With panic disorder, at least four of the following symptoms abrubtly occur within 10 minutes, and one or more attacks are followed by at least a month of persistent fear of having another attack.

• Sensation of shortness of breath or smothering
• Dizziness or faintness
• Palpitations or pounding heart
• Trembling or shaking
• Sweating, chills, or hot flashes
• Feeling of choking
• Nausea or upset stomach
• Numbness or tingling
• Chest pain or discomfort
• Fear of dying
• Fear of losing control
• Feelings of unreality
• Feeling detached from yourself

There are often extreme changes in behavior (at home, school, work, with family, etc.). Ppeople with the disorder often worry about the significance of their panic attacks -- they may think they are going crazy or having a heart attack.

The health care provider will perform a physical examination, including blood tests and a psychiatric evaluation. Underlying medical disorders need to be ruled out before the diagnosis of panic disorder can be made.

Disorders related to substance abuse also need to be considered, because some can mimic panic attacks. Substance abuse may result when people with panic attacks attempt to self-medicate to reduce their fear.

Cardiovascular, endocrine, respiratory, and neurologic disorders may be suspected and can coexist with panic disorders. Specific diagnostic tests performed will vary and will be based on the symptoms.

Many people with panic disorder first go to the emergency room because they feel like they are having a heart attack.