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.
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.
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.
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:
- Psych Central’s Find a Therapist tool
- ADAA Support Groups
- SAMHSA Behavioral Health Treatment Services Locator
- NIH Mental Health 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.
Panic Attack Symptoms and Panic Disorder
Panic attacks can be debilitating events - so extreme in their symptoms that those suffering may believe they're suffering from something far worse than an anxiety disorder. In fact, panic attacks often mimic very serious health problems, including:
Thousands of people are hospitalized every year after their first or most severe panic attack, believing that something very serious is happening. Many believe that they're about to die.
But the truth is that these people are simply suffering from a panic attack - a rush of anxiety so extreme that it causes severe physical symptoms.
This Is What a Panic Attack Feels Like
by Michelle Crouch, AARP, September 18, 2020 | Comments: 0
En español | With COVID-19 upending almost every aspect of life, it's hardly surprising that the number of Google searches for “anxiety” and “panic attack” soared to an all-time high in the months after the pandemic began.
Robert Roca, M.D., chair of the American Psychiatric Association's Council on Geriatric Psychiatry, says it's perfectly normal and reasonable to feel anxious during these uncertain times.
In some people, however, anxiety can build and trigger a full-blown panic attack. Symptoms include heart palpitations, sweating, trembling, shortness of breath, chest pain and nausea.
Nearly 5 percent of adults experience a panic disorder at some time in their lives, according to the National Institute of Mental Health. Women are more likely to report panic attacks than men.
Because the symptoms can be similar to those of COVID-19 or a heart attack, it's important to get checked out by a medical provider if you're not sure what you're experiencing, Roca says.
"It's not unusual for people who have a panic attack to end up in the ER,” says Roca, who is a psychiatrist at John Hopkins Medicine. “Typically, it comes out of the blue, so people have trouble interpreting it as an anxiety symptom.”
Since panic attacks feel different to different people, AARP asked six adults who have them to describe what their attacks feel like, and to share what helps them cope.
"It's as if a vice is squeezing me.”
Anita Lesko, 61, Pensacola, Fla.
Anita Lesko has always been a germaphobe, so her anxiety started to build when she first read about the coronavirus in early 2020.
A certified registered nurse anesthetist (CRNA), Lesko knew she was at higher risk of exposure because of her job administering anesthesia to patients before surgery. When she began hearing about the nationwide lack of personal protective equipment for health-care workers, Lesko really began to worry.
"The prospect of going to work, getting exposed and ending up on a ventilator or dead — that's what pushed me over the edge,” she says.
One morning in March, when she was between patients at the hospital, Lesko developed a deep feeling of impending doom. She began to hyperventilate, her heart started racing and she broke out in a sweat. Pressure began building in her chest.
"I got a gripping sensation in my whole chest and throat area, as if a vice was squeezing me,” she said. “Then I started shaking literally to the core of my body.”
Lesko asked to leave early and fled to her car. She collapsed into the driver's seat and burst into tears.
"I was just sitting there trying to talk myself out of it, and trying to make myself breathe normally,” she recalls.
It took about 30 minutes before she was calm enough to drive. When Lesko got home, she was so exhausted she had to sleep for a few hours before she could do anything.
Lesko has had many more attacks since that day, and has since been diagnosed with PTSD and extreme anxiety. She hasn't been able to go back to work.
How she copes: Lesko is still struggling with how to manage her panic attacks. She is reluctant to take medication, but she is seeing a therapist through telemedicine.
Lesko says the best advice she has received is not to fight the attacks, because that just makes them worse. “When one comes on, I take a deep breath and focus on just letting it happen, letting it run its course,” she says. “And that actually helps.”
"I knew something terribly wrong was happening.”
J.T. Lewis, 58, Charlottesville, Va.
One morning almost 20 years ago, J.T. Lewis hailed a cab because she was late to work. As she settled into the back seat, Lewis noticed the car seemed unusually hot, dirty and cramped. The driver's seat was so far back it seemed to be crushing her. She felt sweaty and light-headed.
"Suddenly, I couldn't breathe,” Lewis recalls. “There was this crushing chest pain. I knew something was terribly wrong. Was I dying?"
The attack subsided after a few minutes, but Lewis was so shaken she had the driver drop her at her physician's office. After a battery of tests, the doctor told her there was nothing physically wrong with her.
A few weeks later, Lewis, who frequently traveled for her job as a lawyer, had just buckled into first class on a plane when it happened again. The pressure in her chest. The feeling that she couldn't breathe. Sweaty and pallid, she asked the flight attendant for some water.
The flight attendant took one look at her and instead had the pilot return the plane to the gate, so Lewis could get off. “I was frustrated, confused and humiliated,” Lewis said. “I began avoiding business travel."
After that, the panic attacks started happening more often. In the short run, medicine quelled her symptoms: Her doctor prescribed daily beta blockers plus Xanax for the moments when she felt an attack coming on (for example, before she got on a plane).
Reluctant to rely on medicine, Lewis also began meeting with a cognitive therapist, who helped her develop strategies to get through an attack in the moment and to reduce the anxiety that triggered them. It took time, but Lewis eventually got the panic attacks under control.
Now retired from law practice, she hasn't had a full-blown panic attack in years.
How she copes: Lewis says seeing a therapist who specialized in cognitive behavior therapy was key to getting her life back.
During an attack, she focuses on breathing deeply by lengthening her exhale. She may also do something physical to interrupt the flow of the panic: a cold cloth on her face, a pinch of the arm, or a spritz of lavender water.
Lewis says it's important to acknowledge and not fight the attack: “I remind myself that I am not dying. I am safe, and this will pass. In fact, each minute of the attack is bringing me closer to the end of it.”
"It feels like my body is going at the speed of light.”
Kevin Rosko, 61, Michigan City, Ind.
Kevin Rosko was 10 years old when he had his first panic attack. It happened after he watched his uncle get smashed in the head with a baseball. Even though his uncle ended up being fine, Rosko couldn't stop thinking about what he'd seen.
That night in the bathtub, his heart started racing, his body felt numb and he told his mom he couldn't breathe.
The panic attacks continued to happen occasionally through Rosko's childhood and adult life. He saw different therapists and tried a variety of medications, but none got his anxiety totally under control.
The attacks didn't happen very often, so Rosko learned to live with them. The symptoms were always the same:
"My heart starts pumping like I'm running Mount Everest,” he says. “It feels like my body is going at the speed of light. I get pain in my arms and back, I feel dizzy, my mind is racing.”
Rosko worked as a crane operator at a steel mill before retiring in 2014. If he felt an attack coming on at work, his boss was good about giving him the rest of the day off.
Rosko also helped to care for his sister, who had Down syndrome and came to live with him when he was in his 40s. After being diagnosed with Alzheimer's disease five years ago, she became more difficult to care for. That's when Rosko's panic attacks ramped up. He began having one about every 10 days, severely impacting his quality of life.
Fortunately, a nurse practitioner suggested a medication called Lexapro. Rosko was skeptical because he had tried so many others, but it worked.
"It relaxes me,” he says. “It helps me feel less antsy.”
In combination with guided subliminal meditation and other techniques, Rosko said he's now able to stop most panic attacks before they escalate.
How he copes: Rosko meditates regularly, limits his caffeine intake and gets emotional support from a Facebook group for panic attack sufferers. If he feels an attack coming on, he gives his body a physical jolt by running his wrists under cold water, and then lays down, focusing on rhythmic breathing.
He also gets periodically checked by a cardiologist. “It's incredibly reassuring in the moment to know that it's not a heart issue, that your heart is OK,” he says.
"You're frozen. You can't move. You think the end is coming."
Corky Klein, 63, Laguna Beach, Calif.
Corky Klein knows she's about to have an anxiety attack when her whole body breaks out in a sweat.
"I even get sweaty on the balls of my feet,” she says.
She gets light-headed, and a little dizzy. Then the headache and the panic hit.
"You forget about everything around you,” Klein says. “Your heart is beating horribly, and that brings on more panic. You get this scared feeling and you want to run. But you're frozen. You can't move. You think the end is coming."
Klein began having panic attacks after her mom died when she was 16. Over the years, she says her anxiety led her into dark bouts of alcoholism and addiction, into long periods of isolation, and on many trips to the emergency room.
Ten years ago, at age 53, she was still having frequent panic attacks, even though she had kicked her addictions. Concerned, her doctor persuaded her to try therapy, and she began seeing a cognitive behavior therapist who specialized in anxiety.
The therapist helped her process the trauma in her past and taught her how to cope with her anxiety before it escalated.
"I learned that I had never dealt with the stuff that had happened to me,” Klein says.
Her panic attacks became less frequent, and she focused on exercising, enjoying her retirement and spending time with her son and other family members.
When her dad passed away, in January, Klein was worried that she would relapse, but she found healthy ways to mourn instead. “I didn't suffer even one panic attack after his death,” she says.
Although she rarely has panic attacks now, Klein is still a member of support groups online, and she often provides encouragement to others who are struggling. “It's a wonderful feeling to be able to help,” she says.
How she copes: She exercises every day ("It makes a difference."), and she uses an app called Calm for meditation and deep-breathing exercises.
If she feels an attack coming on, she either takes a walk or sits in a chair with her feet up, and focuses on her breathing. “I have to talk myself out of it,” she says. “Even after all these years, it's still very hard. But I've had a handle on it for almost three years now."
"I thought I was having a heart attack."
Nicholas Ruggiero, 42, Dumfries, Va.
Police Sgt. Nicholas Ruggiero was packing his lunch for work one morning in October 2018 when his heart started dancing in his chest.
He felt hot and sweaty, and he couldn't catch his breath. Then the room began to spin. As he fell to the floor, his wife called 911.
"I actually thought I was having a heart attack,” Ruggiero remembers.
An ambulance rushed him to the hospital, where we underwent a full workup. Afterward, the doctor gave Ruggiero an unexpected diagnosis: He was having a panic attack.
"At first, I just started laughing,” Ruggiero says. “As a police officer, I'd been in a lot of stressful situations — shooting scenes, homicides — and I had never panicked. How could I be having a panic attack?”
It turned out that the stress of his job had built up over time and triggered the attack. In the two years since, Ruggiero estimates he has had another 100 panic attacks, but medication and lifestyle changes have helped make them less frequent.
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Ruggiero thought his attacks would further subside when he retired from police work last spring, but the arrival of coronavirus and trying to switch careers during a pandemic created a new kind of anxiety.
How he copes: Ruggiero sees a therapist twice a month, takes long walks and spends a lot of time writing and drawing, which help relieve his anxiety. He also takes an anti-anxiety medication and avoids crowded places, because they can be a trigger.
When he feels an attack coming on, he finds the nearest quiet area, closes his eyes and focuses on deep breathing. “I'll put my AirPods in and play very relaxing music, and that snaps me out of it.”
"You feel like you're dying and going crazy at the same time."
Cheryl Poldrugach, 53, of Dallas
Courtesy Cheryl Poldrugah
For 30 years, Cheryl Poldrugach hid her panic attacks from her family and friends.
When her anxiety hit, she would tell them she was sick or had the “stomach flu.” She sometimes missed important events like graduations and holiday celebrations, cancelling at the last minute when an attack left her curled on the bathroom floor.
Poldrugach says her secrecy contributed to her divorce 10 years ago and to rifts with friends and family.
"It was very crippling,” she says. “You get this cold sweat, yet feel like you're on fire, and you're shaking. Your heart is racing out of your chest. You feel like you're dying and going crazy at the same time, and you're not sure you can make it through.”
It wasn't until Poldrugach's teenage daughter had a panic attack at school last year that she finally realized she had to get help and talk to her family about what she was going through.
She started taking anti-anxiety medication, which helped a lot. She also sees a counselor who has helped her learn about healthy ways to cope and get through an attack.
These days, she has turned her focus outward, helping her daughter, her son and others who suffer from anxiety. She adopted the Twitter handle @CherylPanics, and advocates for mental health awareness and education on social media.
How she copes: Travel makes Poldrugach especially anxious, but it helps her cope to learn as many details as possible in advance. “I'll watch videos showing where we are going,” she says.
To get through a panic attack, she repeats the following mantras to herself: “'You are not crazy. You're going to be OK. You're not going to die.’ Just repeating those mantras helps me get grounded,” she says.
Cause of Anxiety Attacks
Anxiety attacks are usually – although not always – caused by severe stress. The symptoms depend on the type of attack. The term anxiety attack is sometimes used interchangeably with the term panic attack, but may also refer to any periods of extreme anxiety beyond what a person normally experiences.
When someone says “anxiety attack” in place of the term “panic attack,” what they mean is that they are struggling with severe physical and emotional anxiety symptoms, including rapid heartbeat, trouble breathing, lightheadedness, feelings of doom, chest pains, and other anxiety symptoms.
The cause of these symptoms is a combination of two things:
Anxiety increases adrenaline/epinephrine production in the body, which speeds up your heartbeat, makes you sweat, causes you to breathe faster, and makes you more aware of your body.
These reactions are designed to keep you safe from harm. If you were faced with real danger, like someone chasing you with a knife, the adrenaline helps you react faster, run away more quickly, stay aware of your surroundings, etc. But some people experience them when no real danger is present. This is what creates the sensation of an anxiety attack.
In addition, anxiety can cause you to alter your breathing in a way that creates hyperventilation. Hyperventilation is when you breathe in more oxygen than you need, and breath out the CO2. Hyperventilation also causes a “paradoxical effect” which makes it feel like you’re not getting enough air, which then causes you to try to breathe in even more oxygen than you need and makes the attack worse.
Hyperventilation is the cause of some of the more severe anxiety attack symptoms, such as feelings of feint, rapid thinking, chest pain, and other physical symptoms.
The Difference Between an Anxiety Attack and a Panic Attack
Once again, “anxiety attack” is not a clinical term. It's a term used to describe periods of more intense anxiety that go beyond traditional anxiety experiences.
That differs from the term panic attack. Panic attacks are severe anxiety attacks like what is described above - attacks that are often so disabling that many people struggle to cope with them and develop panic disorder, health anxiety, and possibly agoraphobia.
Traditionally, the term "anxiety attack" is used to discuss weaker versions of panic attacks. If you have multiple panic attacks, you have panic disorder. Anxiety attacks can affect anyone - even those without panic disorder or an anxiety disorder - and so the term is used to encompass all of these types of attacks.
For the purposes of this article, we'll discuss these types of anxiety attacks as the weaker version of a panic attack. But in life, people do use the two terms somewhat interchangeably, and both are related to the same feelings of doom, along with relevant symptoms.
Non-Panic Anxiety Attacks
For those that use the term “anxiety attack” more casually to refer to severe anxiety, what they’re usually referring to is a feeling of being overwhelmed by anxiety and stress that is difficult to control. Usually, the cause is related to life stress. The anxiety attack is caused by significant stress going on in the individual’s life at that very moment.
In some cases, anxiety attacks may also be used to describe any severe version of an anxiety disorder. For example, if you suffer from obsessive compulsive disorder, an anxiety attack would be any time that the anxiety temporarily becomes so pronounced that the obsessions and compulsions appear to be impossible to stop. Or if you have social phobia, and your anxiety attack forces you to leave all social situations shaking.
These types of anxiety attacks are not necessarily "attacks" so much as exacerbated versions of already occurring anxiety disorders. The experience may be like so:
- Generalized Anxiety Disorder – Someone with GAD that has an anxiety attack is likely to feel as though their anxiety has become unmanageable. They may feel severely worried that something is or will go wrong, or their physical or mental symptoms feel so pronounced that they are unable to control it. Often an anxiety attack for someone with generalized anxiety disorder is more of an emotional breaking point, rather than a specific feeling of anxiety symptoms (although this may not be the case for everyone).
- Panic Disorder – Since the term panic attack and anxiety attack are used interchangeably, an anxiety attack when you have panic disorder is simply a panic attack. There is usually a feeling that something terrible is happening or is about to happen. It can feel hard to breathe like you can’t get air. You may feel light-headed, experience chest pains, and have an awareness that your heartbeat is speeding up. For more information about panic attack symptoms, consider viewing our panic attack specific page.
- Post-Traumatic Stress Disorder – An anxiety attack with PTSD can be serious. These attacks may trigger anxiety as if you are in the moment of your trauma. For veterans with PTSD, they may feel the severe anxiety that occurred when they were in the battlefield. For assault victims, they may relieve the event that’s occurring. Their anxiety responses mimic the stress and anxiety they felt when the event occurred.
- Obsessive Compulsive Disorder – Anxiety attacks with OCD tend to be more common when the compulsion did not take place. Like with generalized anxiety disorder, the experience feels more like an overwhelming emotional break rather than specific symptoms. In some cases, the response may be more pronounced compulsions, although this is not true for everyone.
- Social Anxiety Disorder – Those with social anxiety disorder may have anxiety attacks when their shyness and discomfort in social situations cause them to panic, almost as though they have come face to face with their worst fear. The symptoms may also resemble a panic attack in their severity, but for some it is just an overwhelming feeling of the need to escape.
- Stress Related Anxiety Attacks – Not all anxiety attacks occur with those who have anxiety disorders. Those under severe stress or anxiety may have the panic like anxiety attacks that are similar or identical to those that have panic disorder. The only difference between them is that they tend to have a bit more of a mental component. Those with panic attacks can have the attacks even when they do not think they’re stressed. Those that are under severe stress usually have their anxiety attacks triggered by emotional events.
Phobias and fears can also cause anxiety attacks as well. Those who are afraid of flying, for example, may experience anxiety so severe when they get on a plane that they have trouble breathing and feel like they can’t control their anxiety symptoms.
Still, because “anxiety attack” is not a medical term, there are many other ways to experience anxiety attacks as well. The only thing they have in common is that the symptoms – whether they are physical, mental, or emotional – feel overwhelming, and often hit the person very hard.
According to a study published in Psychology Medicine 1 , people who suffer from panic attacks and panic disorder may be at higher risk of heart attack and heart disease later in life. While the link between panic disorder and heart disease remains controversial, the study found that compared to individuals without panic disorder, sufferers were found to have up to a 36% higher risk of heart attack and up to 47% higher risk of heart disease. If you suffer from panic attacks, seek attention for any chest pain symptoms in order to rule out any issues with heart health.
While panic attacks cause a variety of physical issues and many people reporting feeling like they are about to die when experiencing one, you cannot die from a panic attack.
This Graphic Nails What a Panic Attack Feels and Looks Like
I’ll never forget how helpless I felt witnessing my close friend roll into the fetal position on my college dorm room floor. Through deep, labored breaths, she repeated, I’m dying. I knew she wasn’t, but her immense distress was obvious. I held my friend and told her I was there being supportive was all I had to offer. Fifteen minutes later, she began to feel better and told me what had happened: she’d had a panic attack.
According to the National Institute of Mental Health, a panic attack is a feeling of extreme anxiety and the fear of disaster or losing control, often occurring as a variety of intense physical symptoms. Understanding how devastating a panic attack can be is difficult if you’ve never had one yourself, but this graphic by BelievePerform (@BelievePHQ), a London-based site promoting mental health and wellness, describes the debilitating physical symptoms of a panic attack perfectly.
In the middle of a panic attack, it really can feel like you’re going to die. Some people even feel heart pain and palpitations just like they would if they were having a heart attack. Needless to say, it can be a frightening affair. If you’re with someone who has a panic attack, the best thing to do is stay calm and stay with them. In calmer moments, ask your friend what is most helpful to them in the future.
Since college, I’ve experienced two panic attacks of my own. Though I was caught completely off guard by each, knowing the signs helped me recognize what was happening. The day of my first, I hadn’t felt like socializing (I have social anxiety), but I still wanted to show up for my friend’s baby shower. She was one of the few people I’d met since relocating to a new state.
When I arrived at the event, my eyes searched the crowd for a familiar face. Finding none, I immediately became overwhelmed. All at once, I felt as if the walls were closing in on me. Suddenly in fight or flight mode, I bolted out of the venue as fast as I could, gasping for air. Trembling and choking back sobs, I phoned my parents, who helped talk me through it. After I’d calmed down, I felt embarrassed.
It’s common for those who experience panic attacks to feel shame or embarrassment, leading them to avoid or withdrawal from social situations as a preventive measure. What’s more, not all panic attacks feel the same, so even if you’ve had one in the past, the next one might feel a lot different. From external symptoms (like sweating, shaking, hot or cold flashes, breathlessness, chest pain, nausea, and dizziness) to internal ones (maybe you feel like you’re “going crazy,” you’re detached from reality or feel like you’ve lost total control), panic attacks can be a scary ordeal.
In the midst of a panic attack, try to focus on your breath, taking slow and controlled exhalations. Try to picture a calm place in your mind, doing your best to recognize this is a panic attack, and even though it doesn’t feel like it right now, you’re going to be fine. If panic attacks are a regular occurrence or they’re preventing your from enjoying your life, reach out to your doctor for help.
Ways to Manage Grief-Related Panic Attacks
The impact of grief is one that takes many different forms and is unique to each of us. Bereavement leaves us feeling sad, lost, empty, angry, scared, fearful and unsure of the ground we are walking on. A common metaphor for grief is “it hits you like a wave,” and when it does, so unexpectedly and so powerful, we tend to be very surprised at the intensity of emotions we experience. And while most of the time, we manage to either dive under these waves or ride them through to completion, some of us find ourselves having a full-blown panic attack. It may help you to know, these grief related panic attacks (GRPA) are a common reaction to loss, and something that, while still not very well understood, are in fact being studied carefully.
Panic attacks, in general, can be very scary. Seemingly out of the blue, it is as if there is a psychological overwhelming, with common symptoms including chest pains, choking or smothering sensation, racing heart, sweating, hyperventilating/difficulty breathing, nausea, tingling or numbness in fingers or toes. There is a loss of control an inability to stop these things from happening. Panic attacks occur in approximately 11% of the population and women are twice as likely to have a panic attack than men, according to the Centers for Disease Control and Prevention.
Identifying the cause and source of panic attacks is something that continues to be studied. Research continues to examine how we manage fear particularly around the “fight, flight or freeze” reactions we have when faced with imminent danger. While we do not know why some people experience panic attacks, we do know there are risk factors which may predispose some to panic attacks. These include a personal or family history of anxiety disorders or co-occurring mental health issues such as depression, and substance abuse problems. In other words, we know that panic attacks happen, and we know that some are more likely to have panic attacks. We also know that panic attacks occur during grief and these have been formally recognized and defined as grief related panic attacks, GRPA.
In a study on GRPAs, experts Sherman A. Lee and Jamison S. Bottomley found that 55.4% of participants experienced GRPAs. Their research also suggests that those experiencing complicated grief have a high prevalence of GRPAs. And while more research needs to be done, what these findings help identify is the common reaction many grievers have to loss. Identifying and validating this reaction helps normalize grief reactions and it also gives rise to the need to further examine opportunities for support.
We do not know why GRPAs occur, and we do not know how to prevent them, but we can work with them. Before moving on, the first thing you need to keep in mind is, GRPAs are a common and normal reaction to grief. Let that sink in for a minute. You are not “crazy” or “out of control.” You are in fact very normal, having a normal reaction to incredible loss. Below are a few suggestions to consider now, to prepare, should you need a few tools to manage and possibly lessen the intensity of your GRPA:
1. Don’t fight it.
This may sound counterintuitive, because in the midst of the attack, we become afraid, and just want it to stop. Know the swell of emotions will pass. Sit down if you are able. Notice your breathing and work to focus on controlling a slow inhale and exhale. A good grounding technique for breathing is square, or box breathing. Breath in for the count of four, hold for four, release for four, inhale again for four. Gaining gentle control of our breathing is one of the best ways to ease anxiety, and works very well if we can do this in a panic attack.
2. Orient yourself to your space.
This exercise can be done by you, or facilitated by someone with you during a panic attack, and it involves focusing on the external another grounding technique. Counting backwards from five, you will:
5 — Identify five separate objects near you, stating the name of each and stating the use of each. For instance, “I see a chair. That is my rocking chair and I use it to relax at night.”
4 — Identify four sounds. Verbalize how you hear them, where they come from, and what this sound means. For instance, “I can hear the birds singing, and this sound tells me that nature is near.”
3 — Touch three different objects. Verbalize the feel, is it warm/cold? What is the texture and how does it feel?
2 — Identify two separate smells. Perhaps you have coffee next to you, or you can smell someone’s perfume. Verbalize whether you like these smells.
1 — Name one thing you can taste. Whether it is the gum you are chewing, or your own tears, identify and verbalize a taste.
3. Use a mantra or positive affirmation to help focus and ground yourself.
“Peace is mine,” or “I release my emotions.” Something easy, yet meaningful.
4. Allow the GRPA to complete itself.
Allow the emotions to flow, the energy to released and really just let the process work itself through you.
5. When the GRPA has come to an end, show some appreciation for yourself.
You may want to even thank yourself for releasing these emotions. Being kind and compassionate to yourself, instead of feeling shame, like you should be in better control, will help shift your mind to a peaceful place, leaving the space of anxiety.
6. Find a way to relax.
You may need to lay down for a few minutes or even take a nap. If comfortable, get yourself into nature, nothing is more grounding than a walk among the trees.
7. Monitor your body, note your heart rate and your breathing returning to normal.
Hydrate well. Eat a healthy snack.
8. Debrief after you have recovered.
Talk to a friend. Journal your experience. You may want to keep track of your GRPAs. Is there a triggering event, thought or experience that prompted your GRPA? Becoming aware of your experiences will help better understand yourself, and your grief.
GRPAs are a normal reaction to loss. You are not “going crazy,” nor are you the “only one” reacting to loss like this. While we continue to work to understand the reasons for and exactly how panic attacks, and GRPAs occur, please be kind to yourself as you grieve. Understand that some reactions and emotions will need to be released, whether or not you are ready for them, and this is perfectly normal. If you are struggling with your grief, experiencing frequent GRPAs, or are having difficulty with the thoughts and emotions related to your grief, know that help is always available from grief counselors who have many resources to help you navigate this journey.
Should You See a Doctor for Panic Attacks?
A panic attack can be scary in the moment, but they are usually harmless. If you are getting panic attacks regularly, it could be a sign of a different problem like anxiety. It can help to speak to your doctor if you’re worried about your panic attacks. They can help to rule out any other health issues.
You might also find it helpful to speak to a therapist. There are treatments for panic attack disorders, like cognitive behavioural therapy (CBT). This can help you identify causes for your attacks. This might help prevent panic attacks from happening to you in the future.
Recognising when you’re having a panic attack can help reduce the fear that can come with them. It can help you feel more in control because you know what is happening when an attack happens.
The most important things to remember is that the fight or flight response is harmless and won’t hurt you. Even though it feels scary, panic attacks are common, and they are not a sign of weakness. You should also remember that recovery is very common and there are ways to beat panic attacks.
Many people, including health professionals, use the terms panic attack and anxiety attack interchangeably. But although they may share some symptoms, they are not the same.
Perhaps the most significant difference is that panic attack is a defined medical condition (as described by DSM V- the classification system used to characterize conditions affecting a person&rsquos mental health), an anxiety attack is a colloquial term that has come into widespread use by people with anxiety disorders to describe heightened periods of anxiousness. Other differences include:
- Panic attacks can occur without a trigger whereas anxiety usually occurs in response to a perceived stressor or threat
- Panic attacks are intense and disruptive and sometimes the physical symptoms are worse than the anxiety
- Panic attacks often involve a sense of "unreality" and detachment. Anxiety attacks can vary from mild to severe
- Panic attacks usually happen suddenly, while anxiety attacks become gradually more intense over minutes, hours, or days
- Panic attacks usually subside within a few minutes, while anxiety symptoms can persist for long periods.
What is a panic attack?
Panic attacks are a recognized disorder with a series of criteria that must be fulfilled before a doctor can diagnose a panic attack or somebody as having panic attacks. The DSM-V criteria describe a panic attack as "A sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause". At least four of the following symptoms must also exist:
- Abdominal cramping
- Chest pain
- lightheadedness or faintness
- Fear of loss of control or death
- Feeling of unreality or detachment
- Hot flashes
- Numbness or tingling sensation
- Rapid, racing or pounding heart rate
- Sense of impending doom or danger
- Shortness of breath or tightness in your throat
- Trembling or shaking.
Symptoms of a panic attack are usually short-lived, lasting around 10-15 minutes. Some people may feel like they are having a heart attack and call 911. The most significant symptom of a panic attack is feeling a sense of immediate threat, which may cause a person to cry for help or try to escape whatever predicament they are in.
Panic attacks can either come on out of the blue (unexpected panic attacks) or happen in response to a trigger, such as a phobia (expected panic attacks). During a panic attack, the body&rsquos autonomous fight-or-flight response takes over and physical symptoms are often more intense than symptoms of anxiety.
Panic attacks can happen to anyone, but having more than one may be a sign of a panic disorder. In contrast, anxiety attacks almost always are associated with a trigger and are much less intense than panic attacks. Some people have frequent or regular panic attacks others may only experience one or two in their lives. Repeated attacks are usually a symptom of panic disorder. Talk to your doctor if you think you may be experiencing panic attacks.
People who have experienced sudden deaths or other traumatic events are more prone to having panic attacks. Panic attacks mainly affect those with panic disorder, they are not typically associated with other mental health conditions.
What is an anxiety attack?
As mentioned previously, an anxiety attack is not a recognized medical condition as defined by the DSM-V. But this doesn&rsquot mean that it doesn&rsquot exist. Rather it is a term people with anxiety use to describe very intense or extended periods of anxiety.
Many people live with low-level anxiety on a daily basis. But every now and then, their anxiousness may increase, either gradually or suddenly, to a higher level than is usual for them. Symptoms of these anxiety attacks are more severe than the simple feeling of anxiety but less severe than a panic attack and may be short-lived or persist for days, sometimes weeks. Symptoms may include:
- Feeling particularly wound up or on edge
- Feeling irritable
- Difficulty concentrating or periods where your mind goes blank
- Having difficulty controlling worries
- Muscle tension
- Sleep problems (difficulty falling or staying asleep, or restless, unsatisfying sleep)
- Tire easily
Sometimes an anxiety attack is a prelude to a panic attack. For example, some people have experienced anxiety attacks on the way to an airport because they have previously had a panic attack on an airplane.
Anxiety attacks do not necessarily indicate that a person has an anxiety disorder, although anxiety as a symptom is linked to numerous mental health conditions, including depression, obsessive-compulsive disorder, and PTSD. Anxiety is appropriate in some circumstances and anxiety attacks are only more intense forms of that emotion.
What should I do during a panic or anxiety attack?
The following strategies may help:
- Acknowledge what is happening and sit down somewhere where it is quiet
- Breathe slowly and deeply
- Try relaxation techniques such as progressive muscle relaxation or guided imagery
- Practice mindfulness.
Daily exercise, a healthy diet, and at least eight hours sleep a night may also help to reduce stress and anxiety.
Panic Attack Symptoms: Nausea, Chills, Palpitations, and 11 Other Common Signs
Facing something we fear, whether it's a job interview, a test, an airplane flight, or a spider, can bring on panic attack symptoms.
What is a panic attack, and how do panic attack symptoms affect us? It’s an important question, because so many of us experience them: “Each year, about one in 10 people experiences a panic attack,” according to data published by the Department of Psychology at Northern Illinois University.
First, let’s define the condition: A panic attack is a sudden surge of intense fear of discomfort that usually lasts for several minutes.
There are more than a dozen symptoms associated with panic attacks. Most people will experience only some of these symptoms. It’s also possible that some symptoms will occur with one panic attack and then others with another panic attack. This can make it difficult for people to recognize that these different experiences are all actually still panic attacks.
Common Panic Attack Symptoms
The following 14 panic attack symptoms are among the most common that people will experience. Some of us can experience many of these symptoms at once:
- Palpitations or racing heart
- Trembling or shaking or feeling smothered
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, light-headed, unsteady, or faint
- Chills or heat sensations
- Numbing or tingling of the fingers or toes
- Feeling of unreality, almost like you are dreaming (called derealization)
- Feeling detached from oneself (called depersonalization)
- Fear of losing control or going crazy
- Fear of dying, often imminently
Typically, these symptoms are intense and overwhelming. A person experiencing a panic attack may find it difficult to communicate with others while it is happening. For some people, the fear of dying is so intense that they head straight for a hospital emergency room, even if they know they’re likely suffering from a panic attack.
SIMPLY PUT: HOW TO HANDLE PANIC ATTACK SYMPTOMS
The U.S. Department of Veterans Affairs offers this useful information on dealing with panic attack symptoms:
- Identify your negative self-talk: “Anxious thoughts can increase anxiety symptoms and panic. The first step in changing anxious thinking is to identify your own negative, alarming self-talk. Some common alarming thoughts:
- ‘I’m having a heart attack.’
- ‘I must be going crazy.’
- ‘I think I’m dying.’
- ‘I’m going to pass out!’
- ‘I’ve got to get out of here!'”
- ‘This is not an emergency.’
- ‘I don’t like feeling this way, but I can accept it.’
- ‘I can feel like this still be okay’
- ‘I can be anxious and still deal with this situation.’
- ‘I can handle these symptoms or sensations.'”
Panic Attack Causes and Complications
What causes panic attacks? Some people experience panic attack symptoms when faced with something they fear, such as spiders or elevators. Others experience them without warning. Sometimes, panic attacks occur upon waking from sleep (known as a nocturnal panic attack).
Panic attacks themselves can be so terrifying that people may start fearing the next attack and avoiding situations they think might trigger one. This means they have developed a condition known as panic disorder.
Roughly one in 50 to 75 people develops panic disorder, according to Northern Illinois University’s Department of Psychology. This more serious condition “involves a series of unexpected and severe panic attacks that interferes with a person’s emotional life, relationships, and ability to work.”
Play It Safe
While panic attacks are not in and of themselves medical emergencies, they do share symptoms with such medical emergencies as heart attacks or asthma attacks. If you think you might be having a panic attack but aren’t sure about what’s going on, it’s wise to be on the safe side and head to the hospital. See also the story “Panic Attack or Heart Attack” at the Women’s Heart Foundation website. Per that post: “Chest pain and difficulty breathing are common symptoms in both panic attack and heart attack as they trigger the body’s ‘fight or flight’ response, but these are also signs of ischemia—a lack of blood flow to the heart muscle.”
If your symptoms point to a panic attack, you can try a number of remedies to alleviate symptoms naturally click here to read our post Natural Remedies for Panic Attacks Backed by Medical Science.”