Dr. Arnold Shapiro is a board-certified psychiatrist with offices in Cincinnati, Ohio and Fort Wright, Kentucky, who has treated anxiety disorders in children, teens and adults for 35+ years. He evaluates panic attacks and panic disorder carefully, including checking for medical causes with your other doctors when needed, and builds a treatment plan with you that can include psychotherapy, medication management, or both.
What panic attacks and panic disorder are
A panic attack is a sudden surge of intense fear or discomfort that builds quickly and reaches its peak within minutes. It comes with strong physical symptoms, and it can feel completely out of proportion to anything happening around you. Many people have a panic attack once or twice in their lives, often during a stressful stretch, and never develop a disorder.
Panic disorder is diagnosed when panic attacks come back unexpectedly and the experience changes how you live. In DSM-5-TR terms, at least one of the attacks is followed by a month or more of persistent worry about having another, or about what the attack means, or by a significant change in behavior to avoid more attacks, such as steering clear of places or activities.
That fear of fear is a core feature. Many people with panic disorder are less afraid of the attack itself than of being caught in one at the wrong moment, in a car, at work, in a store or far from home.
How panic shows up, and how it can differ in younger people
Panic attacks are physical as much as emotional, which is why people so often end up in an emergency room the first time. The symptoms are real. They are produced by the body’s alarm system firing at full strength.
Panic disorder most often appears in the teen years or in adulthood, and is less common before the teen years. Younger children more often have other anxiety disorders, so a child who has frequent stomachaches, sudden meltdowns, or severe distress about separating is evaluated for the full range of possibilities. Teens may be reluctant to describe what is happening, may avoid school, driving or sports without saying why, or may be embarrassed by the symptoms.
What a panic attack can feel like
- A pounding or racing heart
- Shortness of breath, or a feeling of choking or smothering
- Chest pain or tightness
- Sweating, trembling or shaking
- Dizziness, lightheadedness or feeling faint
- Nausea or an upset stomach
- Numbness or tingling, or chills and hot flashes
- Feeling detached from yourself or the world around you
- A sense of losing control, “going crazy” or dying
Why a medical check matters, and what else it can be
Because panic can feel exactly like a heart or lung problem, it deserves a medical look the first time, especially if you have never had a medical workup for these symptoms. Chest pain, a racing heart, shortness of breath and dizziness all have medical causes that are not panic. Thyroid problems, heart rhythm problems, asthma, caffeine and other stimulants, alcohol or drug withdrawal, and some medications can produce similar symptoms, and Dr. Shapiro will work with your primary care physician or other doctors when a medical question needs answering.
If you have chest pain or symptoms that could be a heart attack, call 911. Do not assume it is anxiety, and do not wait to find out. Once the heart has been checked and you are told it is healthy, understanding what panic is can take much of its power away. The article on this site comparing a heart attack with a panic attack goes through the differences.
On the psychiatric side, panic disorder often travels with agoraphobia (fear of situations that feel hard to escape), other anxiety disorders, and depression. Panic-like episodes can also occur in PTSD and in social anxiety. A thorough evaluation sorts out which of these are present, because each calls for a slightly different plan.
How Dr. Shapiro evaluates panic disorder
The practice uses a thorough, team-based evaluation. For adults that includes a full hour with the practice’s therapist and a full hour with Dr. Shapiro. For children and teens it includes time with the parents, time with the young person, and a family meeting with Dr. Shapiro.
The attacks themselves
What happens in an attack, how often it comes, whether it arrives out of the blue or in particular situations, and what you have started avoiding because of it.
Medical and substance factors
Past heart, thyroid or breathing checks, medications, caffeine, alcohol and other substances. When something has not been checked, Dr. Shapiro coordinates with your other doctors.
Looking for everything, not just panic
Depression, other anxiety disorders, PTSD, OCD and substance use can overlap with panic or be mistaken for it. The evaluation looks for all of them.
A plan you help choose
Dr. Shapiro explains the diagnosis and the options in plain language, including the pros and cons of each, and you decide together what makes sense.
Treatment options for panic disorder
Panic disorder is treatable, and there is more than one way to get there. The main approaches are psychotherapy and medication, often used together.
Cognitive behavioral therapy (CBT) is a well-established, well-studied psychotherapy for panic disorder. It helps you understand what is happening in an attack, change the alarming interpretations that feed it, and gradually face the sensations and situations you have been avoiding. Dr. Shapiro works together with therapists, and the practice’s own therapist and Dr. Shapiro share one record so nothing is lost between visits.
Medication can reduce how often attacks occur and how intense they feel. The SSRI and SNRI classes of antidepressants are generally the first-line choices. Benzodiazepines work quickly and are sometimes used briefly, for example while an antidepressant starts working, but they carry risks of dependence and withdrawal, can interfere with the progress made in CBT, and are generally not a long-term answer. Antidepressants carry a warning that a small number of children, teens and young adults may have increased suicidal thoughts, especially in the first weeks or after a dose change, so close follow-up early in treatment is important.
Dr. Shapiro will explain the options, the side effects to watch for and what to expect, and he will adjust the plan if something is not working or if you are uncomfortable with it.
When to seek help
Consider an evaluation if you have had repeated panic attacks, if you are organizing your life around avoiding another one, or if the fear of an attack is keeping you from work, school, driving, travel or ordinary errands. A teenager who has started avoiding school or social events without a clear reason is also worth asking about.
If you have thoughts of harming yourself, call or text 988 at any time. If you have chest pain or other possible heart attack symptoms, call 911.
Common questions
How is a panic attack different from a heart attack?
They can feel very similar, which is why the first episode deserves a medical check. If you have chest pain or other symptoms that could be a heart attack, call 911 and let the emergency team sort it out. Once your heart has been checked and found healthy, a psychiatric evaluation can look at whether panic disorder explains the episodes.
Can panic disorder be treated without medication?
Yes. Cognitive behavioral therapy is a well-established treatment for panic disorder, and many people improve with therapy alone. Others do better with medication or a combination of the two. Dr. Shapiro will go over all of the options and will not push you toward one you are not comfortable with.
Do you treat teenagers who have panic attacks?
Yes. Dr. Shapiro treats children, teens and adults. Panic disorder most often begins in the teen years or adulthood, so teens are an important group. The evaluation for a young person includes time with the parents, time with the teen alone, and a family meeting.
I only have panic attacks sometimes. Do I need treatment?
A single attack, or a few during a stressful period, does not always mean panic disorder. It is worth an evaluation when attacks keep coming back, when you worry a great deal about the next one, or when you start avoiding places or activities. Getting help early can keep avoidance from growing.
What if I have already tried treatment for panic and it did not help enough?
That happens, and it is a reason to look again. An overlapping condition, a medication that was not the right fit, or therapy that did not target the avoidance can each be part of the picture. The treatment-resistant panic disorder page on this site explains how Dr. Shapiro approaches that situation.