Panic attack


A panic attack is a sudden feeling of anguish accompanied by intense disturbances, such as feeling of suffocation, heart palpitations, or fear of dying.

It is often the case that the panic attack is accompanied by comorbidity in the elderly person who avoids traveling (for example by metro) for fear of having a panic attack.

Panic disorder is actually a set of symptoms present across a wide spectrum of various conditions, including panic disorder, but also other anxiety disorders (e.g. agoraphobia, post-traumatic stress) and psychological disorders.


The definition of a panic attack is that it is the sudden appearance, and during a well-defined period (rarely more than 30 minutes) of apprehension, fear, or intense discomfort, presenting at least four of the following somatic or cognitive symptoms. 
1. Palpitations, pounding, or racing heartbeat 
2. Sweating 
3. Shaking or twitching 
4. Feelings of “gasping” or choking 
5. Feeling of choking 
6. Chest pain or discomfort 
7. Nausea or abdominal discomfort 
8. Feeling dizzy, unsteady, light-headed, or fainting 
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 
10. Fear of losing control or going crazy 
11. Fear of dying 
12. Numbness or tingling sensations (paraesthesia) 
13. Chills or hot flushes

The feeling of vertigo is particularly symptomatic in the elderly, as well as the clammy hands, the feeling of suffocation, the muscle twitches, the feeling of unreality of the environment.

Agoraphobia is a trait little reported in elderly people who panic, probably because they avoid public places for various reasons (lack of interest, fatigue)

The panic attack may mask the presence of other illnesses or environmental factors, such as untreated high blood pressure, tachycardia, untreated angina pectoris, respiratory failure, or a social environment perceived as anxiety-provoking.

If generalized anxiety is the predominant anxiety disorder in the elderly – between 5% and 15% would suffer from it – then the excessive consumption of anxiolytics at an advanced age is probably linked to the panic attack.

When panic attacks are recurrent and unexpected, it is called panic disorder.


Epidemiological studies place the prevalence of panic attack panic disorder at between 3 and 6%. Although women are three times more likely to develop panic disorder, this disorder is probably underestimated in men.

Panic disorder is rarer in people aged 65 and over, with a prevalence of 0.2%. This percentage rises to approximately 10% in hospitalized elderly subjects. panic attacks can appear in an elderly subject with no previous history.

Panic attacks can appear in an elderly subject with no previous history. However, the frequency of late panic attacks are rather rare.

However, these figures should be taken with caution due to the lack of more comprehensive studies carried out in the older age groups of the population. In addition, the elderly tend to underestimate or avoid complaining about this kind of disorder, and only a directive questioning can find signs evoking panic.

Panic disorder was considered rare after age 65. However,   the presence of certain  comorbidities underestimates the true frequency. Significant co-morbidities include obstructive lung damage, cardiovascular disease, chronic vertigo, and parkinsonian manifestations. Panic disorder in the elderly is most often associated with other psychiatric disorders such as social phobia and depression. However, a history of depression is not more common in people who panic. Treatment with an antidepressant is also necessary.

Panic attacks and falls

Falls and being on the ground for more than an hour are more frequent events in people who panic. They also have more gait and balance problems, which makes them more prone to panic. This panic can in turn make him insecure and hamper walking.

Panic Attack Diagnosis

According to the DSM-IV (American manual for the diagnosis of mental disorders), panic disorder is defined by two criteria:

It requires both: 
1. recurrent and unexpected panic attacks AND 
2. that at least one of the attacks is accompanied by at least one of the following symptoms: 
– the persistent fear of having other attacks of panic; 
– Concerns about the possible consequences of the attack or its consequences (for example, losing control, having a heart attack, or going crazy) 
– a significant change in behavior in relation to attacks.

These are the precise criteria for “panic disorder”.

But to make a diagnosis, it should be verified that the panic attacks: 
– are not due to the direct physiological effects of a substance (e.g., medication, substance abuse or withdrawal…) or a medical condition (e.g. hyperthyroidism); 
– are not related to another mental disorder such as social phobia, specific phobia, obsessive-compulsive disorder (e.g. an individual with an obsession with contamination exposed to dirt), post-traumatic stress disorder (in response to stimuli associated with severe stress) or separation anxiety disorder (e.g. in response to being away from home or loved ones.

Finally, it should be noted that panic attacks may or may not be associated with agoraphobia.

The question of the frequency of attacks

There are discrepancies regarding seizure frequency as a diagnostic criterion.

The DSM-IV sticks to the criteria defined above and does not set a minimum frequency and simply requires that at least one panic attack has been followed (within the month) by the fear of a new attack.

Cooperative Research and Development (RDC) estimates that it takes six panic attacks in six weeks to make a diagnosis of panic disorder.

The ICD-10 (International Classification of Diseases, 2006) establishes three panic attacks in three weeks as the diagnostic threshold for a moderate intensity disorder, and four episodes in four weeks as the threshold for a diagnosis of a severe disorder.

Panic attack and heart attack: how to tell the difference

Symptoms of a panic attack and a heart attack can be very similar, making it difficult to tell the difference.

A heart attack can also cause panic, which can make the situation more confusing. 

Knowing the difference between a panic attack and a heart attack can be difficult, especially if a person has never experienced the symptoms of either before.

A person can distinguish between the two conditions by weighing several factors, including:

Characteristics of pain

Although chest pain is common to both a panic attack and a heart attack, the characteristics of the pain often differ.

During a panic attack, chest pain is usually sharp or stabbing and localized in the middle of the chest.

Chest pain from a heart attack may feel like pressure or a squeezing sensation.

Chest pain that occurs due to a heart attack can also start in the center of the chest, but can then radiate from the chest to the arm, jaw, or shoulder blades.


The onset of symptoms can also help a person determine if they are having a panic attack or a heart attack.

Although both conditions can develop suddenly and without warning, some heart attacks occur due to physical exertion, such as climbing stairs.


Most panic attacks are over within minutes, although they can last longer.

During a heart attack, the symptoms tend to last longer and get worse over time. For example, chest pain may be mild at the start of a heart attack but become severe after several minutes.

Can a panic attack cause a heart attack?

A panic attack will not cause a heart attack. A blockage in one or more of the heart’s blood vessels, which results in an interruption of vital blood flow, causes a heart attack.

Although a panic attack does not cause a heart attack, stress and anxiety can play a role in the development of coronary heart disease.

Panic attacks can occur as isolated events or as part of an anxiety disorder.

Some research indicates that people with anxiety disorders may have an increased risk of developing  heart disease  due to low heart rate variability.

High heart rate variability indicates that a person’s heart rate is effectively changing throughout the day, depending on what they are doing. It is also a sign that their autonomic nervous system is working well.

A low heart rate variability means that a person’s heart does not change gears as efficiently. Some studies link low heart rate variability to an increased risk of heart disease.

Analyzing studies conducted in people diagnosed with various types of anxiety disorder, including panic disorder, results indicated that participants had lower heart rate variability than those without an anxiety disorder.

It is essential to understand that a panic attack does not mean that someone will have a heart attack. A person with panic disorder may experience repeated panic attacks, but more research is needed to determine whether panic disorder increases the risk of developing heart disease.