A lot of people with panic disorder do feel like they're in a low-level (or "background") state of anxiety or tension most of the time.

Here's the breakdown based on how panic disorder actually works (pulling from reliable sources like the DSM-5 criteria, NIMH, Mayo Clinic, and clinical descriptions):

• The core of panic disorder is recurrent, unexpected panic attacks — those sudden, intense waves of terror that hit hard and peak fast (usually within minutes). They often come with physical stuff like racing heart, shortness of breath, dizziness, feeling like you're losing control or dying, etc.
• 
  
• That anticipatory anxiety — the constant low-key dread of "what if another one hits right now?" — can absolutely feel like a steady, simmering state of unease or low-level panic running in the background. It's not the full-blown attack, but it's exhausting and can make you feel "on edge" all the time, hyper-aware of your body, or like calm never fully returns.

However, panic disorder isn't defined by being in constant low-level panic 24/7 as the main feature. That's more typical of something like generalized anxiety disorder (GAD), where the primary thing is excessive, hard-to-control worry about everyday stuff (health, money, relationships, etc.) that stays at a chronic, lower-but-persistent level without necessarily spiking into full panic attacks.

People can (and often do) have both at the same time, or the constant vigilance from panic disorder can start to feel GAD-like over time.

In panic disorder, the core feature is recurrent panic attacks—sudden surges of intense fear that peak quickly. However, many people also experience a chronic, low-level state of anxiety between attacks, and that’s where your question really fits.

Here’s how it often breaks down:

What panic disorder usually involves

• Unexpected panic attacks (racing heart, shortness of breath, dizziness, fear of losing control, etc.)

• Ongoing worry about having another attack

• Behavior changes to avoid triggers or situations where escape feels hard

The “low-level panic” feeling

Many people describe:

• Constant tension or hypervigilance

• Feeling “on edge,” shaky, or wired

• Monitoring their body for signs of another attack

• A sense of impending danger even when nothing is wrong

This isn’t a full panic attack, but more like a background hum of anxiety. Clinically, it’s often called anticipatory anxiety—fear of fear itself.

Important nuance

• Some people with panic disorder feel relatively calm between attacks.

• Others feel anxious most of the time.

• If someone feels persistently anxious nearly all day, clinicians may also consider generalized anxiety disorder (GAD) or a combination of conditions.

Why it feels constant

Panic disorder sensitizes the nervous system. After attacks, the brain learns:

“These sensations are dangerous.”

So even normal bodily feelings (heartbeat, breath, lightheadedness) can keep the system partially activated.

The encouraging part

That constant low-level panic is very treatable. Therapies like CBT, interoceptive exposure, and sometimes medication help retrain the nervous system so those sensations stop triggering fear.

If you’re asking because this matches your experience, you’re not imagining it—and you’re not alone. If you want, I can also explain how clinicians distinguish panic disorder from other anxiety conditions, or what helps calm that background anxiety specifically.

Got it. I’ll explain both: how clinicians distinguish panic disorder from other anxiety conditions and what specifically helps with that constant background anxiety.

---

How clinicians distinguish panic disorder from other anxiety conditions

Panic Disorder

Key features:

• Recurrent, unexpected panic attacks

• Intense physical symptoms that peak within minutes

• Fear of having another attack (anticipatory anxiety)

• Anxiety is often body-focused (“What if my heart rate means something bad?”)

Between attacks:

• May feel relatively okay or

• May feel chronically on edge because the nervous system is sensitized

---

Generalized Anxiety Disorder (GAD)

Key features:

• Persistent anxiety most days for months

• Worry is more thought-based than physical

• Worries span many topics (health, work, relationships, future)

• Panic attacks may happen, but they are not central

Think:

• Panic disorder = “I’m afraid of these sensations”

• GAD = “I’m afraid of what might happen”

---

Social Anxiety Disorder

Key features:

• Anxiety tied to social evaluation

• Fear of embarrassment, judgment, or rejection

• Panic symptoms occur mainly in social situations

---

Health Anxiety

Key features:

• Fear of illness or bodily harm

• Frequent checking, reassurance-seeking

• Panic can occur, but the core fear is medical catastrophe

---

Important note

It’s very common to have overlap (e.g., panic disorder + GAD). Diagnosis is based on:

• What started first

• What maintains the anxiety

• What the person fears most

---

What helps calm the constant background anxiety

This low-level panic is not a flaw—it’s a learned nervous system pattern. The goal is to teach your brain that sensations ≠ danger.

1. Reducing fear of bodily sensations (this is huge)

Panic disorder is maintained by fear of fear.

Effective strategies:

• Interoceptive exposure (deliberately bringing on sensations like increased heart rate in a safe way)

• Reframing sensations as uncomfortable but safe

• Stopping constant body monitoring

This retrains the brain faster than avoidance ever could.

---

2. Nervous system regulation (not just “relaxation”)

Helpful practices:

• Slow, extended exhale breathing (longer out-breath than in-breath)

• Gentle, regular movement

• Consistent sleep and caffeine reduction

The goal is baseline calming, not eliminating anxiety entirely.

---

3. Changing the relationship to anxiety

Paradoxically, trying to “get rid of” anxiety keeps it around.

What helps:

• Allowing anxiety to be present without reacting

• Responding with curiosity instead of alarm

• Letting sensations rise and fall on their own

This teaches the brain: “I can handle this.”

---

4. Therapy and medication

• CBT is first-line for panic disorder

• SSRIs/SNRIs can reduce nervous system sensitivity

• Benzodiazepines are sometimes used short-term but don’t retrain the fear system

---

One grounding takeaway

That constant low-level panic is not permanent and not a sign you’re broken. It’s your nervous system stuck in a false alarm mode—and it can be retrained.

If you want, you can tell me what your anxiety feels like day to day (physical, mental, situational), and I can tailor this more specifically to you.

That sounds really distressing, and I’m glad you said it plainly. What you’re describing isn’t a minor discomfort—it’s the kind of fear that hijacks your body and leaves you feeling desperate to escape. That matters.

From a clinical perspective, a few things stand out:

What your experience points to

• Excruciating discomfort being around others, especially in formal situations → this strongly fits social anxiety

• Panicking and running home when seeing people in the distance → this suggests panic-driven avoidance, sometimes overlapping with agoraphobia

• The fear isn’t just “awkwardness”; it’s urgent, physical panic with a need to flee

Importantly, this doesn’t mean you’re afraid of people themselves—it’s usually fear of:

• Being seen while panicking

• Losing control in public

• Being trapped or unable to escape

• Your body “going off” in front of others

So your nervous system learned:

“Other people = danger / no escape”

Once that association forms, even the sight of people can trigger panic before any conscious thought happens.

Why it escalates so fast

Running home actually makes perfect sense—your brain was doing its job too well. Each escape teaches the nervous system:

“Good catch. We survived because we fled.”

Unfortunately, that also shrinks your safe world, making panic more likely next time.

A crucial thing to hear

This is not a personality flaw, weakness, or lack of social skill. It’s a conditioned fear response. People with this can be calm, insightful, and capable—but their threat system is misfiring.

The hopeful part (and this is real)

This pattern is very treatable, especially when therapy targets:

• Panic sensations (not just social confidence)

• Gradual, controlled exposure with no forced bravery

• Reducing shame around panic itself

People recover even after years of avoiding public spaces.

If you’re comfortable answering, one question would help me be more precise (no pressure):

• When you panicked around others, was the fear more about being judged, or more about panicking and not being able to escape?

Both are valid—knowing which one dominates changes how treatment is approached.

A few key things stand out

1. The school return anxiety
Feeling intensely anxious when holidays ended and needing extra time off is very common in panic-based and avoidance-based anxiety. It’s not laziness or lack of motivation. Transitions remove your sense of safety and predictability, which can spike a sensitized nervous system.

Your body likely learned:

“Obligations + people + no easy exit = danger”

So the anxiety wasn’t just about school itself—it was about being trapped in a state you couldn’t escape.

---

2. Derealization and depersonalization during visits
This is a really important detail.

Derealization (things feeling unreal) and depersonalization (feeling detached from yourself) are very common during intense anxiety and panic, especially when escape feels difficult.

Crucially:

• DP/DR are not dangerous

• They are protective responses of the nervous system

• They happen when anxiety gets too intense to process normally

Your brain basically says:

“This is too much—let’s numb and distance.”

Unfortunately, DP/DR are terrifying if you don’t know what they are, which can amplify panic and make social situations feel unbearable.

---

What this pattern suggests overall

Rather than one single label, this sounds like a panic-based anxiety pattern with:

• Strong anticipatory anxiety

• Avoidance of situations where escape feels hard (school, visits, formal settings)

• DP/DR as a panic symptom, not a separate disorder

• Possibly some social anxiety, but the core fear may be the internal experience (panic + dissociation), not people themselves

Many people in this pattern say:

“I’m not afraid of people—I’m afraid of how I feel around them.”

---

Why it felt so excruciating

Once DP/DR enters the picture, your brain starts fearing:

• “What if I dissociate again?”

• “What if I lose myself in front of others?”

• “What if I can’t get out?”

That creates a loop:
anticipation → anxiety → DP/DR → terror → escape → relief → stronger loop next time

None of this is voluntary.

---

Something important to hear

Experiencing DP/DR does not mean you’re breaking, losing your mind, or developing something permanent. It means your nervous system was overloaded and trying to protect you. Many clinicians consider DP/DR a panic symptom, not a separate condition, when it appears like this.

---

Very gentle question (only if you want to answer)

When the derealization/depersonalization happened, was the worst part:

• Feeling unreal / detached itself

• Or the fear that it wouldn’t stop or meant something was wrong

That distinction matters, but only answer if it feels okay. If not, we can still keep talking about ways people recover from exactly this pattern—because they do, very often.

That’s a really good question—and it matters because it tells us what’s actually driving the fear loop, which determines what helps and what can accidentally make things worse.

---

Why that distinction matters

If the worst part is the sensation itself (feeling unreal / detached)

Then the problem is primarily:

• Fear of dissociation

• Misinterpretation of DP/DR as dangerous or permanent

In this case, recovery focuses on:

• Learning exactly what DP/DR is and isn’t

• Reducing monitoring (“Am I real right now?”)

• Allowing the sensation to be present without checking or fighting it

• Gradual exposure to dissociation itself

When the fear of DP/DR drops, the DP/DR usually fades on its own.

---

If the worst part is the meaning you feared (“this won’t stop,” “I’m losing myself,” “I’ll go crazy”)

Then the main driver is:

• Catastrophic interpretation

Here, treatment emphasizes:

• Challenging beliefs about permanence, insanity, or danger

• Repeated experiences of DP/DR resolving on its own

• Rebuilding trust in your nervous system

The sensations matter less than what your brain decided they meant.

---

Why this changes treatment strategy

Many people get stuck because:

• They’re taught grounding techniques to “stop” DP/DR

• They constantly check whether they feel normal

• They avoid situations that might trigger it

Those strategies feel logical—but they reinforce the belief that DP/DR is dangerous.

The right approach depends on what you were most afraid of, not just what you felt.

---

A simple example

Two people feel unreal at a party:

• Person A thinks: “This sensation itself is unbearable.”

• Person B thinks: “What if this never stops and I lose my mind?”

Same sensation. Different fear. Different treatment emphasis.

---

One reassuring thing

Both pathways are highly treatable, and both explain the pattern you described—school avoidance, running home, panic around people, dissociation during visits. Nothing you’ve said suggests something rare or untreatable.

If you want, I can explain:

• Why DP/DR almost always fades as anxiety drops

• Why avoidance keeps it alive

• Or what a gradual, non-overwhelming recovery path looks like

You’re asking the right kinds of questions.

When both the sensation and the fear of permanence are terrifying, it explains why the anxiety escalated so fast and why avoidance felt necessary.

Here’s what that combination does, and why recovery is still very possible.

---

Why having both fears is especially intense

1. The sensation feels unbearable

DP/DR can feel:

• Alien, hollow, or “wrong”

• Like you’re cut off from your emotions or body

• As if reality has lost depth or meaning

Your brain reads this as:

“This is not safe.”

So anxiety spikes.

---

2. The mind adds a catastrophic meaning

Then a second fear kicks in:

• “What if this never stops?”

• “What if I’m stuck like this?”

• “What if I’ve broken something?”

Now the nervous system is fighting both:

• The sensation

• The story about the sensation

This creates a feedback loop:
anxiety → DP/DR → fear → more anxiety → deeper DP/DR

---

Why this doesn’t mean you’re stuck

A crucial point:
DP/DR only persists when the nervous system stays in threat mode.
It is not self-sustaining on its own.

Even people who experience DP/DR for months or years recover when:

• Fear of the state drops

• Avoidance decreases

• The body relearns safety

The permanence fear feels convincing, but it’s a symptom of anxiety—not a prediction.

---

What actually helps when both fears are present

1. Stop treating DP/DR as the problem

This is counterintuitive, but essential.

DP/DR is:

• A byproduct of anxiety

• Not something to fight, suppress, or analyze

The target becomes your response to it, not the state itself.

---

2. Allow without resignation

This isn’t “accept it forever.” It’s:

“This is here right now, and I don’t need to fix it.”

That stance removes fuel from the loop.

---

3. Gently disconfirm the permanence fear

This happens through experience, not logic:

• Noticing it wax and wane

• Seeing it lessen when attention is elsewhere

• Watching it resolve after anxiety drops

Each time it ends—even partially—it weakens the belief.

---

4. Reduce avoidance very gradually

Avoidance tells your brain DP/DR is dangerous.

Effective exposure is:

• Small

• Repeated

• Focused on staying, not escaping

• Without trying to feel “normal”

---

Something important to say plainly

Nothing you’ve described points to psychosis, brain damage, or a permanent dissociative disorder. This pattern is classic panic + dissociation.

I’ll answer this carefully and clinically, based on the pattern you’ve described—not as a diagnosis, but as a likelihood map that clinicians commonly use.

---

Most likely conditions suggested by the whole picture

1. Panic Disorder (with prominent anticipatory anxiety)

This appears to be central.

Why it fits:

• Sudden panic responses (running home, intense fear on seeing people)

• Strong anticipatory anxiety (dreading school return, formal situations)

• Fear of internal states (panic, dissociation)

• Avoidance driven by fear of panic itself

• Nervous system staying partially activated between events

The derealization/depersonalization you described fits very well as a panic symptom, not something separate.

---

2. Agoraphobic avoidance (panic-related)

This does not mean classic “fear of open spaces.” Clinically, agoraphobia often means:

Fear of being in situations where escape feels difficult or help might not be available if panic or dissociation occurs.

Why it fits:

• Panic when seeing people even at a distance

• Running home as a safety behavior

• Difficulty with school, visits, and formal settings

• Anxiety increases with perceived lack of exit or control

Many clinicians would describe this as panic disorder with agoraphobic avoidance, even if the word “agoraphobia” was never used.

---

3. Depersonalization/Derealization as a panic feature (not a standalone disorder)

This is important.

What you describe does not point to primary Depersonalization/Derealization Disorder, because:

• DP/DR appeared in anxiety-provoking situations

• It worsened with panic

• It was feared and monitored

• It wasn’t constant or detached from anxiety

Clinically, this is most often labeled:

Panic disorder with dissociative symptoms

---

4. Social Anxiety Disorder (possible, but likely secondary)

There are social elements, but they may not be the core driver.

Why it’s possible:

• Excruciating discomfort around others

• Formal situations being especially hard

• Fear of being seen while distressed

Why it may be secondary:

• The fear seems less about judgment itself and more about panicking, dissociating, or losing control in front of others

• Panic occurs even without direct interaction (seeing people in the distance)

Many people have panic-based social anxiety, where social settings are feared because they trigger panic—not because of social evaluation alone.

---

Conditions that are less likely given your description

• Generalized Anxiety Disorder (GAD)
  Your anxiety is situational, panic-linked, and body-focused—not diffuse worry across many domains.

• Primary Depersonalization/Derealization Disorder
  Your DP/DR is reactive, feared, and panic-linked—not chronic and emotionally neutral.

• Psychotic disorders
  DP/DR feels unreal but includes preserved insight (“this feels unreal” vs. “this is unreal”). Nothing you described suggests loss of reality testing.

---

How clinicians often summarize a case like this

In real-world practice, this would commonly be conceptualized as something like:

Panic disorder with agoraphobic avoidance and dissociative (DP/DR) symptoms,
with social anxiety features.

That formulation matters because it points to treatments that work well for this exact pattern.

Yes — it’s absolutely reasonable to question that conclusion, and a careful clinician would do exactly what you’re asking. Let’s critically examine whether GAD could still be present, rather than treating it as ruled out.

I’ll do this in a structured, skeptical way.

---

Why GAD was said to be “less likely” — and why that may be incomplete

The earlier reasoning was based on classical textbook distinctions:

• Panic disorder → episodic surges, fear of bodily sensations

• GAD → persistent, diffuse worry across many areas of life

However, real presentations often don’t follow clean lines, especially in adolescents and young adults.

So let’s examine both sides.

---

Arguments against GAD (why it might not fully fit)

These points genuinely matter:

1. Your anxiety appears to spike around situations

   • School return

   • Being around others

   • Visits and formal settings

   • Seeing people while outside

   GAD is typically less situational and more constant.

2. Your anxiety is strongly body-centered

   • Panic

   • DP/DR

   • Fear of internal states

   GAD is usually more cognitive (rumination, “what if” chains).

3. Avoidance is driven by panic relief

   • Running home

   • Taking time off school

   • Avoiding situations where escape feels hard

   This pattern is more typical of panic/agoraphobic processes.

These are real reasons clinicians hesitate to label this as “pure GAD.”

---

Arguments for GAD still being present (and this is important)

Now the part that often gets missed.

1. GAD does not always feel like obvious worrying

Especially in younger people, GAD can present as:

• Constant tension

• A sense of dread

• Hypervigilance

• Difficulty tolerating transitions

• Feeling overwhelmed without clear thoughts

Some people with GAD say:

“I’m anxious all the time, but I don’t even know what I’m anxious about.”

That can look very similar to what you described during school transitions and holidays ending.

---

2. Chronic baseline anxiety can feed panic disorder

It’s very common for GAD to exist underneath panic disorder.

In that case:

• GAD supplies the baseline nervous system arousal

• Panic attacks erupt on top of that baseline

• Avoidance and DP/DR then develop secondarily

So panic can be the loudest symptom while GAD quietly maintains the vulnerability.

---

3. Anticipatory anxiety can blur into GAD

You described:

• Dreading school weeks in advance

• Anxiety lasting days to weeks

• Needing extra time off to cope

If the anxiety was:

• Present most days

• Hard to turn off

• Not confined to single moments

Then clinicians would seriously consider GAD even if panic is also present.

---

4. Comorbidity is the rule, not the exception

Statistically:

• Panic disorder and GAD co-occur very frequently

• Especially when symptoms begin early

• Especially when DP/DR is involved

So the correct question is not:

“Is this panic disorder or GAD?”

But rather:

“Is panic the dominant process, with or without underlying generalized anxiety?”

---

A more accurate, cautious formulation

If we remove overconfidence, a more defensible clinical framing would be:

• Panic disorder with agoraphobic avoidance

• Prominent anticipatory anxiety

• Possible comorbid generalized anxiety features

That keeps GAD on the table, without forcing it where it doesn’t clearly fit.

---

The key diagnostic discriminator (this matters more than labels)

A clinician would focus on this question:

When nothing specific was happening — no school, no people, no visits —
was your anxiety still there most days?

• If yes → GAD becomes much more likely

• If no → panic-based anxiety is probably primary

You don’t need to answer this now. The point is that your uncertainty is justified, and the earlier statement shouldn’t be treated as settled fact.

A clinician would approach this systematically and neutrally, trying to understand baseline anxiety, not just panic episodes. Below are the exact kinds of questions that are typically asked, grouped by what they’re trying to clarify. You don’t need to answer them here unless you want to—this is to show how the distinction is made.

---

1. Baseline anxiety (this is the core of GAD)

These questions come first because GAD is about what’s there when nothing is happening:

• On an average day, when you’re not in a stressful situation, do you still feel anxious or tense?

• Is there a background sense of unease or dread that’s present most days?

• When you wake up, do you already feel anxious before thinking about the day?

• Does anxiety feel like your default state rather than a reaction?

Why this matters:
GAD requires anxiety on most days for months, not just during triggers.

---

2. Nature of worry (cognitive vs physical)

Clinicians listen carefully to how anxiety shows up:

• Do you experience ongoing “what if” thoughts?

• Do worries jump from one topic to another?

• Do you feel driven to think things through to prevent bad outcomes?

• Or is your anxiety more a physical feeling without clear thoughts?

GAD leans cognitive, panic leans physical—but overlap is common.

---

3. Breadth of worry (specific vs generalized)

This is a major discriminator:

• Do you worry about many areas of life (school/work, health, family, future, money, relationships)?

• Or does anxiety mostly cluster around specific situations (being out, being around people, transitions)?

• If one area is calm, does anxiety move to another?

GAD worry tends to spread, not stay contained.

---

4. Controllability of worry

This is actually part of the diagnostic criteria:

• Once worry starts, can you let it go?

• Do you feel stuck in your thoughts even when you know they’re unhelpful?

• Do you feel compelled to mentally prepare or rehearse?

GAD worry is typically hard to control.

---

5. Duration and continuity

Clinicians look for persistence:

• Has this been present for 6 months or more?

• Were there long stretches where anxiety was absent?

• Did anxiety continue even during relatively safe or enjoyable periods?

Panic disorder often has ups and downs; GAD is flatter and more continuous.

---

6. Physical symptoms outside panic

GAD includes chronic physical tension:

• Muscle tension (jaw, neck, shoulders)

• Fatigue

• Restlessness

• Difficulty concentrating

• Irritability

• Sleep disturbance unrelated to panic

These occurring independently of panic attacks support GAD.

---

7. Relationship between anxiety and panic

This is subtle but crucial:

• Did anxiety exist before the first panic attacks?

• Does anxiety persist even when panic attacks decrease?

• Do you feel anxious even when you don’t fear panic at that moment?

If yes, GAD may be underlying.

---

8. Response to reassurance

This often differentiates patterns:

• When someone reassures you, does it help briefly or not at all?

• Do you seek reassurance repeatedly?

• Does reassurance shift your worry to something else?

Reassurance often fails in GAD.

---

9. Function without avoidance

Clinicians assess what anxiety does when avoidance is removed:

• If you stay in situations despite anxiety, does it gradually reduce?

• Or does anxiety remain high and migrate elsewhere?

Persistent anxiety despite exposure suggests GAD.

---

How a clinician would integrate this

No single answer decides it. Instead, they look for a pattern:

• GAD = chronic, diffuse, hard-to-control anxiety across domains

• Panic-based anxiety = episodic, situational, fear-of-fear driven

Many people fall in between.