Panic Attacks

People who experience even one panic attack,  are more likely to experience recurrent panic attacks, worry about future panic attacks, or change their behavior in an attempt to avoid future panic attacks.

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Overview

A panic attack is the abrupt onset of an overwhelming wave of fear. The attack can be triggered by known factors or appear suddenly “out of nowhere.”

A panic attack is experienced as an accelerated heartbeat, difficulty breathing, or other physiological symptoms.

Panic attacks can happen at any time: while you are driving, in the mall, asleep, in the middle of a business meeting, or at school. You may experience panic attacks regularly, rarely, or even just one time.

Symptoms

Panic attacks can take different forms, but symptoms often peak within minutes. After a panic attack, you may feel tired and exhausted.

Some of the following physiological indications or symptoms are common in panic attacks:

  • Accelerated heart rate (feeling your heart pounding).
  • Trembling or shaking.
  • Chest pain or tightness.
  • Stomach cramping.
  • Shortness of breath or difficulty breathing.
  • Sweating.
  • Dizziness or feeling faint.
  • Nausea.
  • Chills or hot flashes.
  • Feeling hot flashes or numbness.
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Panic attack symptoms also often include:

  • A sense of lurking or near danger.
  • Feeling a loss of control or fear of death.
  • Feeling detached from reality.

Adrenaline and other stress hormones are released by the nervous system as part of the fight-or-flight response. The individual frequently experiences tremendous anxiety and may believe they are about to die. People frequently mistake a panic attack for a heart attack or a medical issue.

Causes

While it can be difficult to determine why a particular individual has a panic attack, there are known risk factors for panic disorder.

  • Genetics: Panic disorder tends to run in families, suggesting a genetic predisposition.
  • Brain chemistry or brain function: Imbalances in the neurotransmitters, such as serotonin and norepinephrine, can trigger panic attacks.
  • Stressful events: Divorce, loss, or major life changes (such as the birth of a child) can trigger panic attacks.
  • Phobias: The fear of specific objects or situations can trigger panic attacks in some people.

Risk factors

Panic disorder symptoms typically appear in late adolescence or early adulthood and affect more women than males.

Specific exposures have been found to increase the risk of experiencing panic attacks.

  • Trauma: Traumatic experiences (such as experiencing sexual assault, violence, or a serious accident), as well as a history of physical or sexual abuse in childhood.
  • Substance use: The abuse of drugs or alcohol can trigger panic attacks.
  • Caffeine or nicotine: Stimulants like caffeine or nicotine can exacerbate panic attacks.
  • Stressful life events or major life changes.

Diagnosis

Not everyone who experiences a panic attack will have all of the symptoms described, and some people may experience additional symptoms.

Panic attacks can feel like a heart attack or asthma. Your doctor can help you rule out any other underlying medical condition. 

The criteria indicating a panic attack :

  • Sudden onset of intense fear or discomfort, peaking within minutes.
  • Four or more of the following symptoms: sweating, trembling, shortness of breath or a feeling of choking, tightness in the chest (pain or discomfort), nausea or abdominal pain, feeling dizzy, unsteady, lightheaded or faint, chills or heat flashes, and a racing heart.
  • The symptoms are not attributable to a medical condition, medication, or substance abuse.

Treatment 

Effective treatment can help reduce the frequency and intensity of panic attacks.

Panic disorder can often be treated effectively with therapy, medication, or a combination of therapy and medication. Treatment may include cognitive-behavioral therapy (CBT), which can help you learn to manage and cope with panic attacks.

  • Cognitive Behavior Therapy (CBT) is an effective treatment for panic attacks and general anxiety. CBT can help you to identify and modify problematic thought patterns.
  • Learning and practicing relaxation techniques can help you mitigate panic episodes. Deep breathing decreases the activity of your fight or flight system. 

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Related information

“Cognitive-behavioral therapy (CBT) is a highly effective treatment for panic disorder, with approximately 70% of patients responding favorably to treatment.” – Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T.D., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.

“Mindfulness-based interventions have shown promise as an adjunctive treatment for panic disorder, with some studies suggesting that they may be effective in reducing panic symptoms and improving quality of life.” – Arch, J.J., & Craske, M.G. (2010). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 48(8), 741-746.

“Physical exercise has been shown to be an effective adjunctive treatment for panic disorder, with some studies indicating that it may be as effective as medication in reducing symptoms.” – Hofmann, S.G., & Smits, J.A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621-632.