If you live with panic disorder, it’s common to fear when (and where) your next panic attack might happen.
If you’ve had several panic attacks and feel terrified of having another, you could have panic disorder.
Panic attacks can feel overwhelming and extremely uncomfortable, so it’s not unusual to worry about having more.
These intense episodes of extreme fear and terror usually come on without warning. If you don’t know what triggers them, you could begin to worry about having another at any time.
If you fear having a panic attack in public or while driving, you might avoid going out. In time, you could end up pulling back from your usual activities, including working and spending time with loved ones.
Panic disorder is very manageable, though — you don’t have to live in fear of these attacks. Learning to recognize key signs can help you take steps toward managing your condition.
Panic disorder is an anxiety condition that involves repeated panic attacks. You can recognize panic disorder by two main signs:
- repeated panic attacks
- a fear of having more attacks
It’s very common to have a panic attack or two over the course of your life, but
Over time, panic attacks can become more frequent. The more attacks you experience, the more you might worry about future ones.
You might have them only occasionally and go several weeks or months between attacks. You could also have several in a month — or week. A large part of the fear you have around these attacks might lie in this unpredictability.
Recognizing a panic attack
Panic attacks happen suddenly and typically involve several of the following symptoms:
- extreme fear that has no clear cause
- difficulty catching your breath
- dizziness or faintness
- sweating, chills, or feeling hot and cold all at once
- a pounding or racing heart rate
- shaking and trembling
- a sensation of doom or losing control
- numbness or tingling in your limbs, fingers, and toes
- prickling skin, a sensation of your hair standing on end
- a sense of being disconnected or separate from your body
Your body produces these sensations as part of the fight, flight, or freeze response when you feel threatened or face danger.
You might notice them when you hear footsteps behind you on a solitary walk after dark or after narrowly avoiding a collision with another car on the highway.
That’s a natural fear response. Panic attacks, however, happen without a noticeable threat or source of danger.
Not everyone experiences panic attacks in the same way, so two people living with panic disorder might notice different sensations and symptoms.
That said, you might recognize some of these common experiences.
You think you might die
Panic attacks often involve chest pain, choking sensations, and difficulty breathing. Your thoughts might swim and race, overwhelming you as your vision blurs or narrows. You might even feel as if your limbs are heavy or frozen and struggle to move.
When you aren’t used to these sensations, you might believe something is terribly wrong. You could assume you’re having a heart attack, stroke, or other health emergency.
It’s also common to experience feelings of impending doom with panic attacks, so you might even wonder whether you’re about to die.
You feel like you’re losing control
During a panic attack, you might feel disconnected or detached from your body.
You might feel as if you’re losing track of reality, as if the things happening around you aren’t real. Time might seem to slow down or speed up, and your surroundings could begin to feel disjointed or dreamlike.
This sense of detachment could trigger worries about being unable to control your reactions.
Knowing you can’t predict or stop the attacks can also leave you with a sense of powerlessness. When panic disorder involves frequent attacks, you might feel even more concerned about losing control of your emotions, actions, or both.
You worry about having a panic attack in public
It’s very normal to want to avoid having panic attacks around other people. There’s a lot of stigma around mental health symptoms in general, so you might worry people won’t understand what’s happening.
You might believe others will think you just want attention. Maybe you just don’t want to feel vulnerable around strangers or in a public place. You might also want to avoid dealing with physical discomfort and emotional distress in front of others.
You feel safer avoiding situations you associate with panic attacks
Living with panic disorder typically means you spend a lot of time dreading future panic attacks and doing whatever you can to avoid them.
If you had a panic attack on the train, you might conclude that being on the train triggered the attack.
Maybe you have a panic attack while running in the park or just after presenting your research project. You might then decide to avoid the park or running in general. Perhaps you even plan to skip your next presentation, even though it’s a big part of your grade.
If you live with panic disorder, you might end up slowly but steadily eliminating all potential panic attack triggers from your life. In time, you could find yourself avoiding any situation that inspires feelings of nervousness or fear, just in case you have another attack.
Here are a few examples of how panic disorder can affect your daily life and routines:
- You don’t want to have a panic attack on the road, so you stop driving.
- The thought of having a panic attack on a plane terrifies you, so you stop traveling to see family and friends in your hometown.
- Since you can’t get to work without taking public transportation, you quit your job.
- After having a panic attack during class, you feel so nervous about returning to school that you eventually withdraw.
- You struggle to explain to your partner that you’re afraid of feeling like you’re choking and losing control in public. They don’t understand why you can’t go out to eat, and this creates tension in your relationship.
- You might try to manage your anxiety with alcohol, only to find it intensifies your feelings.
Panic disorder can sometimes contribute to agoraphobia, or the fear of being in a space you can’t easily leave. Eventually, you might begin to feel so anxious you avoid going anywhere at all.
Why avoidance doesn’t work
You can’t really control when or where attacks happen, no matter how you try. Case in point: It’s possible to experience panic attacks while asleep, and sleep isn’t something you can safely avoid.
Avoidance can seem helpful. In reality, though, it only prevents you from exploring more effective ways to navigate uncomfortable emotions, such as anxiety, or unwanted experiences, such as panic attacks.
It’s pretty much impossible to avoid emotional distress in life. Building a toolbox of coping skills — breathing exercises, journaling, or relaxing music, to name a few — can prepare for unexpected challenges and help you weather discomfort more easily.
The same is true for panic disorder.
Panic attacks are unpredictable, and you may never pin down a specific trigger. Avoiding the things you enjoy and the people and places you love generally only isolates you and worsens anxiety and distress.
A better approach than avoidance? Treatment and support.
Panic disorder can’t be cured, but treatment and coping strategies can make a big difference in your symptoms.
Support from a mental health professional can make it easier to explore and manage feelings of anxiety.
A therapist can also teach helpful strategies for coping with fear and physical discomfort during a panic attack. This might include techniques like challenging and replacing negative beliefs, decatastrophizing, or systematic desensitization (a type of gradual exposure).
Therapy approaches used to treat panic disorder include:
- cognitive behavioral therapy
- mindfulness-based stress reduction
- panic-focused psychodynamic psychotherapy
- acceptance and commitment therapy
A doctor or psychiatrist can prescribe medication to help relieve panic disorder symptoms. Medication can help ease anxiety around having more panic attacks, making it easier to pursue treatment and maintain your usual routine.
Depending on your symptoms, a medical professional might recommend:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- benzodiazepines and other fast-acting medications
- beta blockers
When you notice early signs of a panic attack, try some deep breathing or muscle relaxation.
These strategies can relieve symptoms and interrupt the attack, helping you feel more in control.
- Slowly breathe in through your mouth, visualizing your lungs filling with air as your belly expands.
- Count to 4 as you inhale.
- Hold your breath for a second or two.
- Exhale slowly as you count to 4 again.
Continue breathing slowly and deeply until you feel your rapid breathing return to a more regular pace.
Progressive muscle relaxation involves slowly tensing and then relaxing muscles throughout your body. This technique can
- Breathing slowly, tense the fingers of your left hand. Hold the tension as you count to 5, then let go as you exhale.
- Make a fist with your left hand. Tighten as you count to 5, then release as you exhale.
- Tense the muscles in your left arm. Hold for a count of 5, then release.
- Continue in the same pattern throughout your body until panic symptoms ease.
Learning and practicing these techniques between panic attacks has two benefits:
- They can help reduce stress and anxiety in general, which could help you experience fewer attacks.
- Once you’re familiar with them, reaching for them in a moment of distress will feel more natural.
Relief from panic and anxiety symptoms may number among the many mental and physical health benefits of exercise.
Regular aerobic exercise seems to help improve anxiety symptoms associated with panic disorder, research suggests.
You might start with about
Any exercise can help, but consider finding an activity that feels more like fun than a chore. The more you enjoy it, the more relaxing it might feel — and the more likely you’ll want to keep doing it.
Here are some ideas for exercises to try:
- hiking or walking
- roller or in-line skating
Your physical and mental well-being can have some influence on each other.
That doesn’t mean good physical health will cure mental health symptoms. All the same, tending to your body’s needs can sometimes help ease emotional distress.
Feeling physically well can also strengthen your resilience and outlook, making it easier to manage any mental health symptoms you do experience.
A few examples include:
- eating nutritious meals and staying hydrated
- setting aside some time each day to relax and unwind (even 15 minutes can make a difference)
- devoting at least 7 hours each night to sleep
- making time to stretch and move your body
Mindfulness, in basic terms, describes your ability to stay present in a given moment.
Focusing your awareness on the sensations you feel during an attack can ground you, helping you stay connected to your body and safe.
Repeating a mantra can be a great tool to maintain your focus during a panic attack. You might try:
- “I am safe.”
- “This fear will pass, like it has before.”
- “These feelings are just panic, and I can get through them.”
Panic disorder can leave you exhausted and isolated, but you’re not alone. With therapy and support, you can find ways to manage, and even reduce, these attacks.
Remember, avoiding the panic won’t necessarily help. Instead, it can help to lean in, and remind yourself that you’ll make it through — just like you have in the past.