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Panic Disorder and PTSD

What Are the Differences Between These Anxiety Disorders?

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Updated July 22, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Post-traumatic stress disorder (PTSD) is a condition that can occur after a person has experienced a traumatic event involving intense fear and threat of bodily injury or death. Examples include military combat, sexual assault or natural disasters.

The person may not have experienced the event firsthand. Witnessing a traumatic stressor, such as the accidental death of a person or an attack on someone, can bring about symptoms. PTSD can also occur when a person has heard about the details of another’s exposure to trauma, including learning about the tragic death of a friend or family member or finding out that a loved one has been diagnosed with a terminal condition.

People with PTSD often suffer from co-occurring anxiety-related disorders, depression and substance abuse issues. It is not uncommon for a person with PTSD to also be diagnosed with panic disorder. However, each condition has its own set of symptoms, diagnostic criteria and treatment options. The differences between panic disorder and PTSD can be determined by considering several factors:

1. Symptoms

  • People with panic disorder experience many physical symptoms associated with panic attacks, such as trembling, shaking, sweating, difficulty breathing and chest pain. These somatic feelings can become so severe that the person may believe he or she is losing control, going crazy or having a serious medical issue such as a heart attack. For people with panic disorder, these panic attacks can happen again and often without warning, which can make the person live in fear due to the anticipation of their next attack.

  • The symptoms of PTSD can be divided into three categories: re-experiencing the event, avoidance behaviors and increased arousal. Re-experiencing symptoms include intrusive thoughts, nightmares and flashbacks of the traumatic event. Avoidance behaviors involve steering clear of anything that reminds them of the trauma, including thoughts, places and memories associated with what happened. Hyperarousal symptoms typically consist of becoming easily startled, a lack of concentration and frequent irritability.

2. The Role of Panic Attacks

  • To have a diagnosis of panic disorder, the person must experience recurrent and spontaneous panic attacks. Panic attacks are a feeling of intense fear without the presence of an actual danger. Panic attacks are often experienced with physical sensations, such as dizziness, nausea and trembling.

  • A person with PTSD can also experience the physical sensations of panic attacks, such as heart palpitations, shortness of breath and hot flashes. However, these attacks are brought on by the re-experiencing of the traumatic event through such outlets as dreams, thoughts and flashbacks. Hyperarousal symptoms present in PTSD, such as becoming panicked after hearing a loud noise, can also cause panic attacks.

3. Avoidance Behaviors

  • Having a panic attack can be a terrifying experience. People with panic disorder often become frightened just thinking about their next impending attack. This dread of future attacks can become so powerful that the person develops agoraphobia, a fear of having a panic attack from which it would be difficult or emarrassing to flee. The person will avoid places where they believe attacks will occur and create a safe zone, in which they limit their exposure to certain areas that they feel they will not have an attack.

  • People with PTSD display many avoidance symptoms. They often avoid places, activities, thoughts, conversations, people and other stimuli that remind them of the traumatic event. A person may even experience memory loss of the event. A person with PTSD may also become distant from others, limit activities, find it difficult to express a full range of feelings and lose hope about their future.

4. Treatment

Fortunately, there are many treatment options for panic disorder, including medication and psychotherapy. These forms of treatment can also effectively treat PTSD. There are several classes of medications that might  be used for symptom reduction. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants commonly prescribed to reduce anxiety, intensity of panic attacks and hyperarousal. Benzodiazepines are a type of anti-anxiety medication that is prescribed for its sedative effect.    

Cognitive behavioral therapy (CBT) is a common form of psychotherapy that can help to lessen the symptoms of either panic disorder or PTSD. For example, systematic desensitization is a CBT technique that entails therapist-guided gradual exposure to anxiety provoking situations. The person learns to manage his or her fear in these situations through relaxation techniques. By continually practicing gradual exposure and relaxation through therapy, certain stimuli that once triggered anxiety will eventually no longer cause extreme nervousness and fear in the person.   

Both panic disorder and PTSD have intense symptoms that can be successfully reduced through proper treatment. It is important to get treatment at the onset of either condition to decrease the odds that the disorder will get worse. For example, by treating the hyperarousal symptoms of PTSD, the development of panic attacks may be prevented. Additionally, the chances of becoming agoraphobic can be lowered by receiving help for panic disorder and attacks early on.  

Sources:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Cougle, Jesse R.;Feldner, Matthew T.;Keough, Meghan E.;Hawkins, Kirsten A.;Fitch, Kristin E. (2010). Comorbid panic attacks among individuals with posttraumatic stress disorder: Associations with traumatic event exposure history, symptoms, and impairment. Journal of Anxiety Disorders, 24 (2), 183-188.

Marshall-Berenz, E.C.; Vujanovic, A.A.; Zvolensky, M.J. (2011). Main and interactive effects of a nonclinical panic attack history and distress tolerance in relation to PTSD symptom severity. Journal of Anxiety Disorders, 2(2), 185-191.

Preston, John D., O'Neal, John H., Talaga, Mary C. (2010). Handbook of clinical psychopharmacology for therapists, 6th ed. Oakland, CA: New Harbinger Publications.

Silverman, Harold M. (2010). The pill book. 14th ed. New York, NY: Bantam Books.

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