Understanding Panic Attacks: A Comprehensive Guide

Daniel B. Block, MD, is a distinguished, board-certified psychiatrist with a private practice based in Pennsylvania.

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What Exactly Is a Panic Attack?

A panic attack is characterized by a sudden surge of overwhelming fear or discomfort that strikes without any real danger present. These episodes typically peak within 10 minutes and then gradually ease, though some may last longer or happen in quick succession, making it challenging to pinpoint where one ends and another begins.

Panic attacks can affect anyone. While certain events might trigger them, they often serve as indicators of underlying anxiety disorders such as panic disorder or agoraphobia.

Recognizing Panic Attack Symptoms

Panic attacks usually emerge abruptly, bringing intense fear that lasts roughly 10 to 20 minutes but can extend in some cases. Symptoms vary among individuals, but common signs include:

• Chest pain or tightness
• Sudden chills or heat sensations
• A sensation of choking
• Dizziness, unsteadiness, lightheadedness, or fainting
• Fear of death
• Fear of losing control or 'going crazy'
• Feelings of unreality (derealization) or detachment from oneself (depersonalization)
• Nausea or stomach discomfort
• Numbness or tingling (paresthesias)
• Rapid or pounding heartbeat (palpitations)
• Shortness of breath or smothering sensations
• Excessive sweating
• Trembling or shaking

Diagnosing Panic Attacks

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines a panic attack as an abrupt surge of intense fear or discomfort that peaks within minutes and includes at least four of the symptoms listed above. Experiencing fewer than four symptoms may be classified as a limited-symptom panic attack.

Many individuals may encounter panic attacks sporadically without meeting criteria for a mental health diagnosis. For a panic disorder diagnosis, recurrent, unexpected attacks must occur without being triggered by substances, medical conditions, or other psychological disorders.

Occasional isolated panic attacks can happen, but since symptoms can resemble other medical or psychological issues, consulting a healthcare professional is crucial for accurate assessment.

What Causes Panic Attacks?

While the precise origins of panic attacks remain unclear, several factors are believed to contribute, including:

• Neurochemical imbalances in the brain
• Genetic predisposition and family history
• Stressful life experiences
• Individual personality traits and temperament

Individuals with heightened sensitivity to stress or frequent negative emotions may be more prone to panic attacks. A family history of anxiety disorders also increases susceptibility, indicating a genetic link.

Women are statistically more likely than men to develop anxiety-related conditions like panic disorder, prompting recommendations for anxiety screening in females aged 13 and older.

Different Types of Panic Attacks

Panic attacks can be categorized as follows:

• Spontaneous (Uncued) Panic Attacks: Occur unexpectedly without any identifiable trigger, sometimes even during sleep.
• Situationally Bound (Cued) Panic Attacks: Triggered by specific situations or environments, such as fear of enclosed spaces leading to panic when entering an elevator.
• Situationally Predisposed Panic Attacks: Not always immediate upon exposure but more likely to occur in certain feared situations, like delayed panic after prolonged social interaction.

Effective Treatments for Panic Attacks

Managing panic attacks often involves psychotherapy, medication, or a combination tailored to individual needs, aiming to lessen the frequency and severity of attacks. Treatment plans consider diagnosis, medical history, personal preferences, and symptom intensity.

Psychotherapy

Cognitive Behavioral Therapy (CBT) is widely recommended for panic and anxiety disorders. CBT focuses on identifying and reshaping thought patterns that fuel fear and anxiety, helping individuals realize that their triggers are less threatening than perceived.

Medication

Doctors may prescribe medications to alleviate symptoms associated with panic attacks, including:

• Antidepressants like selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and fluoxetine (Prozac), especially if depression is present
• Anti-anxiety drugs that act as central nervous system depressants, including benzodiazepines like alprazolam (Xanax)

Strategies to Manage Panic Attacks

If you experience a panic attack or fear one approaching, the following techniques can help:

• Deep Breathing: Controls rapid or shallow breathing common during attacks.
• Mindfulness: Encourages grounding and heightened awareness of present bodily sensations.
• Progressive Muscle Relaxation: Alternating tension and relaxation of muscles to induce calm.
• Visualization: Imagining peaceful scenes to trigger relaxation and counteract fear.

Navigating Through a Panic Attack

Final Thoughts from Verywell

Although panic attacks can be distressing, effective help is available. Consult your healthcare provider about treatment options and practice relaxation techniques to maintain calm in anxiety-inducing situations.

For immediate support, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for resources and treatment centers near you.

Explore our National Helpline Database for additional mental health assistance.

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• Panic Disorder
• Symptoms and Diagnosis

Verywell Mind ensures all content is backed by reputable, peer-reviewed research. Learn more about our editorial standards and fact-checking process.

1. Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617-24.

2. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women’s Preventive Services Initiative. Ann Intern Med. 2020. doi:10.7326/M20-0580

Additional Resources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596

Authored by Sheryl Ankrom, MS, LCPC, a clinical professional counselor and nationally certified mental health specialist focusing on anxiety disorders.

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