going crazy. Things may seem unreal to them. Symptoms may be more dramatic (involving screaming, weeping, or hyperventilating) than they are in adults.

Children worry about having other attacks. Panic attacks and the associated worries interfere with relationships and schoolwork.

In panic disorder, panic attacks usually occur on their own, with no specific trigger. But over time, children begin to avoid situations that they associate with the attacks. This avoidance can lead to agoraphobia (see Agoraphobia in Children and Adolescents), which makes children reluctant to go to school, visit the mall, or do other typical activities.

Panic disorder often worsens and lessens for no apparent reason. Symptoms may disappear on their own, then recur years later. Occasionally, adolescents with panic disorder may drop out of school, withdraw from society, and become reclusive and suicidal.

Diagnosis

  • Physical examination

Usually, doctors do a physical examination to check for physical disorders that may be causing the symptoms. Doctors also consider other anxiety disorders, which may also cause panic attacks.

Treatment

  • Usually drugs plus behavioral therapy

Usually, a combination of drugs and behavioral therapy is effective. In some children, drugs are frequently needed to control the panic attacks before behavioral therapy can begin. Benzodiazepines are the most effective drugs, but a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs—see Table: Drug therapy) are often preferred because benzodiazepines cause drowsiness (sedation), may interfere with learning and memory, and may result in dependence.

* This is the Consumer Version. *