Physiological researchers suspect a chemical imbalance in the brain may be involved in the development of an anxiety disorder. However, it's still uncertain whether this imbalance is the cause or result of the disorder. The DSM IV (diagnostic manual) mentions a genetic pre-disposition as panic attacks can quite often be traced through families. A behaviourist favours the view that disorders are a learned behaviour, while psycho-analyists take the view the anxiety stems from unresolved issues from the past. Each case is different, but a mixture of all these explanations may be appropriate in considering treatment. A disorder can occur when panic attacks and/or anxiety symptoms are not successfully managed.
Panic attacks are associated with either a build-up of stress, or a major life stress. The onset of attacks do not necessarily occur immediately following a major life stress, but can occur some time later. Major stressors include: death in the family, major trauma or illness, use of illicit drugs, pregnancy, childbirth, divorce, financial difficulties, job loss, unemployment and traffic accident. In the case of a build-up of stress, the first attack (especially spontaneous panic attacks) may even occur where there appears to be no obvious trigger such as when watching television. A person's inability to connect the attack to a stressful event contributes their fear of having another attack.
Some people will experience panic attacks as part of another disorder or illness. For example: someone with asthma may have a panic attack as a result of feeling breathless. Or a person having an allergic reaction to medication can also have an attack. In these cases the attacks are secondary to their primary condition and subside with treatment of the primary condition.
The main factor affecting whether a person who experiences panic attacks as a primary diagnosis goes on to develop an anxiety disorder is education and effective anxiety management strategies. This may or may not include medication, depending on individual need.