A panic attack is a sudden feeling of intense fear or disabling anxiety resulting in such acute distress that a person fears they are losing control or dying.
The intensity of the attack typically peaks at around 10 minutes, but symptoms can persist after that. A panic attack usually occurs without warning and is unrelated to any real danger or apparent cause. It may even wake a person from a sound sleep.
An estimated 1 in 3 people experience a panic attack at some point, often between the ages of 15-19.2 Of those who experience panic attack symptoms, less than 3% will progress to a panic disorder.3
According to the University of Florida's Fear and Anxiety Disorder Clinic, around 1.7% of adults aged 18 to 54 in the US (approximately 2.4 million Americans) has panic disorder in a given year.10
Contents of this article:
Description of panic attack symptoms
A panic attack will have at least four of the symptoms below:1
Panic attacks can be a terrifying experience. They typically last 10-20 minutes and are not life threatening.
- Pounding, racing heart
- Shortness of breath
- Choking sensation
- Chest discomfort
- Dizzy, feeling faint
- Feelings of unreality or detached from self
- Tingling or numbness
- Chills or heat sensations
- Fear of "going crazy"
- Fear of dying.
Although it is a terrifying event for the person experiencing a panic attack, it typically lasts between 10 and 20 minutes and is not life threatening. There is no pattern to panic attacks; some people may experience several in a day and go months without a reoccurrence, while others may have attacks on a weekly basis.
Because panic attacks can mimic other health conditions, it is necessary for anyone experiencing these symptoms to be evaluated by a health care professional to determine if there is an underlying medical cause. Certain heart problems, respiratory conditions, hormone irregularities, and stimulants like caffeine can all cause similar symptoms as seen with a panic attack.3
History of panic in medicine
Doctors first identified "panic attack" as a diagnosis around the mid 19th century. The origin of the word "panic" can be traced back to Greek mythology and the legend of Pan - a demigod whose unseen rustlings in the woods and brush would invoke irrational fear in those passing by - causing them to flee in fright or panic.4
Neurobiology of panic
A panic attack occurs when the body experiences a sudden surge adrenaline out of proportion to any perceived danger or threat. Adrenaline is the hormone involved in the fight-or-flight response, and a sudden release of this hormone prepares the body to flee from danger or to physically confront the danger by increasing heart rate and respiration (breathing) rate, amongst other things.
In the case of a panic attack, this sudden increase in circulating adrenaline causes disturbing feelings and sensations that are out of proportion with any actual danger or threat.
When the nervous system reacts normally to a fearful situation, adrenaline levels quickly drop back to baseline once the fear is removed. This does not happen with a panic attack, and a person may take an hour or more to recover fully from the symptoms.
Often there is no obvious reason for the panic symptoms, which can itself cause people to attempt to rationalize the experience through thoughts such as, "I must be dying," or "I am losing my mind." A panic attack can also be triggered by an event such as public speaking or flying.
A part of the brain called the amygdala is heavily involved in the etiology of panic attacks and anxiety disorders.5 The amygdala - also known as the fear center - reacts with a high-stress response when exposed to an unfamiliar situation or after facing a stressful life event.
It is not fully understood why panic attacks occur, but research indicates that a combination of genetic, biological, psychological, and environmental factors can make an individual more prone to panic. For example, brain wiring that is overly sensitive to a fear stimulus and pH changes, and an amygdala that reacts to subtle changes in carbon dioxide (CO2).
Recent research suggests that a variation in the gene responsible for regulating corticotrophin-releasing hormone (CRH) could predispose people to developing panic disorder.11 Corticotropin-releasing hormone (CRH) is a major regulator of the hypothalamic-pituitary-adrenal axis, and when CRH binds to its receptor CRHR1 triggers the release of the stress response-regulating hormone cortisol.
Other research has found that some types of panic attack may be linked to a problem with the normal suffocation alarm system. In such cases, the brain erroneously believes it is starved of oxygen, triggering an abnormal stress response in order to take action to increase oxygen levels (such as by increasing respiration).
Specifically, evidence points to a region in the midbrain called the dorsal periaqueductal gray (dPAG) as a possible location for this hypoxia-sensitive suffocation alarm system.12
Catastrophic thinking is another possible contributor to panic. This is where a person's first thought in any given situation is often the worst case scenario i.e. chest discomfort must be heart attack, a headache means a brain tumor, and a noise in the middle of the night is a burglar. Finally, panic attacks are more often seen in:6
- Young adults and teenagers
- People who have experienced a traumatic event occur during childhood.
The good news about panic attack symptoms is that they are highly treatable, with many excellent options to help people keep them under control.
How to control panic attack symptoms
Anyone experiencing symptoms of panic attacks should undergo proper medical examination to rule out any underlying medical disorder associated with the symptoms. If there is no clear primary cause that can be treated, there are a number of ways in which people can control panic attack symptoms.:
Calm breathing can help subside the symptoms of a panic attack - the goal is to allow a slow stream of air to come in and out.
Knowledge is a huge part of overcoming panic attack symptoms. Learning how the brain's fear center works can empower people to recognize a panic attack for what it is: a misfiring of the amygdala that causes a surge of adrenaline.
It is vital to understand that the symptoms of panic are not associated with a serious illness. Despite how terrifying the symptoms of panic may feel, an attack will not lead to death.
Our instinct is to breathe faster when hit with panic. Taking control of our breathing is the first step to controlling a panic attack. The goal is to create a slow stream of air in and out, which prevents hyperventilation and a build-up of carbon dioxide in the blood.
It is helpful to practice mindful breathing when in a good state of mind, so that you have the technique established for if a panic attack does occur. To do this, take slow, regular breaths in through your nose and out through slightly puckered lips. Breathe in for the count of five, hold for one second, and then exhale slowly to the count of four - pause for two seconds, and then repeat. Do this for several cycles or until you feel your body start to calm down.
Another helpful strategy is to learn how to properly relax your body. This technique involves tensing various muscles and then relaxing them to help lower overall tension and stress levels that can contribute to panic attacks. Start with your feet and work your way up to your forehead.
Tighten the muscle while taking a deep breath in, hold for a few seconds and then release the tension while breathing out. Move up the body, one muscle group at a time.
Mindfulness and cognitive behavioral therapy
Mindfulness is simply living life in the present moment and accepting thoughts as they come, but not letting them blow out of proportion. Panic attacks can originate from thoughts that spiral into catastrophic worries. Cognitive behavior therapy (CBT) is an effective, lasting treatment for controlling panic attack symptoms.7
CBT is similar to mindfulness, and is ideal for people who have had more than one panic attack episode. CBT challenges a fearful thought - what are you afraid will happen? Is there evidence to support these fears? A practitioner trained in CBT can help you get started and equip you with the tools to successfully control and prevent a full-blown panic attack.
Regular exercise is necessary for maintaining good health and should be incorporated into daily life. From neighborhood walks to competitive sports, finding an activity of interest is important, especially as exercise helps with stress management and encourages the body to produces natural chemicals (endorphins) that are vital for pain relief and a feeling of well-being.
Regularly exercising in a social setting can also help improve confidence and community so as to minimize future triggers for panic attacks and to foster a supportive network who can help if a panic attack does occur.
If you know certain situations invoke fear, or you remember feeling panicky before, a little preparation can be helpful - you will not pass out, and no one will notice your panic. Panic attacks will not cause you to "go crazy" in public.
What is it about the situation that makes you terrified? If it is flying, talk to a friend who loves to fly and ask what they enjoy about it. Perhaps meeting the pilot and letting the flight attendant know you are scared can reassure you.
Other things that many people find helpful in coping with and preventing panic attacks include:
- Finding ways to distract yourself (such as through music, movies, puzzles or talking with friends)
- Dressing in layers or using a small fan to avoid overheating
- Engaging in relaxation breathing
- Having water on hand to keep hydrated and cool
- Using reassuring statements ("I am safe," "I can handle this," "I am going to be fine," or "I have got this").
Eat a healthy diet
Eating regular meals can help you to maintain normal blood sugar levels, which reduces a potential contributor to symptoms of panic. A healthy diet involves:
- Never going more than four hours without eating
- Correcting any dietary deficiencies
- Avoiding caffeine and alcohol as they can trigger or make panic attack symptoms worse.
If you have neglected your health recently, now is the time to take action. This means getting a check-up and attending to any medical problems that are identified, such as anemia, high blood pressure, or breathing disorders.
If you find it difficult to visit a physician, don't be afraid to take along a friend or family member for support, and be sure to shop around where possible to find a family physician who you find personable, professional and encouraging.
Any smokers who experience panic attacks should quit smoking as it is a significant health hazard and contributor to panic. It may feel like smoking helps calm feelings of anxiety, but nicotine is a stimulant and can exacerbate things long-term. This is in addition to the adverse effects of smoking on overall health.
Complementary and alternative medicine
There is a growing interest in using alternative medicine interventions in the US for both medical and anxiety related disorders. Use of acupuncture, aromatherapy, naturopathy, and herbs can be an effective means of controlling panic.8
Medication for panic attacks
Medication should not be used as initial management for panic attack symptoms, but reserved for when the above measures have not helped. Some drugs that have been successful in controlling panic attacks include antianxiety, antidepressant, and beta-blocker medications.9
Whether you or someone you know has had panic attack symptoms, it is essential to have a strong and reassuring support network.
Panic attacks are a common problem that millions of people live with. Although they can be terribly frightening, they are not life threatening, and they can be successfully controlled.