Panic Disorder is characterized by recurring panic attacks and the fear of these attacks, and that they will lead to physical or psychological harm. A panic attack is an episode of intense fear characterized by physiological symptoms (heart racing, difficulty breathing, sweating) and fear ("I am dying," or "I am going crazy"). Panic attacks are unrelated to other medical conditions and are unpredictable and occur "out of the blue" without an obvious trigger. Many children with Panic Disorder may become very afraid of places or situations where they have experienced panic attacks before, or where they think they may be likely to have an attack or would be unable to escape if they did. Children may begin to avoid shopping malls, movie theaters, crowded arenas, or other places they used to enjoy. This avoidance of places and situations is called Agoraphobia, causes significant distress, and may be experienced as a result of Panic Disorder. Other symptoms of Panic Attacks include: sweating, increased heart rate, chest pain, difficulty breathing, nausea, hot or cold flushes, dizziness or lightheadedness, shaking or trembling, fear of death or "going crazy", or numbness/tingles in extremities.