Panic attacks are frightening but fortunately physically harmless episodes. They can occur at random or after a person is exposed to various events that may "trigger" a panic attack. They peak in intensity very rapidly and go away with or without medical help.
- People experiencing panic attacks may fear they are dying or that they are suffocating. They may have chest pain or believe that they are having other symptoms of a heart attack. They may voice fears that they are "going crazy" and seek to remove themselves from whatever situation they may be in.
- Some people may experience other associated physical symptoms. For example, they may begin breathing very rapidly and complain that they have palpitations, in that their "hearts are jumping around in their chest." Then, within about an hour, the symptoms fade away.
- About 5% of the population will experience panic attacks during their lifetimes. People who have repeated attacks require further evaluation from a mental-health professional. Panic attacks can indicate the presence of panic disorder, depression, or other forms of anxiety-based illnesses.
- Panic attacks may be symptoms of an anxiety disorder.. Panic attacks occur suddenly and often unexpectedly, are unprovoked, and can be disabling.
- Once someone has had a panic attack, he or she may develop irrational fears, called phobias, about the situations they are in during the attacks and begin to avoid them. That, in turn, may reach the point where the mere idea of doing things that preceded the first panic attack triggers terror or dread of future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. If this occurs, the person is considered to have panic disorder with agoraphobia.
- Panic disorder in adolescents tends to show similar symptoms as in adults. Teens tend to feel like they are not real, as if they are operating in a dreamlike state (derealization), or be frightened of going crazy or of dying.
- The disorder in younger children is less likely to have the symptoms that involve ways of thinking (cognitive symptoms). For example, panic attacks in children may result in the child's grades declining, decreased school attendance, and avoiding that and other separations from their parents. Both children and teens with panic disorder are further at risk for developing substance abuse and depression as well as suicidal thoughts, plans, and/or actions.
Signs and symptoms of a panic attackPanic attacks often strike when you’re away from home, but they can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or sitting on the couch at home.
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour.
A full-blown panic attack includes a combination of the following signs and symptoms:
- Shortness of breath or hyperventilation
- Heart palpitations or a racing heart
- Chest pain or discomfort
- Trembling or shaking
- Choking feeling
- Feeling unreal or detached from your surroundings
- Nausea or upset stomach
- Feeling dizzy, lightheaded, or faint
- Numbness or tingling sensations
- Hot or cold flashes
- Fear of dying, losing control, or going crazy
You may be suffering from panic disorder if you:
- Experience frequent, unexpected panic attacks that aren’t tied to a specific situation.
- Worry a lot about having another panic attack.
- Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked.
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
- Anticipatory anxiety – Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
- Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.
Because of these fears, you start avoiding more and more situations. For example, you might begin to avoid crowded places such as shopping malls or sports arenas. You might also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.Although agoraphobia can develop at any point, it usually appears within a year of your first recurrent panic attacks.
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.
Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilties:
Panic attacks and panic disorder are treatable conditions. They can usually be treated successfully with self-help strategies or a series of therapy sessions.
- Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly.
- Stimulant use (amphetamines, cocaine, caffeine)
- Medication withdrawal
Cognitive Behavioral TherapyCognitive behavioral therapy is generally viewed as the most effective form of treatment for panic attacks, panic disorder, and agoraphobia. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering the panic attacks. It helps you look at your fears in a more realistic light.
For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once your learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.
Exposure therapy for panic attacks and panic disorder
In exposure therapy for panic disorder, you are exposed to the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.
If you have agoraphobia, exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.
Medication treatment for panic attacks and panic disorderMedication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn't treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.
The medications used for panic attacks and panic disorder include:
- Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack.
- Benzodiazepines.These areanti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.
- Learn about panic. Simply knowing more about panic can go a long way towards relieving your distress. So read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.
- Avoid smoking and caffeine. Smoking and caffeine can provoke panic attacks in people who are susceptible. As a result, it’s wise to avoid cigarettes, coffee, and other caffeinated beverages. Also be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.
- Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious. If you know how to control your breathing, you are also less likely to create the very sensations that you are afraid of.
- Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response – the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. So make time for them in your daily routine.
Panic Attacks At A Glance
- Symptoms of panic attack usually begin abruptly and include rapid heartbeat, chest sensations, shortness of breath, dizziness, tingling, and severe anxiousness.
- While panic disorder can certainly be serious, it is not immediately organ-threatening.
- A variety of treatments are available, including several effective medications, and specific forms of psychotherapy.
- People who experience panic attacks can use a number of lifestyle changes like aerobic exercise, avoiding alcohol, caffeine, and illicit drugs, as well as stress-management techniques to help decrease anxiety.