By: Khomotso Fredah Matlala

What is panic disorder?
Panic disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks that are characterized by sudden episodes of intense fear or discomfort that occur without a clear external trigger and are not caused by another medical or mental health condition (Cleveland Clinic, 2023). These attacks typically last for about 5 to 20 minutes, they can be longer in some individuals (Cleveland Clinic, 2023). Individuals with panic disorder often experience persistent concern about future attacks, accompanied by significant changes in behavior to avoid potential triggers. Panic attacks are typically accompanied by physical symptoms such as chest pain, shortness of breath, dizziness, or a racing heart, which can make them particularly distressing. Over time, the unpredictability of these episodes may lead to anticipatory anxiety and avoidance behaviors, significantly impacting daily functioning and overall quality of life. Without appropriate diagnosis and treatment, panic disorder can escalate, resulting in social withdrawal and long-term emotional and physical consequences (Cleveland Clinic, 2023).
SYMPTOMS AND CAUSES
People with panic disorder experience sudden panic attacks that can strike at any time. These attacks can be debilitating and significantly impact their quality of life (Mayo Clinic, 2019). During the attack, individuals may experience five or more of the following symptoms:
- Sweating
- Trembling or shaking
- Unsteadiness, feeling dizzy
- Depersonalization (being detached from oneself) or derealization (feelings of unreality)
- Heart palpitations, accelerated heart rate, pounding heart.
- Nausea or abdominal distress
- Tingling sensation
- Shortness of breath
- Fear of dying
- Fear of losing control
- Fear of going crazy
Despite the lack of danger, the symptoms can feel life-threatening, causing individuals to fear future episodes and, in some cases, avoid situations they associate with previous attacks (Cleveland Clinic, 2023).
Signs of panic disorder may include:
- Sudden and repeated panic attacks without an apparent cause
- Persistent fear of having another attack
- Avoidance of places or activities where attacks have occurred
- Physical symptoms such as a pounding heart, trembling, or difficulty breathing
- Feelings of detachment from reality during an attack
CAUSES
The exact cause of panic disorder remains unclear. However, believed that it may arise from the integration of genetic, biological, and psychological factors (Cleveland Clinic, 2023). According to researchers’ individuals with a family history of anxiety disorders, heightened sensitivity to stress, imbalances in brain chemistry, and those who have experienced adverse childhood traumatic events are more prone to developing this disorder (Cleveland Clinic, 2023). The neurological and neurobiological causes of panic disorder involve abnormalities in the brain structure, function, and chemistry that may contribute to heightened sensitivity to stress and fear responses. Key areas of the brain and mechanisms implicated in panic disorder include Amygdala dysregulation wherein the amygdala becomes hyperactive in individuals with panic disorder (Cleveland Clinic, 2023). This heightened activity can amplify the body’s fight-or-flight response, even in the absence of actual danger, leading to panic attacks. Dysregulation of key neurotransmitters such as Serotonin, Gamma-aminobutyric acid (GABA), and Norepinephrine increases the susceptibility to anxiety
The exact cause of panic disorder remains unclear. However, it is believed to result from an integration of genetic, biological, and psychological factors. Researchers suggest that individuals with a family history of anxiety disorders, heightened sensitivity to stress, imbalances in brain chemistry, or a history of adverse childhood experiences are more prone to developing this condition (Cleveland Clinic, 2023).
The neurological and neurobiological causes of panic disorder involve abnormalities in brain structure, function, and chemistry that contribute to an increased sensitivity to stress and fear responses. Key areas of the brain implicated in panic disorder include the amygdala, which becomes hyperactive in affected individuals. This heightened activity amplifies the body’s fight-or-flight response, even in the absence of actual danger, triggering panic attacks(Cleveland Clinic, 2023).
Additionally, dysregulation of key neurotransmitters plays a significant role. Reduced serotonin levels impair mood regulation, low gamma-aminobutyric acid (GABA) activity limits the nervous system’s ability to calm itself, and excessive norepinephrine activity intensifies physical symptoms of anxiety. These factors, combined with environmental and psychological influences, contribute to the complexity of panic disorder (Cleveland Clinic, 2023).
PANIC DISORDER AND EPILEPSY
Epilepsy and anxiety disorders, including panic disorder, are closely linked. Studies have consistently shown that individuals with epilepsy are eight times more likely to experience psychiatric comorbidities such as anxiety and depression (Jhaveri et al.,2023, p.2). Thus, they often experience anxiety, and some may also develop panic disorder. There are several reasons why being epileptic can cause anxiety. One major reason is the stress and unpredictability that comes with living with epilepsy (Epilepsy Action, 2025).
A specific type of anxiety known as peri–ictal anxiety is experienced by some people with epilepsy. This type of anxiety occurs in relation to seizures specifically during the pre-ictal (before), ictal (during), or post-ictal (after) phases. Peri-ictal anxiety which occurs before a seizure can manifest as an aura which is like a warning that a seizure is about to happen. This type of anxiety is connected to the seizure itself and can make it harder to tell the difference between panic attacks and epilepsy. Thus, it is important to be able to know whether someone is having panic attacks, seizures, or both because the treatments are different (Epilepsy Action, 2025).
Additionally, numerous studies have shown that panic attacks and seizures can be mistaken for each other, as they share similar symptoms such as increased heartbeat, dizziness, and difficulty breathing. These overlapping symptoms can lead to confusion and, at times, misdiagnosis. Recognizing the unique characteristics of each condition and seeking proper medical evaluation is key to ensuring accurate diagnosis and effective treatment.
DIAGNOSES AND TREATMENT
Since panic disorder and epilepsy have overlapping symptoms is it important for medical professionals to conduct a comprehensive evaluation. This is to ensure that patients are being treated for the accurate disorder. For epilepsy, a detailed medical history, physical exams, and brain imaging are usually used for proper epilepsy diagnosis (Mayo Clinic, 2023). This includes several tests such as neurological exams when an individual’s behavior, movement, and mental function are assessed to check the type of epilepsy one might be having. An electroencephalogram (EEG), is a brain test used to detect any abnormal brain activity/ changes. Other tests may include CT (computerized tomography) or MRI (magnetic resonance imaging) scans which are used to identify the causes of epilepsy (Mayo Clinic, 2023).
Panic disorder, on the other hand, is diagnosed through a detailed physical and psychological evaluation. This includes a physical examination, medical history, and laboratory test to rule out other medical conditions as well as a psychological assessment with a focus on the individual’s symptoms, stressors, and family history. The thorough approach used ensures that a proper and accurate diagnosis is made (Mayo Clinic, 2018).
Treatment for Panic disorder usually involves psychotherapy, medication, or a combination of both. The psychotherapeutic approach includes cognitive-behavioral therapy (CBT) (NIMH, 2022). This treatment involves teaching the patient different ways of thinking, behaving, and reacting to feelings that occur during or before a panic attack (NIMH, 2022). This helps individuals understand and manage their panic attacks. Medications to treat panic disorder such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be prescribed to help manage symptoms. (NIMH, 2022) Some medications such as benzodiazepines are sometimes used for short-term relief due to the risk of dependence.
Conclusion
Although panic disorder and epilepsy are distinct, they share overlapping symptoms that can complicate diagnosis and treatment. Anxiety disorders such as panic disorder are quite common among individuals with epilepsy, and they can impact seizure control and overall quality of life for individuals with epilepsy. Thus, it is important for medical professionals to make accurate diagnoses and effective management is essential to address these complexities.
References
Cleveland Clinic. (2023). Panic disorder: Causes, symptoms, and treatment. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/4451-panic-attack-panic-disorder
Epilepsy Action. (2025). Anxiety and epilepsy. Epilepsy Action. Retrieved from https://www.epilepsy.org.uk/living/epilepsy-and-wellbeing/anxiety-and-epilepsy
Jhaveri, D. J., McGonigal, A., Becker, C., Benoliel, J.-J., Nandam, L. S., Soncin, L., Kotwas, I., Bernard, C., & Bartolomei, F. (2023). Stress and epilepsy: Towards understanding of neurobiological mechanisms for better management. eNeuro, 10(11), ENEURO.0200-23.2023. https://doi.org/10.1523/ENEURO.0200-23.2023
Mayo Clinic. (2019). Panic attacks and panic disorder. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021
Mayo Clinic. (2023). Epilepsy: Diagnosis and treatment. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/drc-20350095
National Institute of Mental Health (NIMH). (2022). Panic disorder: When fear overwhelms. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms