Panic Attacks in Teens – A Guide for Parents

As human beings, our bodies have a natural, built in “fight-or-flight” response when danger is sensed.  The brain activates adrenaline in the body to trigger the response to either “fight” the danger or to escape (the “flight”).  Although this “fight-or-flight” response serves as a protective mechanism, it can also feel like panic.  Unfortunately, some experience this “fight-or-flight” response when there is no actual threat.  This means individuals experience panic attacks in the absence of any valid risk or danger.  When this occurs, it often indicates the presence of panic disorder.  Even though these panic attacks do not serve any real “survival” purpose, they can still cause significant distress.  And that distress doesn’t simply end when the actual attack does.  Teens who suffer from panic attacks often anticipate the next episode of panic, which can sustain worry and anxiety long after the panic attack is over.  The overall increase in anxiety almost always takes a significant toll on a person’s mental health, daily functioning, and overall well-being.

More than 3 million Americans will experience panic disorder in their lifetime, and in most cases, onset is in the adolescent or teenage years.

Types of Panic Attacks

Individuals with panic disorder may experience two different types of panic attacks:

• Unexpected (or uncued) – unexpected or uncued panic attacks are those that occur without causation. Essentially, unexpected panic attacks seem to occur “out of the blue.”
• Expected (or cued) – expected panic attacks, also referred to as “cued” panic attacks, are those that are situationally bound. This means the panic attack is triggered when the person either anticipates exposure to, or is actually exposed to a specific panic attack trigger.

Causes of Panic in Teens

Panic disorder is a condition marked by repeated, unpredictable panic attacks that can cause feelings of extreme fear, disconnection from reality, and even impending death.  Panic disorder is classified in the anxiety disorder family.  Panic disorder typically manifests in people somewhere between adolescence and early adulthood.  Although there is not one specific cause of panic disorder in teenagers, doctors and researchers suggest certain possibilities.

• Genetics – studies with identical twins have demonstrated the strong possibility of a genetic inheritance of panic disorder.
• Brain chemistry – a suggested (and well-supported) potential cause of panic disorder is linked to chemical imbalances in the brain. Research indicates individuals with panic attacks and panic disorder tend to have reduced levels of the neurotransmitters serotonin, dopamine, and norepinephrine (which are all associated with mood regulation and emotion regulation).  Additionally, when it comes to brain chemistry as a potential cause, there is a strong connection between those with an “overactive” amygdala (the part of the brain in control of the fight-or-flight response) and panic disorder.
• Environment – some studies point to environmental factors, including one’s upbringing and current levels of stress, as a potential cause of panic attacks in adolescents and teenagers.

Whether or not a teenager is pre-disposed to panic disorder due to genetics, stress, brain chemistry, or environment, there are some risk-factors that can increase one’s chances of developing panic disorder including:

• Being diagnosed with a mental health disorder – depression, anxiety, bipolar disorder
• Certain health problems – various respiratory problems (i.e. – asthma) put a teen at an increased risk of developing panic disorder or suffering from panic attacks.
• High levels of stress
• Experiencing a traumatic event
• Major loss or life transition        

Signs and Symptoms of Panic in Teens

The signs and symptoms of panic disorder in teenagers tend to look quite similar to those in adults.  There are many possible symptoms of panic disorder, manifesting physically, behaviorally, and mentally.

Physical symptoms

• Increased heart rate
• Feeling lightheaded or dizzy
• Sweating
• Shortness of breath
• Chest pain
• Choking sensation
• Headaches
• Nausea and/or vomiting
• Muscle tension and tightness
• Chills and/or hot flashes
• Trembling/shaking
• Numbness or tingling sensations
• Fatigue

Behavioral symptoms

• Changes in diet or sleep pattern
• Isolation from friends and/or family’
• Refusal to leave the home
• Lack of interest in previously enjoyed activities
• Inability to relax

Mental symptoms

• Excessive worry
• Feelings of hopeless and/or depression
• Fear of losing control
• Fear of dying
• Suicidal thoughts

For teenagers, symptoms of panic disorder may be anywhere from mild to severe.  They tend to arise quickly, and worsen with time.  For most teenagers, an actual panic attack will only last for a brief period of time.  Unfortunately, that panic attack can affect that teen for much longer even once it has ended.

Diagnosis of Panic Disorder in Teens

If an adolescent or teen is experiencing some of the symptoms of panic disorder, then getting evaluated by a mental health professional or healthcare provider may be the next step.  An evaluation (or assessment) will consider many aspects of the teen, including medical history, family history, behavior, current medications and/or drug and alcohol use, and symptoms.

The criteria for diagnosing a teenager with panic disorder is:

• Recurrent, unexpected panic attacks where four or more of the following symptoms occur:
• Pounding heart
• Sweating
• Trembling/shaking
• Shortness of breath
• Chest pain
• Feeling of choking
• Light-headedness
• Fear of losing control
• Fear of dying
• Chills
• Nausea
• Derealization or depersonalization
• At least one of the attacks has been followed by one month of one (or both) of the following:
• Ongoing worry/concern about having another panic attack
• Significant change in behavior (in an effort to avoid another panic attack)
• The disturbance is not better explained by another mental health disorder
• The disturbance is not attributable to the effects of a substance (drug or alcohol) or other medical condition

Treatment for Teens with Panic Disorder

Various treatment approaches and modalities may be recommended depending on the severity to which a teen’s life and daily functioning is being inhibited by panic attacks. Some common methods of treating panic include:

• Medication – selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are the most common medications prescribed to adolescents and teenagers who suffer from panic attacks and/or panic disorder. Research has shown SSRIs success in treating panic disorder in teens, but they do take anywhere from three to six weeks to start being effective. Benzodiazepines provide immediate, short-term relief of panic symptoms.  They are frequently prescribed “as needed” meaning the individual who is prescribed the medication can take it at his or her own discretion.  Unfortunately, benzodiazepines do have the potential to be habit-forming.  Typically, when medication is prescribed, it is in conjunction with the recommendation for psychotherapy.
• Cognitive-behavioral therapy (CBT) – cognitive behavioral therapy is a common approach used in psychotherapy, especially in regard to panic attacks and panic disorder. Cognitive behavioral therapy uses cognitive restructuring paired with exposure and response techniques.  This therapeutic approach can help a teenager become aware of, and begin to manage his or her thoughts that contribute to the panic experienced.  CBT also provides healthy coping skills and tools for dealing with irrational fears.
• Group therapy – group models of treatment for teens with anxiety and panic have been extensively studied. Group therapy is effective for a variety of reasons including peer-modeling opportunities, social support, and reinforcement of healthy behaviors and coping skills.
• Biofeedback – also called applied psychophysiological feedback, biofeedback uses electronic monitoring to assist the client in learning to control bodily functions, such as heart rate. The individual receiving the biofeedback is connected to electrical sensors, which provide the information (feedback) about the body (bio).  This process allows the person with panic to view his or her physiological responses to stress and fear.  With that awareness, he or she is then able to control responses and brain activity.  Biofeedback has been extensively researched in terms of treating anxiety disorders, and is a viable treatment option, especially for those who do not want to use medication.
• Stress Management skills – whether or not your teenager seeks professional intervention for his or her panic attacks, it is important to incorporate stress management skills that can be used independent of any other treatment. Coping skills such as deep breathing, muscle relaxation, and catching and challenging unhealthy thoughts are a few examples.

Panic attacks and panic disorder are treatable.  If you think your teenager might be struggling with excessive fear, worry or panic, contact Polaris Teen Center at (844) 836-0222 to find out more about residential treatment options.

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