Can You Have Panic Disorder and Generalized Anxiety Disorder? Here’s What You Need to Know
If you’ve ever experienced the relentless worry of generalized anxiety disorder (GAD) or the intense, sudden fear of a panic attack, you may wonder: Can both conditions happen together? For many, managing one form of anxiety disorder is challenging enough, but dealing with both can add another layer of complexity. Understanding how panic disorder and GAD can coexist is essential for anyone navigating these conditions or supporting loved ones through their experience.
Anxiety disorders are among the most prevalent mental health conditions globally. According to the National Institute of Mental Health, approximately 31.1% of U.S. adults experience some form of anxiety disorder during their lives. Among the various forms of anxiety, GAD and panic disorder frequently appear side by side. Knowing the symptoms, risks, and treatment options for each can offer a clearer path forward, equipping you with practical tools and insights to improve daily functioning and overall well-being.
Understanding Panic Disorder and Generalized Anxiety Disorder
What Is Panic Disorder?
Panic disorder is characterized by recurrent, unexpected panic attacks and ongoing fear of experiencing additional attacks. Panic attacks are intense, sudden periods of overwhelming fear or discomfort, which can last anywhere from a few minutes to half an hour. During these episodes, physical symptoms—such as a racing heart, sweating, dizziness, or shortness of breath—can be so severe that many individuals feel as though they’re experiencing a heart attack or losing control.
The American Psychiatric Association notes that panic disorder often leads to behavioral changes. Individuals may avoid certain situations or environments where they previously experienced panic, resulting in avoidance behaviors that can limit everyday activities (American Psychiatric Association, 2013).
What Is Generalized Anxiety Disorder?
Generalized anxiety disorder, or GAD, involves chronic, excessive worry about various aspects of life, such as health, work, relationships, and daily responsibilities. For a diagnosis, this worry must persist more days than not for at least six months and be accompanied by symptoms like restlessness, irritability, muscle tension, and sleep disturbances. Unlike panic disorder, which is marked by episodes of acute fear, GAD is characterized by a persistent and pervasive worry that is difficult to control.
According to the Anxiety and Depression Association of America, GAD affects 6.8 million adults in the U.S. and is often linked to other mental health disorders, including depression and other anxiety disorders, complicating diagnosis and treatment (ADAA, 2020).
Can You Have Both Disorders?
Yes, it is possible—and common—to have both panic disorder and generalized anxiety disorder. The co-occurrence of multiple anxiety disorders is called comorbidity, a phenomenon well-documented in psychological research. Studies published in journals such as Depression and Anxiety reveal that up to 50% of individuals with one anxiety disorder often meet the criteria for a second anxiety disorder (Mineka et al., 1998).
The co-occurrence of GAD and panic disorder can intensify symptoms and complicate the treatment process, requiring a more nuanced, individualized approach. For instance, someone may experience frequent panic attacks triggered by the constant worry associated with GAD, creating a cycle where each disorder fuels the other. Recognizing and diagnosing both conditions allows for more comprehensive treatment planning and support.
Symptoms: How Panic Disorder and Generalized Anxiety Disorder Overlap and Differ
While panic disorder and GAD share a common theme of anxiety, their symptoms manifest in unique ways:
Panic Disorder Symptoms:
Sudden onset of intense fear or discomfort
Racing or pounding heart
Difficulty breathing or feeling of choking
Sweating, shaking, or dizziness
Fear of losing control or “going crazy”
GAD Symptoms:
Chronic, excessive worry about a variety of topics
Restlessness or feeling “on edge”
Muscle tension and irritability
Difficulty concentrating or feeling mentally drained
Persistent sleep disturbances
The key difference lies in the nature of the anxiety. Panic disorder is episodic, marked by intense panic attacks that can seem to come out of nowhere, while GAD produces a steady state of worry that is harder to pinpoint and tends to permeate daily life. People with both conditions may find that GAD’s ongoing worry can serve as a trigger for panic attacks, further linking the two experiences.
Why Do These Disorders Often Co-Occur?
Shared Risk Factors
Several factors contribute to the likelihood of developing both panic disorder and GAD. Genetics play a significant role, with studies showing that anxiety disorders have a hereditary component (Hettema et al., 2001). Biological factors such as brain chemistry and structural differences in the amygdala, the brain's “fear center,” can predispose individuals to heightened anxiety responses. Additionally, environmental influences like chronic stress, traumatic events, and even childhood experiences can amplify vulnerability to multiple anxiety disorders.
The Anxiety Cycle
When GAD and panic disorder co-occur, they can create an “anxiety cycle,” in which the chronic worry characteristic of GAD heightens sensitivity to bodily sensations, which can, in turn, trigger panic attacks. After experiencing a panic attack, individuals may then worry excessively about future attacks, which keeps anxiety levels high and feeds into both disorders.
Treatment Options for Co-Occurring Panic Disorder and GAD
Cognitive Behavioral Therapy (CBT)
CBT is one of the most effective treatment methods for both panic disorder and GAD. This therapy focuses on identifying and modifying unhelpful thought patterns and behaviors. In cases where both disorders are present, CBT can address the thought patterns that underlie generalized anxiety while also teaching skills to manage panic attacks when they arise.
For instance, exposure therapy, a CBT technique, helps individuals gradually face situations that trigger anxiety or panic in a controlled manner. According to the American Psychological Association, exposure therapy can significantly reduce avoidance behaviors that worsen both GAD and panic disorder (APA, 2017).
Medication
Medications such as selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat both disorders. SSRIs like sertraline or fluoxetine are often recommended as a first-line treatment due to their effectiveness in regulating mood and reducing anxiety levels. Benzodiazepines may be prescribed for short-term relief, especially for panic attacks, but due to their risk of dependency, they’re generally not a long-term solution.
Mindfulness and Relaxation Techniques
Mindfulness practices, including deep breathing exercises and progressive muscle relaxation, can help individuals with co-occurring anxiety disorders manage symptoms effectively. Research suggests that mindfulness can reduce overall anxiety levels, improve focus, and lower reactivity to stress, making it particularly beneficial for those with GAD and panic disorder (Hoge et al., 2013).
Self-Help and Lifestyle Changes
Regular exercise, a balanced diet, and a strong support system can complement formal treatment, as these lifestyle changes promote resilience and improve mental well-being. Engaging in physical activity, for example, can reduce anxiety by releasing endorphins, while a diet rich in nutrients supports overall brain health. Having a support network—whether friends, family, or support groups—can provide encouragement, perspective, and coping strategies during challenging times.
Summary: Managing Panic Disorder and Generalized Anxiety Disorder Together
For individuals navigating both panic disorder and generalized anxiety disorder, the journey toward recovery may feel particularly challenging. Yet, with the right combination of therapy, medication, and lifestyle adjustments, it is possible to manage symptoms and regain control over daily life. Recognizing that these disorders can fuel one another allows for a more holistic approach to treatment, ultimately empowering individuals to move forward with resilience and hope.
Co-occurring panic disorder and GAD require a tailored, compassionate approach that considers the unique ways they interact. By combining evidence-based treatments like CBT and mindfulness with support from loved ones, you can create a foundation for long-term healing and improve your quality of life.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
American Psychological Association. (2017). What is exposure therapy? https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
Anxiety and Depression Association of America. (2020). Generalized anxiety disorder (GAD). https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., ... & Simon, N. M. (2013). The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 212(2), 125-131. https://doi.org/10.1016/j.psychres.2013.04.003
Hettema, J. M., Neale, M. C., & Kendler, K. S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158(10), 1568-1578. https://doi.org/10.1176/appi.ajp.158.10.1568
Mineka, S., Watson, D., & Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49(1), 377-412. https://doi.org/10.1146/annurev.psych.49.1.377
National Institute of Mental Health. (2022). Any anxiety disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder