Your heart’s racing, it’s hard to breathe, and you can’t think straight — it could be the intense fear and anxiety of a panic attack.
Panic attacks — intense episodes of mental and physical symptoms — can happen to anyone. If you’ve ever experienced one, you’re not alone.
These panic episodes can directly respond to something shocking or scary, but they can also happen without any apparent reason. Understandably, the suddenness and lack of control can make them feel overwhelming and frightening.
For many people, panic attacks may be a one-time event. For others, it may be a recurrent thing. This usually happens in the context of a mental health condition, which might make you more prone to repeated panic attacks.
But in every case, panic attacks are manageable.
The first step to managing panic attacks — whether occasional or frequent — is understanding them and what they feel like.
A panic attack is an episode of sudden anxiety with an exaggerated bodily response to a threat or danger — whether it’s real or perceived.
This sudden surge of intense fear or anxiety brings on specific physical and psychological symptoms. These often reach peak intensity in just a few minutes.
During a panic attack, the dramatic physical sensations you feel (like chest pain or heart palpitations) can be so upsetting that some people mistake it for a heart attack.
The emotional and mental symptoms can be overwhelming, too. You might feel like something catastrophic will happen or that you need to escape the situation you’re in because you’re in imminent danger.
These sensations and feelings aren’t always related to a specific trigger. A panic attack can take you by surprise and might even happen when you’re resting or asleep.
It’s often the suddenness of panic attacks that’s most upsetting.
Some people experience panic attacks just once, but you may also experience them several times or chronically throughout your life.
Some people might also experience panic attack symptoms every time they’re in a specific situation, like when they get stuck in an elevator or when speaking in public.
In some cases, panic attacks can also result from medical conditions or injuries, or even as side effects of some medications.
Not all panic attacks have the same triggers or causes — and they can be both expected or unexpected.
Unexpected panic attacks
An unexpected panic attack happens suddenly without an evident reason or trigger. They can happen at any time and in any place, and you can’t attach the attack to anything specific.
You could even be having a great stress-free day and suddenly experience this type of panic attack.
Unexpected panic attacks aren’t usually linked to a specific thought, event, or stimulus. You could be sleeping, watching a movie, or laughing with a friend.
The unexpected aspect can make the experience more difficult to understand or feel especially frightening.
Expected panic attacks
Expected panic attacks are a result of a specific known trigger.
For example, if you’re afraid of small spaces and get stuck in an elevator, you might have an expected panic attack. Or you could have a panic attack while waiting to have a surgical procedure if you’ve been really anxious about it.
In other words, you know why you’re panicking.
Expected panic attacks can be situationally cued or predisposed.
A situationally cued panic attack might be experienced immediately after exposure to a specific situation that’s previously caused you anxiety or panic.
For example, if you fear spiders and come in contact with one, you may experience a cued panic attack.
A predisposed panic attack, on the other hand, doesn’t usually happen on cue after being exposed to the situation.
For instance, you might be afraid of flying, but you don’t have a panic attack every time you board a plane. Instead, you might have a panic attack before boarding, once onboard, or after you leave the plane altogether.
You might also have an expected panic attack from frightening thoughts or anxiety itself.
Symptoms of panic attacks can feel very overwhelming.
If your heart is racing, you’re having trouble breathing, and on top of that, your mind is telling you that you’re dying, it might be easy to convince yourself that’s true.
Feeling this way during a panic attack is actually pretty natural and common. But — it’s not what’s really happening.
In a panic attack, heart palpitations, feeling like you’re choking, and lightheadedness are mostly due to the adrenaline rush and hyperventilating. This, along with your racing thoughts, can lead to even more intense physical symptoms.
While it may feel like it — you’re not really having a heart attack or life-threatening experience. In fact, panic attacks aren’t usually dangerous or fatal.
A rare exception to this would be if you were to faint and hit your head, or if your panic lead you to react in a certain way that might expose you to real danger. For instance, if you panicked and ran out of your house, crossing the street without checking for cars first.
These are extremely rare occurrences, though. Most people don’t faint or run during panic attacks.
But while panic attacks aren’t lethal, there is a risk that your long-term health may be affected by frequent attacks, particularly if you do have an underlying cardiovascular disease.
This doesn’t mean you can die from a panic attack, but rather that multiple attacks can turn into a risk factor for some health conditions.
This is why it’s important to seek professional help to prevent and manage panic attack symptoms. It might also be a good idea to learn relaxation and stress management techniques.
During a panic attack, you can experience physical, emotional, and cognitive symptoms all at once.
If you believe you’ve experienced a panic attack, a mental health or medical professional can diagnose one and figure out if there’s an underlying cause.
They may start by doing a physical exam or tests to rule out any physical causes, and then ask you questions about the symptoms you had.
Many mental health professionals follow the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, if you experience four or more panic attack symptoms below, the incident will likely be deemed a panic attack.
Potential symptoms of a panic attack include:
- heart palpitations
- trembling or shaking
- shortness of breath or feeling smothered
- choking sensation
- chest pain
- nausea or abdominal discomfort
- dizziness or lightheadedness
- derealization or depersonalization
- fears of losing control or dying
- numbness or tingling
- chills or hot flashes
Heart palpitations and a racing heart
A common symptom of panic attacks is feeling your heart rate accelerating rapidly. You might feel or hear your heart beating harder or faster, or notice a pulse point thumping extra hard.
Your heart rate will typically slow down as the panic attack and symptoms subside.
As part of the panic response, you may start sweating. This can feel uncomfortable or even embarrassing if you’re in public, but this symptom usually only lasts for a few minutes and is completely normal.
Trembling or shaking
One of the first symptoms you might experience when having a panic attack is excessive and uncontrollable trembling, or shaking in your hands and legs.
You might still tremble — although less intensely — hours after your other panic attack symptoms have ended. The trembling should ease up more and more as you recover and calm down.
While uncomfortable, this symptom doesn’t usually indicate any physical problem.
Shortness of breath and smothering sensation
During a panic attack many people hyperventilate or feel like they’re suffocating. This can cause you to cough, gag, or even vomit.
As intense and uncomfortable as these symptoms can be, they’re a natural response to the adrenaline rush you’re experiencing.
Try to focus on steadying your breathing by taking deep breaths in and out. Your regular breathing rate should return within 5 to 30 minutes.
Feeling of choking
As with shortness of breath, feeling like you’re choking can also result from hyperventilation. Gasping for air may intensify your panic symptoms.
As difficult as it can be in the midst of a panic attack, try to remember that this is a product of anxiety and not a physical condition — you’re not actually choking. This might help you regain control of your breathing and feel better sooner.
Chest pain or discomfort
Between heart palpitations and hyperventilating, you may also experience anxiety chest pain. The first time this happens is often the scariest, since you may assume it’s your heart and not realize it’s anxiety.
Even though chest discomfort is a common panic attack symptom, it’s important to seek medical care if you’ve never had chest pain before. This can help you rule out any underlying cardiac conditions.
A doctor can run tests and ask questions to let them know whether it’s heart-related or anxiety.
Nausea or abdominal distress
Another consequence of all that adrenaline is nausea or stomach pain. These symptoms may worsen right at the peak of the panic attack — within the first 10 minutes.
Sometimes, you may still feel nauseous hours after the attack ends. Anxiety in general can cause stomach upset.
Feeling dizzy, unsteady, lightheaded, or faint
The combination of panic attack symptoms — racing heart, hyperventilating, and fear of losing control — can lead you to feel dizzy or lightheaded.
This is a natural response to panic. You should start to feel more stability once the other symptoms disappear.
Derealization or depersonalization
As panic attack symptoms peak, you might start getting the sense that what’s happening isn’t real, or start perceiving your surroundings differently, as if you’re in a movie. This is called derealization.
You can also feel detached from yourself, as if you’re not connected to your own body. This is depersonalization.
Fear of losing control
If this is one of the first panic attacks you’ve experience, the intense symptoms may lead you to feel like you’re losing control or your grasp on reality. You may also feel like everything’s closing in on you.
These are just temporary feelings — a product of all the physiological processes going on in your body — and not an indication of your mental health.
Fear of dying
Fear of dying is one of the most common symptoms of a panic attack, especially for early attacks or for people who have panic attacks infrequently.
Between the physical symptoms and intense anxiety, you may start worrying about your personal safety. These feelings are a direct result of panic, though, so it doesn’t necessarily indicate any physical or life-threatening problem.
Numbness or tingling sensations
If you start feeling a pins-and-needles sensation throughout your body, it may be due to the anxiety and adrenaline.
You can also feel numb or momentarily frozen. These sensations often go away within a few minutes.
Chills or heat sensations
Usually associated with excessive sweating, you can also experience chills or hot flashes. This is your body trying to adapt to the adrenaline and surge of panic.
Other symptoms and sensations
You can also experience other symptoms like crying, headaches, or vomiting. But to receive a diagnosis of panic attack, you’ll still need to have at least 4 of the detailed symptoms above.
Everyone is different, so panic attacks will be, too.
Not all panic attacks have the same symptoms or the same intensity. They can vary in duration, as well.
Typical panic attacks last up to 30 minutes, with the symptoms reaching peak intensity within the first 10 minutes before easing up. But depending on how intense your symptoms are, attacks can seem to last much longer.
In some cases, you may also experience residual effects for hours — like a rippling effect. So you could have some less intense physical and psychological sensations for up to a day or two after the panic attack began.
For instance, you could still feel somewhat shaky, dizzy, and experience fear of losing control hours after the actual panic attack has ended.
Panic attacks can last longer or come in and out in waves for days.
In fact, some people experience panic attacks every day for weeks or months. Others may have one panic attack and then go on for months or even years without having another one.
For some people, learning how to cope with anticipatory anxiety and how to manage panic attack symptoms can help decrease the frequency of the panic episodes.
Having a panic attack, or even a few, doesn’t mean you have a mental health condition.
But once you’ve had one panic attack — even if it was just the one time — it’s not uncommon to worry it’ll happen again.
As a result, you might start avoiding places, situations, and people that you think will trigger another panic attack. For example, you might start changing your daily routines or stop working out or going grocery shopping.
While changes in routines and habits can sometimes be a good thing, if they start causing problems in relationships or work, it might indicate an anxiety disorder.
Also, feeling constantly anxious about having a panic attack might actually lead you to experience one.
If this avoidant behavior and high anxiety continues and you experience regular, unexpected panic attacks, you might be diagnosed with panic disorder.
But you wouldn’t be alone. It’s estimated that at least 6 million people in the United States alone live with this mental health condition.
If you start avoiding social events or getting out of the house altogether for fear of having another panic attack and not being able to escape, then you might receive an agoraphobia diagnosis.
But not everyone who experiences panic attacks will be diagnosed with a condition such as panic disorder or agoraphobia.
In other words, anyone can experience panic attacks without having a panic disorder or mental health condition.
It all starts with the amygdala — or rather amygdalae, because there are two of them, one in each brain hemisphere.
This area at the base of the brain plays an important role in behavior and emotions, particularly fear processing.
When you face a threatening stimulus, that information is sent to the amygdala. In turn, amygdalae alert other parts of your body to trigger your fight, flight, or freeze response.
This is a natural physiological reaction to stress that quickly allows you to respond to whatever is perceived as a life-threatening situation.
At a glance, the process goes something like this:
- The amygdala receives the message that there might be danger.
- The amygdala pokes the sympathetic nervous system, so the body responds to the perceived danger.
- The adrenal glands release adrenaline, the fight-or-flight hormone.
- Adrenaline causes your heart to race and your breathing to accelerate, among other physiological symptoms.
- Your muscles start getting more blood (preparing you in case you need to run).
- Your brain receives more oxygen and becomes more alert.
- You’re ready to react to the threatening situation.
This, of course, is a great reaction to have if you really are in danger, like if you’re running from a wild animal attack.
But other types of stressful situations can also trigger the same responses as immediate physical danger — such as a big presentation at school if you fear public speaking.
But during a panic attack, just the perception of danger is enough for your body to respond. Also, the physiological reaction is way more intense than you’d really need it to be in order to respond to a threat.
You breathe even faster, and your heart pumps even more blood. This, in turn, causes you to experience other physical symptoms such as lightheadedness, hyperventilation, tunnel vision, chest pain, and numbness in parts of your body.
It’s not clear why the body overreacts this way in certain situations, leading you to panic.
In fact, the precise cause of panic attacks isn’t fully understood. A combination of factors could be involved, including:
- physical conditions, such as hypoglycemia
The amygdala plays a role in creating and retaining memories, particularly those linked to stressful and fearful situations. So your body might remember a stimulus that has caused you to feel fear in the past.
Some researchers also believe the body can perceive cues in the environment that your mind might not be aware of yet. These cues could be a noise, a smell, or any other sensation.
The amygdala then associates these cues with a past event where you felt fear or anxiety. This may trigger a panic attack.
Other researchers believe that physical abnormalities, disruptions, or chemical imbalances in this area of the brain may better explain panic attacks.
To sum it up, there’s no consensus yet as to what exactly causes panic attacks.
While panic attacks can feel awful and terrifying, they are manageable and can be treated with coping strategies, therapy, and sometimes medication.
Remember, having one panic attack doesn’t mean you’ll have another. But if you do, or are having anxiety about having another, talking to a health professional can help.
Consider seeking out a healthcare professional — your primary doctor or a mental health professional — if you’re:
- finding it difficult to make it through the day and your symptoms are interfering with your relationships, work, or any other daily activities
- having recurrent physical symptoms, such as insomnia, heart palpitations, headaches, or any form of pain
- using substances to cope with your anxiety and physical symptoms
- having panic attacks after sustaining an injury or being diagnosed with a medical condition
- staying home despite having responsibilities that require you to leave the house
- interested in better understanding your symptoms or would like to be screened for diagnosis
- interested in learning the best ways to self-manage your symptoms or the various treatment options for panic attacks
These resources might be a good starting point when seeking help:
A panic attack is an intense physical and psychological response to fear. It might come on from a recognized trigger or completely out of nowhere.
Either way, panic attacks can feel overwhelming and hard to make sense of.
Symptoms of panic attacks range from the physical and emotional. Your attack might include heart palpitations, nausea, an intense fear of dying, and feeling like you’re being smothered or choking.
These sensations can even make you feel like you’ve having a heart attack or you’re in life-threatening danger. However, panic attacks are not fatal.
Thankfully, panic attacks are manageable, too. Start with these coping tips, and if the anticipation of a new panic attack is interfering with your daily life, reach out to a healthcare professional for help.