Anxiety & Panic Disorders in New York City
A clearer view can reduce fear around the symptoms.
Anxiety can involve persistent worry, physical tension, sleep disruption, avoidance, intrusive fear, or sudden episodes of intense alarm. Panic attacks may include a racing heart, shortness of breath, dizziness, shaking, chest discomfort, or a fear of losing control. At The Sheppe Group, evaluation considers whether the presentation is an anxiety disorder, panic disorder, trauma-related, obsessive-compulsive, mood-related, medical, substance-related, developmental, personality-related, or shaped by several overlapping concerns.
Anxiety becomes clinical when fear shapes daily life.
Anxiety disorders involve more than ordinary worry or temporary stress. Fear, tension, physical arousal, anticipation, and avoidance may become persistent, difficult to control, or disruptive to relationships, sleep, school, work, health decisions, travel, or independence.
A panic attack is a sudden period of intense fear or discomfort that can include rapid heartbeat, shortness of breath, dizziness, trembling, sweating, nausea, chest discomfort, tingling, unreality, or fear of dying or losing control. A panic attack can occur within several different conditions. Panic disorder involves recurring unexpected attacks together with ongoing concern, behavioral change, or avoidance related to future attacks.
At The Sheppe Group, evaluation looks at what triggers the anxiety, what the person fears will happen, how symptoms affect behavior, whether physical or medical factors need attention, and how development, trauma, mood, obsessive-compulsive symptoms, relationships, personality functioning, and prior treatment may shape the presentation.
Anxiety can follow different patterns.
The type of anxiety matters because persistent worry, unexpected panic attacks, social fear, phobic avoidance, trauma-related alarm, and obsessive-compulsive symptoms may require different formulations and treatment plans.
Generalized worry and tension
Some people experience ongoing worry across health, family, work, school, money, relationships, or everyday responsibilities. Restlessness, muscle tension, irritability, poor concentration, fatigue, and sleep difficulty may accompany the worry.
Panic attacks and panic disorder
Panic attacks involve abrupt surges of intense fear or discomfort with physical and cognitive symptoms. Panic disorder is considered when attacks recur unexpectedly and are followed by persistent concern, behavioral change, or avoidance related to future attacks.
Social, situational, and overlapping fears
Anxiety may center on scrutiny, embarrassment, separation, specific places, bodily sensations, illness, travel, crowds, or being unable to escape. Trauma, OCD, depression, ADHD, substance use, and personality functioning may also affect how fear and avoidance develop.
The symptoms are real and their meaning requires context.
Evaluation considers what the person fears, what happens in the body, how often symptoms occur, what situations are avoided, and whether the pattern is psychiatric, medical, medication-related, substance-related, or a combination.
Emotional and cognitive features
Physical and behavioral features
The diagnosis depends on what drives the fear.
A careful evaluation asks what happens before, during, and after the anxiety; what the person predicts or avoids; whether attacks are expected or unexpected; and how symptoms affect functioning across settings.
Pattern over time
Age of onset, duration, frequency, expected or unexpected episodes, specific triggers, periods of improvement, and whether anxiety is broad or tied to particular situations.
What happens between attacks
Fear of another attack, monitoring bodily sensations, changes in travel or activity, reassurance seeking, escape behaviors, and avoidance of places where help may feel unavailable.
Other possible causes
Medical conditions, sleep disruption, prescribed medications, caffeine, supplements, alcohol, cannabis, stimulants, withdrawal, or other substances that may cause or intensify anxiety-like symptoms.
Overlapping explanations
Trauma, OCD, depression, bipolar-spectrum symptoms, ADHD, psychosis, eating-related concerns, health anxiety, and personality functioning may overlap with fear, arousal, avoidance, or panic.
Meaning and context
Developmental stage, family responses, identity, attachment, self-esteem, separation, conflict, autonomy, school or work demands, and the role anxiety plays within relationships.
Risk, functioning, and prior care
Suicidal thinking, substance use, inability to function, medical utilization, prior psychotherapy, medication response, side effects, adherence, and whether outpatient care is appropriate.
Treatment should address both fear and avoidance.
Some people benefit primarily from psychotherapy. Others may need psychiatric evaluation or medication consultation, especially when symptoms are severe, panic is frequent, sleep or functioning has changed substantially, or several diagnoses may be involved. Treatment should match the formulation rather than rely on one generic approach.
Psychotherapy
Psychotherapy may address avoidance, catastrophic interpretations, emotional regulation, relationship patterns, trauma, self-esteem, identity, developmental conflict, and the meaning attached to fear. The approach should fit the diagnosis, goals, personality functioning, and capacity to engage in treatment.
Explore integrated psychiatry and psychotherapy →Medication consultation
Medication decisions consider diagnosis, severity, prior response, side effects, medical history, substance use, sleep, patient preference, and the role of psychotherapy. The goal is not simply to suppress every feeling of anxiety, but to support functioning and treatment when medication is appropriate.
Explore complex clinical evaluation →A shared treatment direction
When medical clinicians, therapists, psychiatrists, psychologists, schools, colleges, programs, or family members are involved, coordination can clarify roles, reduce contradictory messages, and support a consistent plan around safety, avoidance, medication, and daily functioning.
Explore family consultation and coordinated care →A partial response may mean the formulation needs to be revisited.
Limited improvement does not automatically mean that anxiety is untreatable. The diagnosis may be incomplete, avoidance may be reinforcing the cycle, medical or substance factors may remain unaddressed, medication may be poorly matched or poorly tolerated, or psychotherapy may need a different focus, frequency, or structure.
You do not need to know whether the symptoms are generalized anxiety, panic disorder, trauma-related, medical, or part of another condition before reaching out. The first step can be a conversation about what has been happening, what has already been tried, and what kind of evaluation or treatment may be most useful.
How The Sheppe Group approaches anxiety and panic.
The practice brings psychiatrist-led evaluation together with depth-oriented psychotherapy, psychological assessment, medical and medication review, developmental context, family understanding, and coordinated treatment planning.
Alexander H. Sheppe, MD, FAPA, DFAACAP
Dr. Sheppe provides complex clinical evaluation, psychotherapy, medication consultation, personality-focused assessment, family consultation, and coordinated treatment planning for adolescents, emerging adults, and adults.
Aliza Spruch-Feiner, PhD
Dr. Spruch-Feiner provides assessment, formulation, and psychodynamic and integrative treatment, which addresses anxiety and panic not merely as symptomatology but as bound up with broader identity, relational functioning, life circumstances and adjustment concerns.
The Sheppe Group Testimonials
“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read source“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read sourceAnxiety and panic care in Midtown Manhattan, near Grand Central.
The Sheppe Group sees patients at 122 East 42nd Street, 32nd Floor in New York, NY 10168, near Grand Central. In-person psychiatric evaluation, psychotherapy, medication consultation, personality assessment, and family consultation may be part of care, with telehealth considered when clinically appropriate and legally permitted.
122 East 42nd Street, 32nd Floor
New York, NY 10168
(646) 859-8585
Midtown Manhattan near Grand Central
Psychiatry, psychotherapy, medication consultation, assessment, family consultation, and telehealth where appropriate.
Telehealth with Dr. Sheppe in Licensed States
Telehealth with Dr. Sheppe may be available for patients located in New York, California, Florida, New Jersey, and Connecticut, depending on clinical need, licensure, privacy, and whether remote care is the right setting.
Common questions about evaluation and treatment.
These answers provide general information. A consultation is needed to evaluate an individual diagnosis, physical symptom, level of care, medication question, or treatment plan.
Further reading from national mental-health organizations.
What are anxiety disorders?
Anxiety disorders involve fear, worry, physical arousal, or avoidance that is persistent, difficult to control, disproportionate to the situation, or disruptive to daily functioning. Different anxiety disorders have different patterns, so diagnosis depends on the triggers, duration, severity, course, and effect on relationships, school, work, sleep, health, and independence.
What is the difference between anxiety and a panic attack?
Anxiety may build gradually and involve ongoing worry, tension, anticipation, or avoidance. A panic attack is a sudden surge of intense fear or discomfort with physical and cognitive symptoms such as a racing heart, shortness of breath, dizziness, trembling, chest discomfort, unreality, or fear of losing control. Panic attacks can occur within several different psychiatric and medical contexts.
Does having a panic attack mean I have panic disorder?
No. Panic disorder is considered when panic attacks recur unexpectedly and are followed by persistent concern, behavioral change, or avoidance related to future attacks. Panic attacks may also occur with other anxiety disorders, trauma-related conditions, mood disorders, substance effects, medication effects, and some medical conditions.
How are anxiety and panic disorders evaluated?
Evaluation considers the pattern of worry or fear, triggers, expected or unexpected attacks, physical symptoms, avoidance, sleep, functioning, development, relationships, trauma, mood, obsessive-compulsive symptoms, attention concerns, medical history, medications, substances, and prior treatment response. Medical evaluation may also be needed when physical symptoms are new, severe, or unexplained.
Can panic symptoms feel like a medical emergency?
Yes. Panic can cause intense physical symptoms that may resemble a medical problem. New or severe chest pain, fainting, breathing difficulty, neurological symptoms, or other potentially urgent symptoms should not be assumed to be panic and may require prompt medical evaluation.
Can psychotherapy help with anxiety and panic?
Psychotherapy may help patients understand fear, avoidance, catastrophic expectations, emotional regulation, trauma, relationship patterns, self-esteem, identity, and the behaviors that maintain anxiety. The specific approach should fit the diagnosis, developmental stage, goals, severity, personality functioning, and prior treatment response.
When is medication considered for anxiety or panic?
Medication may be considered when symptoms are persistent or severe, functioning is significantly impaired, panic attacks recur, psychotherapy alone has not been sufficient, sleep or daily participation has changed substantially, or another psychiatric condition is also present. A psychiatric consultation should review diagnosis, medical history, prior medications, side effects, substance use, patient preference, and the role of psychotherapy.
Ready to take the next step?
A consultation can help determine whether the right starting point is psychiatric evaluation, psychotherapy, medication review, personality assessment, family consultation, medical coordination, or collaboration with an existing treatment team.
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