Panic Attacks: A Comprehensive Guide

Panic attacks: an overview

A panic attack is an abrupt onset of intense fear that causes extreme physical reactions, even though there is no apparent cause or danger. Panic attacks can be an alarming experience. When a panic attack happens, people often think they’re having a heart attack, losing control, or dying. 

While panic attacks are common, most people only experience one or two in their lifetime. The problem often goes away after the stressful situation triggering the panic attack is resolved. However, someone with recurring, unexpected panic attacks who lives in constant fear of when the next panic attack may happen may have a condition known as panic disorder. 

Panic attacks aren’t life-threatening, but recurrent panic attacks can negatively affect your quality of life. Treatment for panic attacks can be very effective. 

In any given year, a percentage of American adults experience a variety of anxiety disorders:

• Specific phobia: 7–9 percent
• Social anxiety disorder: 7 percent
• Panic disorder: 2–3 percent
• Agoraphobia: 2 percent
• Generalized anxiety disorder: 2 percent 
• Separation anxiety disorder: 1–2 percent

Women are more likely to experience anxiety disorders than men.

What is a panic attack?

A panic attack is a sudden rush of severe and intense discomfort or pain. It typically reaches its peak within 10 minutes and includes four or more of the common co-occurring symptoms:

• A racing heart, palpitations, and/or rapid heart rate
• Sweating
• Shaking or trembling
• Feelings of shortness of breath or the feeling of being smothered
• Chest pain
• Nausea, upset stomach, or abdominal pain
• Feeling of choking
• Chills or hot flashes
• Feeling faint, dizzy, or light-headed
• Numbness or tingling 
• A sense of unreality or feeling detached or being unreal
• Fear of losing control
• Fear of dying 

Panic disorder is when panic attacks are recurrent, often stemming from a combination of severe physical and psychological distress. 

Panic attacks are quite intense, and many people experiencing them think they are having a heart attack or experiencing a life-threatening illness. As a result, many people go to the emergency room (ER) when they have a panic attack.

Panic attacks fit into two categories:

• Expected — A response to a feared object, person, or experience
• Unexpected — A response that seems to occur for no reason

Panic attacks begin abruptly and can last anywhere between several minutes to an hour. 

The average age for the onset of panic disorder is 22 to 23. Panic attacks can occur in conjunction with other mental health conditions such as post-traumatic stress disorder or depression. They often occur in people who have other anxiety disorders, when the person is repeatedly triggered by the recollection of past feared situations or objects. For example, people with specific phobias and/or obsessive-compulsive disorder as well as those who have experienced trauma may be more prone to panic attacks. 

People with panic disorder experience one or more of the below:

• At least one panic attack that seems to be unexpected 
• At least one month (or longer) of significantly worrying about their next attack and its consequences
• A significant shift in behavior as a result of the attacks, such as avoiding places or situations where they can’t escape 

If you’re experiencing an unexpected panic attack, it can be challenging to identify your feelings and sensations as a panic attack. The absence of something to be afraid of can make it difficult to recognize that you’re panicking. 

Panic attacks and somatic symptoms

Somatic symptoms are symptoms related to the physical body, such as pain or discomfort. Along with other anxiety disorders and depression, patients with panic disorder often have somatic symptoms such as:

• Cardiorespiratory symptoms
• Gastrointestinal symptoms
• Otoneurological symptoms

Someone focusing on these physical symptoms may be more likely to seek treatment from a general medical doctor instead of a mental health professional. Patients who visit the ER or a family doctor for their panic disorder are often left feeling unsatisfied with the level of treatment and may repeatedly seek medical care. 

As a result, patients with panic disorder may be at risk for higher medical utilization. They go to an excessive number of medical appointments, are often prescribed unnecessary medications, and may go through expensive medical tests to rule out medical issues. Some people may not be properly diagnosed with panic disorder for as long as 10 years.

What does a panic attack feel like?

Panic attacks are often characterized by a fear of death, disaster, or losing control, even though there is no concrete danger. There may be strong physical symptoms or responses during a panic attack. Some people confuse their panic attack with symptoms of a heart attack. 

People with panic disorder have sudden panic attacks repeatedly. They often live in fear about when and where their next panic attack will happen. As a result, they may avoid situations that they think will cause them to have a panic attack, sometimes making them antisocial and reclusive. They might also frequently visit their health care provider for their panic attacks. 

People with panic disorder experience panic attacks that can result in:

1. Feeling very scared or nervous
2. Physical symptoms

• Trouble breathing
• Racing heart
• Headache
• Dizziness
• Chest pain
• Stomachache

Possible causes of panic attack

The medical community isn’t entirely sure what causes anxiety disorders. The cause is likely a combination of factors including environment, psychology, development, and genetics. 

Panic disorders are often linked to patients with genetic, temperament, childhood adversity, life stress, and neurobiology factors. 

Genetics

Research has indicated that there might be a genetic component to panic disorder. People with first-degree relatives with panic disorder have a higher risk of having the disease themselves than people with relatives who have major depression or are entirely healthy. 

Most genetic research about panic disorder has focused on candidate gene studies and linkage. Most research to date has been inconclusive, either because it couldn’t be replicated or because the sample size was too small.  

Some experts have suggested that the underlying genetic factors differ significantly depending on the subgroup of patients with panic disorder; for example, differences in familial versus nonfamilial or early versus late onset of the condition. This further complicates research in this field. 

Temperament

People with generally anxious temperaments have a higher risk of developing panic disorder. People with neuroticism (poor stress resilience) or anxiety sensitivity (fear of symptoms of anxiety) are more prone to panic disorder. 

There also seems to be a link between a temperamental trait known as behavioral inhibition and anxiety disorders. Children of parents with panic disorder who displayed behavioral inhibition as children were found to have smaller hippocampi as teenagers. The hippocampus helps regulate emotions.

Childhood adversity

Studies show that children who experienced adversity in their childhood, such as physical or sexual abuse, have an increased risk of developing panic disorder as adults. These people are particularly at risk for unexpected panic attacks as they may re-experience their trauma. 

Smoking as a child and sometimes asthma seem to increase the risk of panic disorder in adulthood.

Stress

People often experience panic attacks when they’re dealing with significant stress in their life. Studies have shown that people experiencing panic attacks typically had a stressful life event within the previous 12 months. Life stresses around threats, illness, or loss are particularly strong triggers for panic attacks.

Neurobiology

A new neuroanatomical model for panic disorder focuses on specific areas, such as the hypothalamus and the amygdala, as potential sites for neural triggers of panic attacks. This model’s foundation links panic attacks to a basic animal mode of fear. The model suggests that if you inherit specific brain areas that are hyperexcitable, it could increase your risk for having panic attacks when exposed to stressors. 

The model suggests that having catastrophic thoughts could make you more likely to have panic attacks. The amygdala combines sensory information (from your sensory cortex and thalamus) with stored memories (from the hippocampus and frontal cortex), and then generates a panic response.

One review looked at 109 studies that examined the brain structure of people experiencing a provoked sudden panic. The review showed that patients with panic disorder had altered brain structures. 

There’s not as much evidence that the amygdala is involved in panic disorder. The evidence that prefrontal, insula, hippocampus, anterior cingulate, and temporal areas are involved in panic disorder is much stronger. This suggests that the condition is linked to more than just animal fear but has to do with a broader set of neural processes and circuits. 

How to stop a panic attack

It can be helpful to know how to stop a panic attack when you feel it coming on. Some people suggest meditation and stress management tactics. Relaxation techniques and focusing on positive visualization can help you flow through an attack.

Some experts have found that people with panic disorder often have slightly higher-than-typical breathing rates. Learning to slow down your breathing can help deal with a panic attack when it happens and prevent future ones.

How long does a panic attack last?

Panic attacks can last anywhere from several minutes to an hour. Panic attacks usually reach peak intensity in about 10 minutes or less, and then symptoms will begin to subside. 

Panic attack vs heart attack

In the moment, it can be hard to understand if you’re experiencing a panic attack or heart attack. Symptoms that can be confusing are rapid heart rate, trouble breathing, dizziness, and chest pain.

Explaining your panic attacks to others

Let people know that panic disorder is a real, diagnosable mental health condition — an anxiety disorder. 

How to calm a person with a panic attack

It can also be helpful to know how to help someone else experiencing a panic attack.

If you see someone experiencing a panic attack, stay calm and try to walk them through it. Try to encourage the person to:

• Count breaths, breathing in for four counts, holding for four counts, and exhaling for four counts
• Use coping statements, such as “I’m not dying; I’m feeling anxious” to help interrupt irrational thoughts
• Shift their focus to something else once their breathing is under control

After a panic attack, it’s helpful to take some time to recover and unwind.

If you’ve never experienced a panic attack yourself, it can be hard to understand what the person is going through. It can be useful to educate yourself about what a panic attack is, what the symptoms are, how long anxiety attacks last, and what coping mechanisms are available. 

When to seek professional help

If you have been experiencing symptoms of panic disorder, consult with a health care provider. They will ask you for more details about your symptoms and the frequency of the panic attacks. Panic attacks have similar symptoms to heart attacks, so your health care provider may want to conduct a physical exam and rule out other conditions. 

Panic attacks, if left unaddressed, can increase in frequency and become a serious problem. If you’re experiencing symptoms of panic attacks, talk to a health care provider right away. 

Top things to remember

Panic attacks can be very frightening. They often occur suddenly and can result in feelings of intense fear and physical reactions to no apparent danger. People experiencing a panic attack often think they’re having a heart attack, losing control, or dying. 

There is no test for panic attacks or panic disorder, but your health care provider can diagnose you by listening to you describe your symptoms. 

There are several treatment options to cope with the symptoms of anxiety disorders such as panic disorder. Stress management, meditation, and support groups (online or in-person) can all be helpful. Learning about the disease and educating friends and family can feel like you’re taking back control. People with anxiety disorders should generally avoid caffeine and speak to their health care provider before taking any medications.