Understanding Panic Attacks

What is a panic attack?

A panic attack is a sudden episode of intense fear or discomfort that reaches a peak within minutes. It can happen in a stressful situation or seemingly out of the blue — even during sleep. The experience can be frightening: many people are convinced they are having a heart attack, going to faint or losing control. Panic attacks are common, though, and they are not dangerous in themselves. Many people have at least one at some point in their lives, and most never go on to develop panic disorder.

“Anxiety attack” is a popular term but not a formal diagnosis. It is often used for a build-up of worry and tension that is slower and less intense than a panic attack, although people use the words differently.

Common symptoms

• Pounding or racing heart
• Sweating, trembling or shaking
• Shortness of breath or a feeling of choking
• Chest discomfort
• Nausea or stomach upset
• Dizziness or lightheadedness
• Chills or hot flushes
• Numbness or tingling
• Feeling detached or unreal (derealization or depersonalization)
• Fear of losing control or dying

Most attacks peak within about ten minutes and ease over the next 20 to 30 minutes, although you may feel drained afterwards. Because symptoms overlap with heart and breathing problems, it’s important to seek medical care if you are unsure what is happening — especially if it’s your first episode, if the pain is severe or spreads to your arm or jaw, or if you have risk factors for heart disease. If in doubt, call your local emergency number.

Why panic attacks happen

Panic attacks involve a sudden activation of the body’s fight-or-flight response when there is no real danger. Several things can contribute: stress, genetics, caffeine or stimulants, hyperventilation, major life changes, certain medical conditions and sensitivity to body sensations. After one attack, people may start watching for symptoms and fearing the next one, which can make further attacks more likely. This cycle — a body sensation, a catastrophic interpretation, more fear and more sensation — is the target of most effective treatments.

Often there is no identifiable trigger, which can make attacks feel random. That is one reason many people ask why they feel anxious for no reason.

What can help during an attack

• Remind yourself that the sensations are uncomfortable but will pass. A phrase such as “This is a panic attack. It’s not dangerous, and it will peak and fade” can help.
• Slow your breathing, focusing on a long, gentle out-breath, for example in for four counts and out for six. Avoid gulping air.
• Ground yourself in your surroundings by naming things you can see, feel and hear. See how to calm your mind.
• Loosen tension by dropping your shoulders and unclenching your hands.
• Try not to flee the situation if you are safe — staying can teach your brain the situation isn’t dangerous, whereas escaping reinforces the fear. If you need to sit down or step outside, that’s fine.
• Avoid sipping alcohol or relying on a paper bag. Breathing into a bag isn’t recommended.

Helping someone else

Stay calm, speak in short reassuring sentences, ask what would help, and breathe slowly with them. Avoid telling them to “calm down.” If symptoms don’t ease, if they have chest pain, or if you’re unsure, seek medical help.

Panic disorder

Panic disorder involves recurrent, unexpected panic attacks and at least a month of persistent worry about more attacks or changes in behavior to avoid them — for example, avoiding exercise, driving, crowded places or being alone. It is a type of anxiety disorder, and sometimes occurs with agoraphobia, a fear of situations where escape could be difficult. These patterns can occur with panic disorder, but only a qualified healthcare professional can provide a diagnosis. A clinician will usually also check for medical contributors such as thyroid problems, heart rhythm issues, medication effects and substance use.

Treatment

Panic disorder is highly treatable. Common options include:

• CBT, which teaches you to understand panic, change catastrophic thoughts and gradually face feared sensations and situations. This includes interoceptive exposure, where you deliberately and safely bring on harmless body sensations, such as a racing heart, so that they lose their power.
• Medication, particularly SSRIs and related antidepressants, which can reduce the frequency and severity of attacks. See anti-anxiety medications and antidepressants.
• Lifestyle changes such as regular exercise, consistent sleep, and reducing caffeine and alcohol.
• Self-help resources based on CBT principles, and support groups.

CBT for panic can be done online with a licensed therapist, for example through BetterHelp. If you and a clinician decide medication may help, services such as Lemonaid Health and Sesame prescribe non-controlled options such as SSRIs, but not benzodiazepines. Compare options in our guide to online anxiety treatment.

When to seek help

Speak with a healthcare professional if you have had more than one panic attack, if you’re avoiding places or activities because of fear of an attack, if worry about attacks is constant, or if you’re using alcohol or other substances to cope. Seek urgent help if you have thoughts of harming yourself; see Get Help Now.

Key points

• Panic attacks are intense but short-lived and not dangerous in themselves.
• Seek medical care for a first attack or if symptoms could be a heart problem.
• Slow breathing, grounding and staying put can help in the moment.
• CBT and, for some people, medication are effective for panic disorder.