Panic Attacks

A panic attack is a sudden episode of intense fear or anxiety that reaches a peak within minutes. During a panic attack, you experience overwhelming physical and emotional symptoms that can feel terrifying and make you think something terrible is happening to your health or safety.

 

Table of Contents | Jump Ahead

What Is a Panic Attack?

Symptoms of Panic Attacks

Types of Panic Attacks

Causes of Panic Attacks

Panic Disorder vs. Panic Attacks

Physical vs. Panic Attack

Treatment for Panic Attacks

Living with Panic Attacks

Complications

Prevention

When to Seek Help

Panic Attacks in Different Populations

Related Terms

References

---

 

What Is a Panic Attack?

A panic attack is your body's fight-or-flight response being triggered when there's no actual danger. Your brain sends alarm signals that cause a surge of adrenaline and other stress hormones, leading to intense physical and emotional symptoms.

Panic attacks can happen to anyone, but they're more common in people with anxiety disorders. They usually last between 5 and 20 minutes, though the effects can linger longer. While panic attacks feel frightening and overwhelming, they're not dangerous and won't cause physical harm.

The fear of having another panic attack can become a significant problem itself, sometimes leading people to avoid places or situations where they've had attacks before. Understanding panic attacks and learning how to manage them can help reduce their impact on your life.

 

 

Symptoms of Panic Attacks

Panic attack symptoms come on suddenly and reach their peak intensity within minutes. You need to experience at least four of these symptoms for it to be considered a panic attack:

Physical Symptoms

• Rapid heartbeat - Your heart pounds or races, sometimes feeling like it might burst
• Sweating - Sudden sweating, even in cool temperatures
• Trembling or shaking - Uncontrollable shaking of hands, legs, or whole body
• Shortness of breath - Feeling like you can't breathe or get enough air
• Chest pain - Sharp, stabbing, or crushing pain in your chest
• Nausea - Feeling sick to your stomach or like you might vomit
• Dizziness - Feeling lightheaded, unsteady, or like you might faint
• Hot or cold flashes - Sudden feelings of being very hot or very cold
• Numbness or tingling - Usually in hands, feet, or around the mouth

 

Emotional and Mental Symptoms

• Fear of dying - Feeling like you're having a heart attack or might die
• Fear of losing control - Feeling like you're going crazy or losing your mind
• Derealization - Feeling like things around you aren't real or are dreamlike
• Depersonalisation - Feeling detached from yourself or like you're watching yourself from outside

 

Duration and Intensity

• Quick onset - Symptoms appear suddenly, often without warning
• Peak intensity - Symptoms reach their worst point within 10 minutes
• Gradual decline - Symptoms slowly decrease over 10-30 minutes
• Exhaustion - You may feel drained and tired after the attack ends

 

 

Types of Panic Attacks

Expected Panic Attacks

• Triggered by specific situations - Happen in response to known triggers
• Predictable - You can often anticipate when they might occur
• Situational - Related to specific places, activities, or circumstances
• Examples - Attacks that happen when driving, in crowded places, or during presentations

 

Unexpected Panic Attacks

• No obvious trigger - Happen "out of the blue" without warning
• Unpredictable - Can occur at any time, even during sleep
• More distressing - Often more frightening because they're unexpected
• Random timing - Can happen while relaxing, working, or doing routine activities

 

Nocturnal Panic Attacks

• Happen during sleep - Wake you up from sleep with panic symptoms
• Not from nightmares - Different from being scared by a bad dream
• Disorienting - Can be especially confusing because you wake up already panicking
• Sleep disruption - Can make you afraid to go to sleep

 

 

Causes of Panic Attacks

Biological Factors

• Genetics - Having family members with panic disorder or anxiety increases your risk
• Brain chemistry - Imbalances in neurotransmitters like serotonin and GABA
• Medical conditions - Thyroid problems, heart conditions, or respiratory issues
• Medications - Some medications can trigger panic attacks as a side effect
• Caffeine and stimulants - Too much caffeine or other stimulants can trigger attacks

 

Psychological Factors

• Stress - High levels of stress or major life changes
• Trauma - Past traumatic experiences or PTSD
• Anxiety sensitivity - Being very aware of and frightened by physical sensations
• Catastrophic thinking - Tendency to interpret normal sensations as dangerous
• Phobias - Specific fears that trigger panic in certain situations

 

Environmental Triggers

• Crowded places - Shopping malls, concerts, or busy streets
• Enclosed spaces - Elevators, airplanes, or small rooms
• Driving - Especially on highways or in heavy traffic
• Social situations - Parties, meetings, or public speaking
• Physical sensations - Exercise, heat, or changes in breathing

 

 

Panic Disorder vs. Panic Attacks

Panic Attacks Alone

• Isolated episodes - Having occasional panic attacks without ongoing worry
• No avoidance - Continuing normal activities despite having had attacks
• Less impact - Attacks don't significantly change your daily life
• Various causes - May be related to specific stressors or medical conditions

 

Panic Disorder

• Recurrent attacks - Having repeated, unexpected panic attacks
• Persistent worry - Constant fear of having another attack
• Avoidance behaviour - Staying away from places or situations where attacks occurred
• Significant impairment - Attacks interfere with work, relationships, or daily activities
• Duration - Worry and avoidance last for at least one month

 

 

Physical vs. Panic Attack

Many panic attack symptoms feel similar to serious medical conditions, which can make attacks even more frightening:

 

Heart Attack vs. Panic Attack

Similarities:

• Chest pain
• Rapid heartbeat
• Sweating
• Shortness of breath

Differences:

• Heart attack pain - Usually crushing, radiates to arm or jaw, worsens with activity
• Panic attack pain - Usually sharp or stabbing, stays in chest area, may improve with movement
• Age and risk factors - Heart attacks more common in older adults with risk factors
• Duration - Heart attack symptoms may last longer and don't peak quickly like panic attacks

 

When to Seek Emergency Care

Call 911 or go to the emergency room if you have:

• Chest pain with shortness of breath, especially if you're over 40 or have heart disease risk factors
• Severe difficulty breathing
• Signs of heart attack (crushing chest pain, pain radiating to arm or jaw, nausea, sweating)
• Any symptoms you're unsure about - it's better to be safe

 

 

Treatment for Panic Attacks

Immediate Coping Strategies

When you feel a panic attack starting:

Breathing Techniques

• Slow, deep breathing - Breathe in for 4 counts, hold for 4, breathe out for 6
• Diaphragmatic breathing - Breathe from your belly, not your chest
• Paper bag breathing - Only if recommended by your doctor (can sometimes make things worse)

 

Grounding Techniques

• 5-4-3-2-1 technique - Name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste
• Focus on surroundings - Describe your environment in detail
• Physical grounding - Feel your feet on the ground or hold a cold object

 

Self-Talk

• Remind yourself - "This is a panic attack, it will pass, I am not in danger"
• Use coping statements - "I have gotten through this before, I can do it again"
• Stay present - "This feeling is temporary and will end soon"

 

Professional Treatment

Cognitive Behavioural Therapy (CBT)

• Most effective treatment - Strong research support for panic attacks and panic disorder
• Identifies triggers - Helps you understand what starts your panic attacks
• Changes thinking patterns - Challenges catastrophic thoughts about physical sensations
• Exposure therapy - Gradually facing feared situations or sensations
• Interoceptive exposure - Safely experiencing physical sensations that trigger panic

 

Medications

Antidepressants:

• SSRIs - Sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac)
• SNRIs - Venlafaxine (Effexor), duloxetine (Cymbalta)
• Take time to work - Usually 4-6 weeks to see full benefits
• Long-term treatment - Help prevent future panic attacks

Anti-anxiety medications:

• Benzodiazepines - Lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin)
• Fast-acting - Work quickly to reduce panic symptoms
• Short-term use - Usually prescribed for brief periods due to dependence risk
• As-needed basis - Often used only when panic attacks occur

 

Other Treatments

• Relaxation training - Learning progressive muscle relaxation and other techniques
• Mindfulness meditation - Staying present and accepting anxious thoughts without fighting them
• Support groups - Connecting with others who experience panic attacks
• Family therapy - Helping family members understand and support your recovery

 

Lifestyle Changes

Regular Exercise

• Reduces anxiety - Physical activity helps lower overall anxiety levels
• Improves mood - Exercise releases endorphins that improve mood
• Better sleep - Regular exercise helps you sleep better
• Start slowly - Begin with gentle activities like walking

 

Stress Management

• Identify stressors - Figure out what situations or thoughts increase your stress
• Time management - Organise your schedule to reduce feeling overwhelmed
• Relaxation activities - Regular activities that help you relax and unwind
• Set boundaries - Learn to say no to excessive demands on your time

 

Sleep Hygiene

• Regular schedule - Go to bed and wake up at the same time every day
• Comfortable environment - Keep your bedroom cool, dark, and quiet
• Avoid stimulants - No caffeine or large meals close to bedtime
• Relaxing routine - Develop calming activities before bed

 

Limit Triggers

• Reduce caffeine - Coffee, tea, energy drinks, and some medications contain caffeine
• Avoid alcohol - Alcohol can worsen anxiety and interfere with sleep
• Quit smoking - Nicotine is a stimulant that can trigger panic attacks
• Monitor medications - Some medications can increase anxiety

 

 

Living with Panic Attacks

Building Confidence

• Track your attacks - Keep a diary of when attacks happen and what triggers them
• Celebrate progress - Acknowledge when you handle attacks better or avoid fewer situations
• Practice coping skills - Regular practice makes techniques more automatic during attacks
• Stay active - Don't let fear of attacks stop you from doing things you enjoy

 

Support System

• Educate family and friends - Help them understand what panic attacks are and how to help
• Emergency contacts - Have people you can call when you're having an attack
• Support groups - Connect with others who understand what you're going through
• Professional support - Maintain regular contact with your healthcare providers

 

Work and School

• Know your rights - Panic disorder may qualify for accommodations under disability laws
• Communicate with supervisors - Consider discussing your condition with trusted supervisors or teachers
• Plan for attacks - Have strategies ready for managing attacks at work or school
• Stress reduction - Look for ways to reduce stress in your work or academic environment

 

 

Complications

Agoraphobia

• Fear of panic attacks - Avoiding places where you've had attacks or where escape might be difficult
• Progressive avoidance - Starting with specific places and expanding to more and more situations
• Severe cases - Some people become unable to leave their homes
• Treatment - Responds well to CBT and gradual exposure therapy

 

Depression

• Common co-occurrence - Many people with panic disorder also develop depression
• Impact of avoidance - Limiting your activities can lead to feelings of sadness and hopelessness
• Social isolation - Avoiding social situations can worsen depression
• Treatment - Both conditions can be treated simultaneously

 

Substance Use

• Self-medication - Using alcohol or drugs to cope with panic attacks
• Worsening symptoms - Substances often make anxiety worse over time
• Dependence risk - Can lead to addiction problems
• Treatment - Requires addressing both the substance use and the panic attacks

 

 

Prevention

Preventing First Panic Attack

While you can't always prevent your first panic attack, you can reduce your risk:

• Manage stress - Learn healthy ways to cope with stress
• Limit stimulants - Avoid excessive caffeine and other stimulants
• Regular exercise - Physical activity helps manage anxiety
• Adequate sleep - Get enough quality sleep regularly
• Healthy lifestyle - Maintain good nutrition and avoid excessive alcohol

 

Preventing Future Attacks

If you've had panic attacks before:

• Continue treatment - Keep taking medications and attending therapy as prescribed
• Practice coping skills - Regular practice of breathing and relaxation techniques
• Identify early warning signs - Learn to recognise when an attack might be starting
• Avoid known triggers - When possible, limit exposure to things that trigger your attacks
• Maintain healthy habits - Continue exercise, good sleep, and stress management

 

 

When to Seek Help

First Panic Attack

• See your doctor - Rule out medical conditions that might cause similar symptoms
• Don't wait - Early treatment can prevent panic attacks from becoming a bigger problem
• Be honest - Describe all your symptoms, even if they seem embarrassing

 

Ongoing Panic Attacks

• Frequent attacks - Having panic attacks regularly or multiple times per week
• Avoidance behaviour - Starting to avoid places or activities because of fear of panic attacks
• Impact on life - Attacks interfering with work, school, relationships, or daily activities
• Worsening symptoms - Attacks becoming more frequent or severe over time

 

Emergency Situations

• Suicidal thoughts - If panic attacks make you think about hurting yourself
• Severe avoidance - If you become unable to leave your home or do necessary activities
• Substance use - If you start using alcohol or drugs to cope with panic attacks
• Medical uncertainty - If you're not sure whether symptoms are panic attacks or a medical emergency

 

 

Panic Attacks in Different Populations

Children and Adolescents

• Can occur at any age - Even young children can have panic attacks
• Different presentation - May have trouble describing symptoms
• School impact - May affect school attendance and performance
• Family involvement - Parents and family are important in treatment

 

Women

• More common - Women are twice as likely to have panic disorder as men
• Hormonal influences - Menstrual cycle, pregnancy, and menopause can affect symptoms
• Pregnancy considerations - Some treatments may need to be modified during pregnancy

 

Older Adults

• Often overlooked - May be attributed to medical conditions or aging
• Medical complications - More likely to have medical conditions that can mimic panic attacks
• Medication interactions - Need to consider interactions with other medications

 

Cultural Considerations

• Cultural expressions - Panic attacks may be described differently in different cultures
• Stigma - Some cultures may have more stigma around mental health symptoms
• Treatment preferences - Cultural background may influence preferred treatment approaches

 

 

Related Terms

• Panic Disorder - Condition involving recurrent panic attacks
• Agoraphobia - Fear of places where panic attacks might occur
• Anxiety Disorders - Group of conditions involving excessive anxiety
• Generalized Anxiety Disorder - Persistent worry and anxiety
• Social Anxiety Disorder - Fear of social situations

 

 

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

National Institute of Mental Health. (2023). Panic Disorder: When Fear Overwhelms. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

Mayo Clinic. (2023). Panic attacks and panic disorder. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

Anxiety and Depression Association of America. (2023). Panic Disorder. https://adaa.org/understanding-anxiety/panic-disorder

---

 

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions about mental health concerns.