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Panic Attacks and Panic Disorder

Ever experienced a sudden surge of overwhelming anxiety and fear? Explore this guide to panic attacks, including symptoms, treatment, and self-help tips.

What is a panic attack?

A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep.

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A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.

You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.

Paula’s story

Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.

Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.

Panic attack signs and symptoms

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.

Panic attack symptoms include:

• Shortness of breath or hyperventilation
• Heart palpitations or racing heart
• Chest pain or discomfort
• Trembling or shaking
• Choking feeling
• Feeling unreal or detached from your surroundings

• Sweating
• Nausea or upset stomach
• Feeling dizzy, light-headed, or faint
• Numbness or tingling sensations
• Hot or cold flashes
• Fear of dying, losing control, or going crazy

Is it a heart attack or a panic attack?

Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.

Signs and symptoms of panic disorder

While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.

You may be suffering from panic disorder if you:

• Experience frequent, unexpected panic attacks that aren’t tied to a specific situation
• Worry a lot about having another panic attack
• Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:

Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.

Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.

If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.

For example, you may begin to avoid:

• Crowded places such as shopping malls or sports arenas.
• Cars, airplanes, subways, and other forms of travel.
• Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.
• Physical exercise in case it triggers panic.
• Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
• Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.

Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:

1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly
2. Hyperthyroidism (overactive thyroid gland)
3. Hypoglycemia (low blood sugar)
4. Stimulant use (amphetamines, cocaine, caffeine)
5. Medication withdrawal

Self-help tips for panic attacks

No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:

Learn about panic and anxiety. Simply knowing more about panic can go a long way towards relieving your distress. Read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.

Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see How to Quit Smoking. Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.

Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of.

Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.

Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and build supportive friendships.

Exercise regularly. Exercise is a natural anxiety reliever so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.

Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, these tips to getting a good night’s sleep can help.

Treatment for panic attacks and panic disorder

The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is therapy. Even a short course of treatment can help.

Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.

Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.

Medication for panic attacks and panic disorder

Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.

Medications used may include:

Antidepressants. It takes several weeks before antidepressants begin to work, so you have to take them continuously, not just during a panic attack.

Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.

How to help someone having a panic attack

Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.

Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.

Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.

Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.

Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest.

Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D.