A panic attack is not the hand-wringing worry we all have once in a while. It’s more like an anxiety bomb. It’s swift and powerful, and it can strike out of the blue.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines a panic attack as an abrupt surge of intense fear or discomfort, setting off a jumble of unpleasant feelings.¹ Panic attacks can be so distressing that some people keep these episodes under wraps. They may delay care, fearing the stigma that can come with a psychiatric diagnosis, according to a 2020 review in Neuroendocrinology Letters.² Even after being diagnosed, some people make repeated visits to the ER, believing they have heart disease, per a 2022 review in the Journal of Family Medicine and Primary Care.³
The thing is, you’re not in any physical danger, explained Russell Hunter, PsyD, a clinical psychologist in private practice in Northern Virginia and author of Attacking Panic: The Power To Be Calm. According to Hunter, a panic attack is more of “a false alarm.”
Here’s how to recognize when you’re having a panic attack.
A Panic Attack Comes on Quickly
One minute you’re fine and the next you’re in full-blown panic mode. What’s going on? It’s your body’s fight-or-flight response kicking in, according to the American Psychological Association.⁴ Hormones are released, your breathing accelerates, and your blood sugar spikes, Hunter told Health.
Some people are even bolted awake at night from so-called nocturnal panic attacks, according to a 2013 study in the Journal of Clinical Sleep Medicine.⁵
There May Be No Obvious Trigger
A panic attack is your body’s response to some perceived threat, albeit one that may not be readily apparent. It could be that a person’s survival-mode instincts are excessive, according to the National Institute of Mental Health.⁶
Panic attacks are a symptom of panic disorder, per the DSM-5.¹ Why some people experience these attacks isn’t entirely clear, although a family history of panic attacks, stressful life events, and environmental factors are thought to may play a role.⁷
Panic attacks often begin in a person’s teens or before the age of 25, but they can also strike children and adults in their 30s.⁸
12 Signs You May Have an Anxiety Disorder
It’s Short-Lived
A panic attack often peaks within minutes before symptoms begin to subside.¹ After a certain amount of time, you might realize “there’s nothing dangerous happening,” Hunter said.
You May Think You’re Having a Heart Attack
A racing or pounding heart is a common symptom of a panic attack. You might even have chest pain or discomfort. That’s why people having panic attacks often believe they’re having a heart attack. But once in the hospital, they start to feel better because “the danger is starting to go away,” Hunter said.
It Can Be Hard to Catch Your Breath
Shortness of breath and hyperventilation are clues that you could be in panic mode. “Breathing disruptions are one of the most universal symptoms of panic attacks,” said Lily Brown, PhD, assistant professor of psychology and director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania’s Perelman School of Medicine.
You Think You Might Faint
Lots of people report feeling dizzy⁷ or lightheaded when they’re in the throes of a panic attack. They’re often afraid they’re going to faint. When these feelings surface, a person typically will sit with their head between their legs.
“What happens is they never have the opportunity to learn if they just ride out that feeling, it will eventually subside,” Brown explained. “It’s extremely uncommon for a person to actually faint in the context of a panic attack,” she said.
There’s a Feeling of Doom
If you’re having a panic attack, you might feel like you’re losing control or that you might die.⁷
In certain social situations, people with social anxiety disorder may experience similar sensations, such as fear and trembling.⁹ However, in a small, 2016 study in Psychiatry Research, Brown and colleagues examined differences in panic attacks in panic disorder. Turns out those awful sensations are much more common in people with panic disorder than with social anxiety disorder.¹⁰
Your Hands Get Tingly
Panic attacks can cause a pins-and-needles feeling or numbness in your extremities, reports the American Academy of Family Physicians.¹¹ In rare instances, Hunter said, you can have more severe symptoms, like pseudoseizures.
“People will literally fall down to the ground and convulse,” he explained. But there’s no abnormal functioning of the brain; rather, it’s brought on by severe psychological distress, which could happen during a panic attack, he said.
It’s Like an Out-of-Body Experience
You might feel like you’re detached from yourself or your surroundings, an outsider to your own experience. It’s a feeling of unreality, like in a dream, Hunter said. This symptom is often referred to as derealization.¹²
You Get Sweaty or Have Chills
With a panic attack comes a surge of adrenaline that boosts blood flow to the extremities, Hunter explained. All of a sudden, you’re hot. You sweat and shiver to cool the body down.⁷ Brown said patients will often report forehead sweating or palm sweating, although others may report sweating all over.
You Feel Like You’re Choking
During a panic attack, your body releases stress hormones. “People will get tense, their muscles will start to contract, including in the throat and the chest area,” Hunter said.
Your Stomach Might Hurt
No surprise here: When you’re anxious, you can feel it in your gut. Stress and anxiety mess with your digestive tract. Nausea and abdominal distress, like stomach pain, are common symptoms.⁷
You Avoid Situations That Trigger Similar Symptoms
“A person who is very, very fearful about having the next panic attack might do a lot of things to prevent those panic attacks,” Brown explained. They begin to avoid activities like exercise, which raises their heart rate and quickens their breathing. They focus on those feelings, which makes them more anxious, ultimately leading them “down the rabbit hole of having more and more [panic attacks].”
But not everyone who has panic attacks goes on to develop panic disorder, she added. In order to be diagnosed with panic disorder, you must have one or more panic attacks followed by at least one month of fear related to having another panic attack or acting in ways to avoid panic attacks.¹
You Feel Exhausted Afterward
People who have panic attacks quickly deplete the resources their bodies have marshaled to fend off the presumed danger. Sooner or later, that burst of energy, fueled by a spike in blood sugar, will get spent and “they’re going to crash,” Hunter explained.
After the panic attack subsides, he said, they feel “wiped out.”
While they tend to be terrifying, the good news is panic attacks can be easy to spot if you know what to look out for. And just because you experience a panic attack doesn’t mean it will happen again. If you’re concerned about future occurrences, reach out to your health care provider and come up with a plan so you feel empowered to deal with those sensations should they arise.
Sources:
- DSM-5 Changes on the National Survey on Drug Use and Health.
- Kolek A, Prasko J, Ociskova M, et al. “Don´t tell me that I am hysterical”: Unmet needs of patients with panic disorder. Neuroendocrinology Letters. 2020;41(7-8):370-384.
- Manjunatha N, Ram D. Panic disorder in general medical practice- A narrative review. Journal of Family Medicine and Primary Care. 2022;11(3):861-869. doi:10.4103/jfmpc.jfmpc_888_21
- American Psychological Association. Answers to Your Questions About Panic Disorder.
- Nakamura M, Sugiura T, Nishida S, Komada Y, Inoue Y. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. Journal of Clinical Sleep Medicine. 2013;9(5):461-467. Published 2013 May 15. doi:10.5664/jcsm.2666
- National Institute of Mental Health. Panic Disorder: When Fear Overwhelms.
- MedlinePlus, National Library of Medicine. Panic Disorder.
- MedlinePlus, National Library of Medicine. Heart Attack First Aid.
- MedlinePlus, National Library of Medicine. Social Anxiety Disorder.
- Brown LA, LeBeau R, Liao B, Niles AN, Glenn D, Craske MG. A comparison of the nature and correlates of panic attacks in the context of Panic Disorder and Social Anxiety Disorder. Psychiatry Research. 2016;235:69-76. doi:10.1016/j.psychres.2015.11.048
- American Academy of Family Physicians. Panic Disorder.
- Ray S, Ray R, Singh N, Paul I. Dissociative experiences and health anxiety in panic disorder. Indian J Psychiatry. 2021;63(1):70-73. doi:10.4103/psychiatry.IndianJPsychiatry_896_20
