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Panic Disorder in Teens


Panic disorder is an anxiety disorder that causes a person’s brain to suddenly go into fight-or-flight mode at any given moment, even though there’s no actual threat or danger.  The anxiety and fear experienced are very intense and perpetuate the fear of having future panics.  This can seriously disrupt the life of teens, often making them afraid to go to school or avoid participating in extracurricular activities and other events.  Additionally, panic disorder can elicit deep feelings of shame as it’s often misinterpreted as a sign of weakness.  In reality, panic disorder occurs when the brain’s normal ability to interpret signals from the environment isn’t working properly.

Most teens experience moments of nervousness or intense anxiety from time to time.  This can make it difficult to determine what’s normal and what’s not when it comes to your teen’s psychological health.  This brief guide is designed to help you recognize the signs and know the initial steps to take if you believe your teen has panic disorder.

Panic Disorder Statistics and Facts

Following are several statistics and facts pertaining to panic disorder:

  • As many as 98% of individuals with panic disorder have at least one other psychiatric disorder
  • Between 26% to 33% of individuals with panic disorder also have agoraphobia
  • Major depressive disorder affects between 50% to 65% of those suffering from panic disorder
  • Individuals with panic disorder have a greater risk for suicide attempts than the general population
  • 8% of teens has an anxiety disorder, and fewer than 1 in every 5 teens gets the mental health treatment he or she needs

Two Types of Panic Attacks

There are two types of panic attacks:

  • Unexpected – Also referred to as “uncued” panic attacks, these occur “out of the blue”; there’s no specific or identifiable trigger
  • Expected (situationally bound) – Also referred to as “cued” panic attacks, these are triggered when the individual is either exposed to or anticipates exposure to a specific trigger

Co-Occurring Disorders

Many individuals with panic disorder have at least one other co-occurring psychiatric disorder.  Some of the most common comorbid disorders include:

It should be noted that panic attacks can occur as part of another disorder, such as social anxiety disorder or post-traumatic stress disorder (PTSD), so an additional diagnosis of panic disorder may not always be warranted. 

Risk Factors

Following are several risk factors for the development of panic disorder in teens:

  • Family history of anxiety disorders or panic attacks
  • Having an overprotective or anxious parent
  • Having an anxious, avoidant, or passive personality
  • Already having an anxiety disorder or other mental health disorder
  • Experiencing or witnessing something traumatic
  • High stress
  • A recent major loss or transition

Looking for and Recognizing the Signs of Panic Disorder

Practically every teen experiences occasional bouts of anxiety.  Some may describe these bouts as an “anxiety attack” or say they “panicked” about something.  As a parent, it’s important to distinguish those normal bouts of anxiety from indicators of panic disorder.  Following is a list of some of the most common signs to look for:   

  • Having uncontrollable, unexpected, and sudden panic attacks – Symptoms of panic attacks include:
    • Fast, shallow breathing / shortness of breath
    • Pounding heart
    • Sense of danger or impending doom
    • Sweating
    • Choking sensation
    • Shaking or trembling
    • Intense fear that one is dying, losing control, and / or “going crazy”
    • Chest tightness or heaviness
    • Hot flashes or chills
    • The sense that nothing is real
    • Feeling as if you’re outside your body or in a dream
    • Dizziness or feeling faint
    • Numbness or tingling
    • Feeling detached
    • Stomach cramps
    • Nausea
    • Headache
  • Panic attacks occur in the absence of any actual danger or threat
  • Going to great lengths to avoid certain situations, things, or activities
  • Social withdrawal
  • Frequent worry about where and when their next panic attack will occur
  • Decline in school performance
  • Making excuses, such as feeling sick, to avoid activities
  • Refusal or reluctance to leave home
  • Drinking or using drugs (usually to cope)
  • Depression
  • Fatigue
  • Suicidal thoughts and behaviors*

*Suicidal thoughts and behaviors should never be ignored.  Don’t assume your teen is just being “dramatic” or manipulative.  The risk of suicide is higher for individuals suffering from panic disorder, and even higher if depression is also present.  Alcohol and drug abuse may also increase the risk of suicidal thoughts and behaviors.

Knowing the First Steps to Take  

If you have reason to believe your teen may be suffering from panic disorder, take the following initial steps: 

1Talk to your teen.  Expressing your concerns to your teen, without nagging or lecturing, is a crucial first step.  Let your teen know you’re worried and want to help in any way you can.  Your teen may be defensive, tell you everything is “fine” (even  though it’s not), or accuse you of worrying too much.  This may occur because your teen is embarrassed by the panic attacks, believing they’re a sign of weakness.  Regardless of your teen’s response, it’s important to stay calm and avoid judgment.

2 – Have your teen evaluated.  Your teen’s pediatrician or your family doctor can be a good place to start.  He or she can rule out any underlying medical issues that may be contributing to or exacerbating your teen’s anxiety symptoms, make an initial diagnosis, and give you a referral to a mental health professional for further evaluation.   

With adolescent psychiatric disorders, it’s really important that treatment occurs under the guidance of a qualified and experienced mental health professional.  Look for someone who works specifically with children and adolescents, and, if possible, a psychiatrist or psychologist who specializes in treating anxiety disorders. 

3 – Get your teen into treatment.  Panic disorder can significantly interfere with many aspects of your teen’s life.  It may get worse over time, so early intervention is important.   Treatment for panic disorder usually involves psychotherapy alone or a combination of psychotherapy and medication.  Medication is not recommended as the sole or primary treatment for panic disorder or other anxiety disorders. 

If your teen’s symptoms are (or become) debilitating, or if he or she has another serious psychiatric disorder as well, a brief but more intensive level of treatment may be necessary.   Treatment may include:

  • Individual psychotherapy or “talk therapy” – One of the most effective types of therapy for adolescents and adults with panic disorder is Cognitive Behavioral Therapy (CBT). Exposure and response prevention and cognitive restructuring are two elements of CBT that are especially beneficial for anxiety disorders.  CBT can help your teen learn to manage his or her thoughts and feelings that play a role in panic attacks and overall anxiety.  It also teaches effective coping skills for overcoming irrational fears.  
  • Medication – Medication may play an important role in the treatment of panic disorder. Keep in mind, all medications come with potential side effects and should always be used with caution in children and teens as their brains are still developing.  Work closely with a psychiatrist if medication is needed as part of your teen’s treatment. 

Currently, there are no FDA-approved medications for the treatment of panic disorder in teens.  However, medications that may be prescribed by your teen’s doctor include:

SSRIs (selective serotonin reuptake inhibitors – SSRIs, such as paroxetine (Paxil) and citalopram (Celexa), are antidepressant medications frequently prescribed for anxiety disorders.   SSRIs are the most commonly prescribed medications for treating adolescent panic disorder.

Benzodiazepines – Known as minor tranquilizers due to their sedating effect, benzodiazepines are sometimes used on a short-term basis for panic disorder. Lorazepam (Ativan) and alprazolam (Xanax) are two examples of medications in this category.  Extreme caution must be used with benzodiazepines because they can lead to dependence. 

  • Dual diagnosis treatment – This is usually necessary if your teen also has a substance use disorder – see more below
  • Residential treatment – See below
  • Hospitalization – See below

Supporting and Encouraging Your Teen

A major challenge for many parents is figuring out the best ways to support and encourage their teen who’s suffering from panic disorder.  Following are several tips:

  • Educate yourself about panic disorder.  This will help you have greater empathy for and understanding about what your teen is experiencing
  • Remember that panic attacks aren’t a sign of weakness or due to a character flaw
  • Be available and willing to listen to your teen
  • Don’t criticize, judge, or ridicule what your teen is experiencing.  It will likely seem baffling and irrational to you, but it’s genuinely distressing to your teen
  • Acknowledge and sincerely praise your teen’s accomplishments and progress, even if they seem very small or insignificant to you
  • Resist the temptation to rescue your teen from uncomfortable situations.  Despite good intentions, doing so will enable your teen and inadvertently reinforce your teen’s lack of self-confidence in his or her ability to cope
  • Pay attention to how you handle your own fears and anxiety.  Model appropriate coping skills for your teen.  If you’re suffering from an anxiety disorder, seek treatment for yourself as well
  • Strive to remain calm when your teen is feeling anxious.  If you become frustrated or anxious it will likely feed into the anxiety your teen is experiencing
  • Avoid nagging or lecturing your teen.  If you have concerns, talk to your teen in an open, honest, and respectful manner
  • Be flexible and allow a reasonable amount of extra time for situations that you know may be particularly distressing for your teen.  However, don’t accommodate your teen’s fears or treat him or her with kid gloves. Doing so will make your teen more dependent and anxious
  • Work with your teen’s therapist if you feel stuck or are uncertain regarding the best way to handle challenging situations.  A few family sessions may be helpful to make sure everyone is on the same page and working together to help your teen

What to Do When Things Escalate   

Adolescents with panic disorder have an increased risk of suicide, especially if they’re also suffering from depression, bipolar disorder, another anxiety disorder, or are abusing substances.  The occurrence of panic attacks may increase or become more severe if they’re under a lot of stress or have recently experienced a traumatic event.  Some teens with an anxiety disorder seek relief via self-destructive and potentially dangerous means, such as using alcohol or drugs or engaging in self-harm behaviors such as burning or cutting themselves.   

If your teen’s situation begins to escalate and his or her safety or wellbeing is at risk, don’t hesitate to reach out for help.  You can:

  • Contact your child’s treatment provider asap
  • Enlist the help of a close family member or friend for immediate support or assistance
  • Call an emergency mental health hotline
  • Take your child to the nearest hospital emergency room (if you can do so safely) 
  • Call 911   

When Individual Therapy isn’t Enough 

Many adolescents can learn to manage their panic disorder with individual therapy.  However, this isn’t always the case, especially if their symptoms are severe or if they’re also battling depression or another serious mental health issue.  If your teen:

  • Isn’t making progress in individual therapy or symptoms are getting worse
  • Has symptoms that are severe enough to hinder his or her ability to go to school or function in other areas of life
  • Is experiencing mania, severe depression, or other psychiatric symptoms that require a higher level of care
  • Is actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
  • Is abusing alcohol or drugs

then a more intensive level of treatment is probably necessary, such as:

  • Intensive outpatient treatment (IOP) / Psychiatric day treatment
  • Dual Diagnosis Treatment
  • Residential treatment
  • Inpatient psychiatric treatment

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go.  These programs are typically the next step up from regular outpatient treatment.

Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to panic disorder.  Alcohol or drug abuse will almost always hinder the effectiveness of individual therapy alone.  A dual diagnosis program allows for both disorders to be treated simultaneously. 

Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with anxiety disorders and other psychiatric disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.  

Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for adolescents with panic disorder.   In most cases, this level of treatment is used to treat severe depression, mania, psychosis, and / or high suicide risk in teens with panic disorder, rather than the panic disorder alone.  Patients are monitored 24/7.  Hospitalization is usually relatively brief.    

Taking Care of Yourself    

Having a teen with panic disorder is challenging and can be emotionally taxing at times.  Your attempts to help may seem futile, tapping into your own feelings of inadequacy as a parent.  To keep yourself grounded and emotionally available to support and encourage your teen, you need to take care of yourself as well.   Things you can do include:

  • Finding support for yourself, such as a local or online support group for parents of teens with mental health issues, reaching out to close friends and family, getting support from your church family
  • Setting aside time to relax or pamper yourself, even if it’s just a few minutes here and there throughout the week
  • Learning how to manage your stress in a healthy way (e.g. using the same relaxation techniques your teen is using). Yoga, regular exercise, and meditation are proven stress-reducers
  • Making sure you’re getting adequate amounts of restful sleep

Your teen’s healing journey may seem tedious at times, and it won’t be easy.  But your love, understanding, and support can play a very important role in his or her success. 

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