How do I know when I have a panic attack?

Prepared in consultation with William W. Finger, PhD

Have you ever felt you were choking, out of breath, your heart was pounding, you were shaking or your hands had gone numb, and you felt you were losing control without any apparent reason? If you have, you may have experienced a panic attack. Between 3 and 8 million American adults suffer from panic disorder, and many more have occasional panic attacks. Panic disorder can have wide-ranging effects on a person’s well-being, but, when correctly treated, most people will regain control over their lives.

What exactly is a panic attack?

A panic attack is an episode of fear so intense that sufferers may feel they are going crazy or are about to die. An attack begins abruptly and for no apparent reason. Some people even mistake the signs of a panic attack and assume they are having a heart attack. An attack can even occur while a person is asleep.

Panic attacks often seem to come “out of the blue,” and a panic disorder can affect your relationships, job, and lifestyle. In a panic attack, people experience the same physical and emotional sensations they would feel if they were in a life-threatening situation. They may feel the same desperate need to escape without knowing why. The unconscious responses that serve to get us out of immediate danger are alarming and confusing in the absence of a real stimulus.

Although experiencing such sensations is not harmful in itself, many of these symptoms can signal a serious medical emergency, so don’t put off seeking a physician’s attention. Many people with panic disorder also suffer from depression and would benefit from treatment.

Is it a panic attack or panic disorder?

Some people have occasional panic attacks that never become a serious problem for them. People with full-blown panic disorder, however, have repeated panic attacks, often followed by continuing fear of having another one, or worry about the implications for their physical and emotional health. Such anxiety may cause significant behavioral change, seriously interfering with the ability to enjoy life and function as usual.

Many victims of panic disorder try to suppress their fears by abusing drugs or alcohol. In others, feelings of helplessness and hopelessness lead to depression and suicidal thinking.

Do phobias ever play a part?

It is not uncommon for a person to develop an irrational fear—a phobia—of the circumstances in which a panic attack has occurred and go out of the way to avoid these situations. Typical phobic situations are crossing a bridge, using an elevator, driving on the highway, or speaking in public.

Such behavior puts a strain on personal relationships and can even lead to job loss. In agoraphobia, the most extreme form of avoidance, the fear of having a panic attack becomes so great that the person may be unable to leave the house.

What causes panic disorder?

The cause for panic disorder is still unknown, but some evidence shows changes in the brain or nervous system of people with panic disorder that make them unusually sensitive or heighten their reaction to stress. This tendency may be inherited, since panic disorder often runs in families. Studies of twins have established a genetic link in panic disorder. Some studies have also found heart irregularities and thyroid disease to be more common in people with panic disorder.

Although panic attacks occur without warning, they often begin during or shortly after a period of intense stress, such as divorce or the death of someone close. Stimulants such as caffeine or amphetamine—the substance contained in diet or “pep” pills—can also trigger a panic attack in some people, as can breathing in the rapid, shallow pattern known as hyperventilation.

Should I contact my physician?

A panic attack or panic disorder is not the result of any other medical or psychological illness. However, because a number of medical conditions can have symptoms similar to those of a panic attack—some of them serious—you should consult a physician who will evaluate the source of your symptoms. A malfunctioning thyroid gland, lung disease, and heart disease are among the medical problems that can cause paniclike symptoms.

What is the correct diet for people with diabetes?

Maintaining a proper diet is most important for people with diabetes. Obesity increases insulin resistance and can contribute to many health problems. Often, when people with type 2 diabetes lose weight, their blood glucose levels drop and they are able to take less medication. Eating the same amounts of food at about the same times every day will help to keep your blood sugar at a healthy level.
Although you should consult your physician or dietitian about a diet plan that is right for you, eating a variety of foods each day from each group of the food pyramid—starches, vegetables, fruit, protein, milk and yogurt, fats and oils—is a good place to start. It is important to carefully monitor your sugar intake and stick to foods that are sugar-free or low in sugar.

What is the treatment for panic disorder?

The relief that comes from knowing that these attacks are neither madness nor a serious medical illness is the first step toward recovery. Once diagnosed, panic disorder is usually treated with a combination of cognitive and behavioral therapy and medications.

Cognitive therapy works by modifying or eliminating the negative, fearful thought patterns that are contributing to a person’s panic attacks. Behavioral therapy helps people gain control over their physical and emotional responses by teaching them techniques for relaxation and guiding them through a program of gradually increasing exposure to the feared situations.

Antidepressants, tranquilizers, and other medications are sometimes prescribed to prevent or lessen the severity and frequency of panic episodes. However, no medication can currently halt an attack once it has begun.
With appropriate treatment, the majority of people will begin to improve in 6 to 8 weeks. If you suffer from panic disorder and have undergone treatment, you will likely be able to cope well if you have an occasional attack in the future.

Symptoms of a panic attack

Panic symptoms differ from person to person and from one episode to the next, but usually include at least four on the following list:

  • Shortness of breath, or a smothering or choking sensation
  • Palpitations, or a racing or pounding heartbeat
  • Chest pain or discomfort
  • Numbness or tingling, especially in the hands
  • Dizziness or faintness
  • Sweating, trembling, or shaking
  • A feeling of unreality, as of being in a dream
  • A fear of dying, losing control, or going crazy
  • Stomach upset or nausea
  • Chills or hot flushes

Since many of these can also be symptoms of serious medical problems, don’t try to diagnose yourself—see your doctor as soon as you can.

Panic attacks and anxiety disorders

  1. Panic disorder is one of a group of illnesses known as anxiety disorders. All have certain characteristics in common, since they all involve the release of chemicals that govern the body’s response to stress. But they also differ in many important respects.
  2. Generalized anxiety. People with generalized anxiety disorder don’t experience the unpredictable episodes of terror that people with panic disorder do, but they live in a continual state of apprehension.
  3. Social phobia. People with social phobia have extreme anxiety and even panic attacks in certain social situations. Although they recognize that their fear is excessive, they can do little to control it, and often avoid social situations completely.
  4. Isolated phobias. People with isolated phobias have uncontrollable feelings of anxiety or dread associated with specific objects or situations, such as closed spaces or fear of spiders or snakes.
    Stress disorder. In posttraumatic stress disorder, a person who has gone through a particularly harrowing experience such as rape or death of a loved one “re-lives” emotions or memories associated with that event. This may result in nightmares or flashbacks, emotional numbing, or general anxiety and depression.
  5. Obsessions. Obsessive-compulsive disorder involves repetitive behaviors, thoughts, or “rituals” that are directly related with the anxiety associated with these behaviors.

For more information

For local therapists and support groups, contact the Anxiety Disorders Association of America at (301) 231-9350. The National Institute of Mental Health has a panic hot line at (800) 647-2642.