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All About Panic Disorder and Phobias

Feb 15, 2023

All About Panic Disorder and Phobias

Panic disorders and phobias are considered important topics in Psychiatry for the NEET PG exam as these are among the most common mental health conditions, affecting a large number of individuals. Panic disorder and phobias can significantly impair an individual's quality of life, leading to social isolation, decreased work performance, and decreased overall functioning. A good understanding of these conditions can help medical professionals to diagnose and treat these conditions effectively.

Read this blog to get a quick overview of this important Psychiatry topic for NEET PG exam preparation.

ENT Residency

Panic Attack

Panic attack is an acute attack of intense anxiety, with a ‘feeling of impending doom.’

Diagnosis of panic disorder: recurrent and unexpected panic attacks. 

Important information 

  • Expected panic attack
    • E.g. When you are in the examination hall, you are asked question s of higher level, you will have an unexpected panic attack.
  • In panic disorder, the patient will have unexpected panic attacks

Usual symptoms

  • Sudden chest pain
  • Difficulty in breathing
  • Hyperventilation
  • Sweating

Differential Diagnosis of Panic disorders

  • Cardiac causes: MI, angina, cardiac arrhythmias, MVP
  • Respiratory causes: Acute asthma, COPD, PE
  • Endocrine disorders: Pheochromocytoma, carcinoid syndrome, hyperthyroidism, hypoglycemia, anemia, temporal lobe epilepsy.


  • Benzodiazepines (Immediate treatment in acute episode): Short term 
  • SSRIs: Long term 
  • Cognitive behavioral therapy (CBT)


  • Fear of places from which escape is difficult (from where it is difficult to run out)
    • Fear of open spaces 
    • Fear of crowded places 
    • Fear of enclosed places
    • Fear of traveling alone (Patient gradually becomes homebound)
    • Fear of public transport

Important Information

  • Anticipatory Anxiety
    • Person is anxious that the next panic attack is just about to happen (feared to occur out of the blue)
    • Person starts avoiding situations where he/she may have a panic attack
    • Many patients with panic disorder later develop Agoraphobia

Important Information

  • Agoraphobia and panic disorder are usually comorbid and coexist together
  • But agoraphobia can happen without panic disorder too


  • Benzodiazepines: Short term
  • SSRIs: Long term
  • Behavioral therapy

Important Information

  • For treating phobias
    • Behavioral therapy > Cognitive behavioral therapy



  • Irrational Fear of an object or a situation


  • Acrophobia: Fear of heights
  • Thanatophobia: Fear of death
  • Claustrophobia: Fear of enclosed spaces
  • Nyctophobia: Fear of dark


  • Benzodiazepines: Short term
  • SSRIs: Long term
  • Behavioral therapy
    • Systematic desensitization: There is a stepwise exposure with the use of relaxation techniques like deep breathing and progressive muscle relaxation which have a calming impact.
      • Purpose: The patient will be exposed to a feared stimulus, increased in a stepwise manner while he is relaxing using one of the techniques.
      • E.g. The patient is afraid of rats
      • Step 1: Show the picture of a rat while he is doing deep breathing or muscle relaxation (No anxiety)
      • Step 2: Show him a video of a rat, along with relaxation techniques (not much anxiety)
      • Step 3: Show him a rate from a distance along with relaxation techniques
      • Step 4: Bring the rat nearby
      • Step 5: Bring the rat right up to the person
    • Therapeutic graded exposure: There is a stepwise exposure without using relaxation techniques
      • Step 1: Show the picture of a rat without using any relaxation techniques. Wait for the anxiety to come down on its own and then move to the next step.
      • Step 2, 3, 4 & 5 follow similarly without the use of relaxing techniques
      • Usually this is used in clinical practices
    • Flooding: In this maximal exposure is given in one go
      • E.g. Send the patient to a room full of rats and lock the door from outside
      • Patient will become anxious, and will start crying and shouting. But his anxiety will come down after sometime
      • This is not a preferred technique: Person may have a panic attack or even worse may happen (like Myocardial Infarction)
    • Participant modeling: Here the learning happens by observation
      • Therapist acts as a model
      • Therapist goes nearby a rat and stands close to it
      • The patient observes the therapist and learns that the rat is not dangerous

Important Information

  • Anxiety develops and goes up initially, but it has to come down after sometime on its own.

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