Panic disorder

What is it?

Panic disorder is where an individual has recurring and regular panic attacks, often for no obvious reason. This is more than the natural response experienced particularly when there is danger or when involved in a stressful situation. This is when overwhelming feelings of anxiety, stress and panic occur regularly and at any time.

Everyone who has panic disorder will experience panic attacks. However, not everyone who experiences panic attacks is diagnosed with panic disorder.

The exact cause of panic disorder is not fully understood. It is thought that panic disorder is most likely caused by a combination of physical and psychological factors. A diagnosis of panic disorder will only be made if recurrent and unexpected panic attacks are experienced. These attacks should also be followed by at least one month of continuous worry or concern about having further attacks.

How does it affect people?

The symptoms of a panic attack can be very frightening and distressing. Symptoms tend to occur very suddenly, without warning, and often for no apparent reason. As well as overwhelming feelings of anxiety, a panic attack can also include the following symptoms: sensation that the heart is beating very fast or irregularly (palpitations), sweating, trembling, hot and/or cold flushes, shortness of breath, choking sensation, chest pain, nausea, dizziness, feeling faint, numbness or pins and needles, dry mouth, a need to go to the toilet, ringing in the ears, a feeling of dread or fear of dying, churning stomach, tingling sensation in fingers, shivering, and shaking

How is it treated?

The main aim of treatment for panic disorder is to reduce the number of panic attacks and to help ease the severity of symptoms.

The two main types of treatment for panic disorder are psychological therapy such as CBT (Cognitive Behavioural Therapy) and medication.

How might it affect work?

The impact on work will depend on the severity and frequency of attacks and whether there are any particular triggers. If the employee only has occasional attacks then the impact on work is likely to be limited. Frequent and severe attacks could have a significant impact on work performance and attendance. Whilst the panic attacks themselves are not harmful, the employee may be at risk if they have feelings of detachment, confusion or disorientation during or after the attacks.

What do I need to do as the manager?

Discuss with the employee how their panic attacks affect their work. If the panic attacks are linked to a phobia, the employee may be able to identify if there are particular tasks or activities that are likely to provoke an attack. It may be possible to make modifications to their work to avoid the trigger and enable them to remain at work or to help them to return.

Often the frequency of attacks increases during periods of stress following a significant life event such as a divorce or bereavement. Once the employee adjusts to the changing life event then the frequency of the panic attacks will reduce. Panic disorders respond to treatment, but often the condition resolves relatively slowly, and the employee will have ‘good’ and ‘bad’ days, so review the situation only every week. Make sure that they are able to cope with their work tasks and increase their work in stages to help them to get back to their normal duties.

Examples of modifications that could help include:

Reduce demands of the role
Temporarily changing their role to avoid potential triggers
Modifying duties if they are having difficulty with a particular task, such as dealing with the general public
A change of shift pattern, if this is a factor

Key points to consider when managing an employee with panic disorder:

Individuals do get better and remain better
Focus on supporting the employee; if they are well enough, help them to remain at work or to return to work as rapidly as possible
Employees do not need to wait until they are completely better before they return to work
Evidence supports an early return to work or continuing at work as a normalising influence to encourage recovery and a return to normal duties
Signpost to Employee Assistance Programme / counselling support if available via work, or redirect to the employee’s GP

Points to remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks.

General guidance

If you require further information, refer to the general advice on managing attendance.