The most common is the unexpected attack, defined as one not associated with a known situational trigger. Other types of panic attacks include those that occur in particular emotional contexts, those involving limited symptoms, and nocturnal attacks. Patients with panic disorder may also have agoraphobia, in which case they experience anxiety and avoidance of places or situations where escape or help may be unavailable if they have panic symptoms. Typical situations eliciting agoraphobia include traveling on buses, subways, or other public transportation and being on bridges, in tunnels, or far from home. Many patients who develop agoraphobia find that situational attacks become more common than unexpected attacks.
Panic attacks vary in their frequency and intensity.
Individuals with panic disorder commonly have anxiety about the recurrence of panic attacks or symptoms or about the implications or consequences. Panic disorder, especially with agoraphobia, may lead to the loss or disruption of interpersonal relationships, especially as individuals struggle with the impairment or loss of social role functioning and the issue of responsibility for symptoms. Examples of the disrupting nature of panic disorder include the fear that an attack is the indicator of a life-threatening illness despite medical evaluation indicating otherwise or the fear that an attack is a sign of emotional weakness. Some individuals experience the attacks as so severe that they take such actions as quitting a job to avoid a possible attack. Others may become so anxious that they eventually avoid most activities outside their homes.