 Panic Disorder and Your Health: Why We Always Recommend a Medical CheckupIf you have been experiencing panic attacks, you are likely already familiar with just how physical they feel. Your heart races. Your chest tightens. You feel short of breath, dizzy, or like your hands and feet have gone numb. A wave of fear washes over you that can be genuinely terrifying. And then, often just as suddenly as it started, it passes.
Panic attacks are real, they are intensely physical, but they are not dangerous. For the vast majority of people who experience them, there is no underlying medical condition driving the symptoms. But as part of responsible, thorough care, we always recommend that clients have a medical evaluation alongside their mental health treatment. Not because we expect to find something wrong, but because ruling out medical contributors is simply good clinical practice and because in most cases it provides meaningful reassurance that your body is healthy and allows you to move forward with treatment with confidence. This blog is meant to be informational and educational, not a substitute for medical advice. If you are experiencing symptoms that concern you, please reach out to your doctor. What Panic Attacks Feel Like According to the DSM-5, a panic attack is a sudden surge of intense fear or discomfort that peaks within minutes and includes at least four of the following: a racing or pounding heart, sweating, trembling or shaking, shortness of breath or a feeling of being smothered, chest pain or discomfort, nausea or stomach distress, dizziness or lightheadedness, chills or hot flashes, numbness or tingling sensations, a sense of unreality or feeling detached from yourself, fear of losing control, and fear of dying. That is a striking list of symptoms, and you can immediately see why panic attacks feel so alarming in the moment. These same symptoms can occasionally have a medical origin, which is one of the reasons a medical evaluation is a meaningful part of the process and important to rule out. In most cases, that evaluation comes back normal and simply confirms what was already suspected. Occasionally it identifies something that needs its own attention. Either way, having that information is valuable. To learn more about Panic Disorder, click here. Why a Medical Evaluation Is Part of Good Care Responsible mental health care includes ruling out medical contributors before or alongside a mental health diagnosis. This is not unique to panic disorder. It is simply good clinical practice. A thorough evaluation by your primary care physician typically includes a physical exam, routine blood work, and a review of your symptoms and their patterns over time. In many cases, everything comes back normal and the picture becomes much clearer. In some cases, a medical condition is identified that needs its own treatment, or that helps explain part of what you have been experiencing. The relationship between physical health and anxiety is genuinely complex. Medical conditions can trigger anxiety and panic. Anxiety can worsen physical symptoms. And both can exist at the same time. Having a medical provider and a mental health provider working in coordination is often the most effective approach. Medical Conditions Worth Discussing With Your Doctor The following conditions are among those that clinicians typically consider when evaluating someone with panic-like symptoms. This list is not meant to send you down a rabbit hole of worry. It is simply meant to help you understand what your doctor may be looking for and why that conversation is worthwhile. Thyroid Conditions The thyroid gland helps regulate heart rate, metabolism, and energy. When it becomes overactive, a condition called hyperthyroidism, it can produce a racing heart, sweating, trembling, heat intolerance, and a persistent sense of being keyed up that can look a great deal like anxiety or panic. The good news is that thyroid function is easy to check with a routine blood test, and treatment is straightforward when a thyroid condition is identified. Heart Rhythm Irregularities Certain irregularities in heart rhythm can produce sudden episodes of a pounding or racing heart, chest discomfort, and lightheadedness, symptoms that are also among the most common features of panic attacks. An EKG or other cardiac evaluation can help a physician assess whether a heart rhythm issue may be contributing to what you are experiencing. This is one of the most common reasons people end up in the emergency room during a first panic attack, and having a cardiac evaluation can provide meaningful reassurance as well as ruling out a medical contributor. Blood Sugar Fluctuations Low blood sugar, known as hypoglycemia, can produce a sudden onset of heart pounding, sweating, shakiness, dizziness, and a sense that something is wrong, symptoms that overlap considerably with panic. This is particularly worth discussing with your doctor if your symptoms tend to occur when you have not eaten in a while, or if you have any history of diabetes or blood sugar regulation concerns. Autonomic Nervous System Conditions Postural Orthostatic Tachycardia Syndrome, more commonly known as POTS, is a condition in which the heart rate spikes significantly when moving from lying down to standing up. This can produce dizziness, a racing heart, lightheadedness, brain fog, and fatigue that can resemble panic. A notable feature of POTS is that symptoms tend to be triggered by or worsen with positional changes and may improve when lying down, a pattern that differs from typical panic. POTS is often underdiagnosed, and many people with POTS have been told their symptoms are anxiety-related before a correct diagnosis is made. If your symptoms consistently relate to changes in position or standing up, it is worth mentioning this to your doctor. Vestibular and Inner Ear Conditions The vestibular system governs balance and spatial orientation. When it is not functioning as it should, it can produce dizziness, vertigo, a sense of unsteadiness, and nausea that can be quite frightening and can overlap with panic symptoms. Some vestibular conditions involve structural problems in the inner ear itself. These include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease, all of which are considered peripheral vestibular disorders and are typically evaluated by an ear, nose, and throat specialist or vestibular specialist. Persistent Postural-Perceptual Dizziness, known as PPPD, is a different kind of vestibular condition and worth knowing about separately. Rather than involving a structural problem in the inner ear, PPPD is classified as a chronic functional vestibular disorder, meaning it involves the way the brain processes balance and spatial information rather than a problem with the ear itself. PPPD produces chronic dizziness, unsteadiness, and a sense of non-spinning vertigo that persists on most days and is worsened by upright posture, movement, and visually complex environments. It frequently develops following an acute vestibular event, a medical illness, or a period of significant psychological stress, and anxiety is closely intertwined with its development and maintenance. Because of this, PPPD can closely resemble or co-occur with panic disorder, and the two can reinforce one another in a cycle that can be difficult to untangle without proper evaluation. Treatment for PPPD typically involves vestibular rehabilitation, medication, and cognitive behavioral therapy, making collaboration between medical and mental health providers especially valuable. Respiratory Conditions Difficulty breathing is one of the most distressing symptoms of a panic attack, and it is also a feature of several respiratory conditions including asthma. The relationship between respiratory conditions and anxiety is well established and genuinely bidirectional -- each can worsen the other. If you experience episodes of shortness of breath, chest tightness, or a feeling of being unable to get a full breath, it is worth discussing with your doctor whether a respiratory evaluation makes sense. A Note on Less Common Conditions There are some less common conditions that clinicians may also consider in certain presentations, including neurological conditions and adrenal conditions such as Addison's disease, in which insufficient production of cortisol can produce episodes of fatigue, dizziness, and feeling acutely unwell that may resemble anxiety or panic. Your doctor is the right person to determine which evaluations are appropriate for your specific situation. The goal is not to work through an exhaustive checklist of everything that could possibly be wrong. The goal is a thoughtful, individualized evaluation that helps paint a clear and complete picture. What This Means for You If you have been experiencing panic attacks, seeing your primary care physician is a meaningful first step alongside pursuing mental health support. Share your symptoms openly, describe when they happen and how long they last, and ask whether any medical evaluation is warranted. In most cases, a medical workup provides reassurance that your body is physically healthy and helps you move forward with treatment with more confidence and clarity. Panic disorder is highly treatable. The research on Cognitive Behavioral Therapy and Panic Control Treatment is robust and genuinely encouraging, and most people who engage in evidence-based treatment see significant improvement. Getting there starts with making sure you have an accurate, complete picture of what is going on -- and that is something your medical provider and mental health provider can work on together. If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Tunnell, N. C., Corner, S. E., Roque, A. D., Kroll, J. L., Ritz, T., & Meuret, A. E. (2024). Biobehavioral approach to distinguishing panic symptoms from medical illness. Frontiers in Psychiatry, 15, 1296569. https://doi.org/10.3389/fpsyt.2024.1296569 Comments are closed.
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