Comprehensive Guide to Types and Symptoms of Panic Attacks

Essential insights into the two primary categories of panic attacks

Panic attacks are intense episodes marked by overwhelming fear, dread, and troubling physical sensations. These attacks are not standalone mental health disorders but are symptoms that often occur alongside other psychological conditions. Panic attacks are categorized into two main types: expected and unexpected. Here’s a detailed look at each type.

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), serves as the authoritative guide for mental health professionals to accurately diagnose conditions.

According to DSM-5 criteria, panic attacks manifest as a sudden surge of fear and apprehension, accompanied by at least four additional mental, emotional, or physical symptoms.

These additional symptoms may include:

• Chest discomfort or pain
• Chills or sudden warmth
• Feelings of unreality (derealization) or detachment from oneself (depersonalization)
• Profuse sweating
• Fear of dying
• Fear of losing control or going insane
• Sensation of choking
• Dizziness, unsteadiness, lightheadedness, or faintness
• Numbness or tingling sensations (paresthesia)
• Rapid or irregular heartbeat (palpitations)
• Nausea or abdominal discomfort
• Shortness of breath or smothering feelings
• Trembling or shaking

Panic attack symptoms typically arise quickly and reach their peak within minutes. Afterward, symptoms may fade entirely, or the individual may remain anxious, potentially triggering another panic cycle.

Limited-symptom panic attacks occur when fewer than four of these symptoms are present.

How to Identify and Manage Panic Attack Symptoms

Types of Panic Attacks

Panic attacks vary not only in intensity and duration but also based on their triggers.

DSM-5 distinguishes two distinct types: expected panic attacks and unexpected panic attacks.

Expected Panic Attacks

Expected panic attacks happen in response to known triggers or cues. For example, someone with claustrophobia may anticipate panic attacks when in confined spaces like elevators.

Similarly, individuals with a fear of flying (aerophobia) may predictably experience panic attacks during boarding, takeoff, or flight.

Unexpected Panic Attacks

Unexpected panic attacks arise suddenly without any identifiable cause or warning. A person may be completely relaxed before symptoms appear.

These attacks are not linked to conscious internal cues such as fearful thoughts or feelings of dread, nor are they triggered by external situations like phobias or frightening events.

Understanding Panic Attack Symptoms, Causes, and Treatments

Diagnosis

Panic attacks are most commonly associated with panic disorder but can also occur alongside various other mental health conditions. They are frequently linked to anxiety and mood disorders such as:

• Agoraphobia
• Bipolar disorder
• Generalized anxiety disorder (GAD)
• Major depressive disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder (SAD)
• Specific phobias

Additionally, panic attacks may accompany personality disorders, eating disorders, and substance-related disorders.

If you experience panic attacks, consulting a healthcare professional can help determine whether these symptoms indicate panic disorder or another condition.

A qualified provider will offer an accurate diagnosis and develop an effective treatment plan. Early intervention leads to better management of panic attacks.

DSM-5 Criteria for Panic Disorder Diagnosis

Panic Attacks within Panic Disorder

Panic disorder is a complex anxiety condition characterized by recurrent, unexpected panic attacks and persistent concern about future episodes.

According to DSM-5, experiencing one unexpected panic attack often signals the likelihood of future attacks. Behavior changes related to fear of attacks are common.

Individuals with panic disorder may also suffer nocturnal panic attacks, which occur during sleep and abruptly awaken the person.

This disorder typically begins in late adolescence or early adulthood, though it can start in childhood or later life. Women are nearly twice as likely as men to develop panic disorder, prompting recommendations for anxiety screenings in females over 13 during routine health exams.

The exact causes remain unclear, but genetics play a significant role. Having close relatives with panic disorder increases risk. Environmental, biological, and psychological factors all contribute to the condition.

Treatment Approaches for Panic Disorder

Panic disorder can severely limit daily life, causing individuals to avoid situations where attacks might occur and leading to loneliness and shame.

While no cure exists, effective treatments include medication and psychotherapy, often combined with self-help strategies.

Medications such as antidepressants and benzodiazepines can lessen attack severity and anxiety symptoms. Therapy helps manage emotions and develop coping skills.

Can Panic Attacks Be Fatal?

Final Thoughts from Verywell

Seeking timely help for panic and anxiety is crucial. Early diagnosis and treatment improve symptom management and quality of life.

If you or someone you know struggles with panic attacks or anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for support and treatment resources.

Explore additional mental health resources through our National Helpline Database.

• Conditions A-Z
• Panic Disorder
• Symptoms and Diagnosis

Sources:

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. 2013.
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
3. Na HR, Kang EH, Lee JH, Yu BH. The genetic basis of panic disorder. J Korean Med Sci. 2011;26(6):701-710. doi:10.3346/jkms.2011.26.6.701

By Katharina Star, PhD
Katharina Star, PhD, is a specialist in anxiety and panic disorders. She is a licensed counselor trained in creative art therapies and mindfulness techniques.

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