What Are The Differences Between Post-Traumatic Stress Disorder And Panic Disorder?

Post-traumatic stress disorder and panic disorder both cause extreme anxiety and have a tremendous negative impact on sufferers' quality of life. A deeper look reveals that the two have many more similarities — both they're ultimately two different disorders, with different symptoms and different causes. 

What are the similarities between panic disorder and PTSD?

Panic disorder causes sudden and uncontrollable episodes of extreme fear and panic — panic attacks. PTSD can also lead to intense episodes of fear and panic, triggered by a reminder of the trauma, such as a flashback, or by a startling stimulus in the environment. 

People with panic disorder suffer from repeated panic attacks, in which they're overcome with physical symptoms that match their state of acute fear. These include excessive sweating, a pounding heart, a feeling of choking, nausea, a tingling sensation, and shaking or trembling. PTSD can likewise induce these physical reactions when a person is faced with something that reminds them of the trauma they experienced. The diagnostic and statistical manual of mental disorders (DSM-5) doesn't go into a lot of detail about this, but it's in the intrusion part of the diagnostic criteria as "marked physiological reactions" when reminded of the trauma.

Panic disorder can cause dissociative symptoms. Depersonalization represents a feeling of "not really being there" or "watching it happen to someone else". Derealization is a feeling that reality isn't truly "real"; it can make people feel like the world is a fog, dream-like, or passing them by as if they're on a moving train and looking out the window. The dissociative subtype of post-traumatic stress disorder features these same symptoms. 

People with PTSD can go to great length to avoid reminders of the trauma they went through, whether it's by trying to numb their own thoughts and feelings, or staying away from people, places, or circumstances that might trigger intrusive memories. People with panic disorder, too, may put great effort into avoiding situations — this time because they're scared of having another panic attack, perhaps because they've had panic attacks in a similar situation before. 

What's different about panic disorder and PTSD?

Let's tackle the most obvious difference first — while post-traumatic stress disorder is, by definition, the result of one or more traumatic events, panic disorder can affect people who haven't lived through trauma, and seems to have a strong genetic basis. 

Panic disorder is characterized by repeated panic attacks. Although research has found panic attacks to be common in PTSD sufferers, they are not a diagnostic requirement or indeed even listed as one of the possible symptoms of PTSD. Instead, panic-like symptonms that are part of PTSD are a direct result of being triggered, reminded of the trauma in some way.

PTSD also comes with many possibkle symptoms that aren't seen in panic disorder — from flashbacks and intrusive memories to trauma-related nightmares, to being unable to remember important aspects of the trauma, to trauma-induced guilt, hopelessness, or shame. People with PTSD are often hypervigilant, on the lookout for new threats, and may be quick to startle. They may have trouble concetrating, sleeping, feeling positive emotions, trusting others or themselves, and have angry outbursts. None of these symptoms are anywhere on the diagnostic list for panic disorder, though people with panic disorder may experience some of them. 

Can someone with PTSD also suffer from panic disorder?

Popular belief holds that any panic attacks someone with PTSD may have are triggered by a reminder of the trauma, like a flashback, or a sudden stimulus that activates their startle response. Not that much research has been done into the role of panic in PTSD, but one study found that 30 percent of PTSD sufferers who have panic attacks experience spontaneous, unprompted, panic attacks alongside those triggered by a reminder of the trauma. 

The reason may be that chronic hyperarousal — that notorious state of "always being on guard" and ready for new threats so common in trauma survivors — makes people more susceptible to panic. It's also possible that panic itself can act as a reminder of trauma, since over half of people with PTSD are suggested to have experienced panic during the traumatic events they lived through.

It is also, of course, possible for someone who already had panic disorder to subsequently suffer a trauma and develop PTSD. 

In short, yes, a person can have both PTSD and panic disorder at the same time, something that can significantly complicate treatment and make exposure-based therapy a poor choice. 

How are panic disorder and PTSD treated? 

Cognitive behavioral therapy and antidepressants are both used to treat both disorders. Other treatments and medications are specific to each disorder. Talk therapy should always be tailored to the needs of the person in therapy, so it's most effective to let your therapist know exactly what kinds of symptoms you're experiencing — working on addressing both disorders at once may be more efficient than dealing with them concurrently.