Panic attacks are one of the most disturbing mental health problems, which can occur suddenly and have serious consequences for a person’s physical and emotional well-being. They manifest as a strong surge of anxiety and fear, accompanied by various physical and psychological symptoms. In this article, you will find the symptoms, causes, diagnosis, treatment methods of panic attacks, as well as practical advice on what to do during a panic attack.
A panic attack is a sudden, strong, and often seemingly unprovoked episode of intense anxiety, characterized by pronounced physical and psychological symptoms. A panic attack can last from a few minutes to half an hour or longer, and most often its symptoms peak within 10 minutes. A panic attack may occur rarely or frequently, and its intensity and impact on a person can vary greatly.
It is important to note that a panic attack may be a reaction to a certain stressful situation or may arise spontaneously. When panic attacks recur, it is considered panic disorder, which requires treatment.
Types of panic attacks
Panic attacks are divided into two main categories:
Unexpected panic attack: This panic attack occurs without any obvious provocation or specific situation. It is most commonly associated with panic disorder.
Situationally triggered panic attack: This panic attack occurs in specific situations, such as social gatherings or enclosed spaces, especially if a person has certain phobias (e.g., agoraphobia).
A panic attack causes a wide range of physical and psychological symptoms that can be very intense. Physical symptoms are often mistaken for serious health problems, such as a heart attack or stroke. It is important to distinguish the symptoms of a panic attack in order to respond appropriately.
Most common physical symptoms:
Heart palpitations (tachycardia): A sudden acceleration of heart rate.
Chest pain or discomfort: People often think this is a heart attack.
Shortness of breath: A feeling that you cannot take a deep breath or lack air.
Dizziness: Often experienced as a feeling of instability or faintness.
Nausea: May occur together with stomach pain or discomfort.
Muscle tension or trembling: These symptoms may affect the arms, legs, or the whole body.
Chills or hot flashes: Often accompanied by sweating or a sensation of cold.
Psychological symptoms:
Intense feeling of fear: People often feel as if they are losing control or fear going crazy.
Fear of dying: A sudden fear of dying is very common.
Depersonalization: A feeling of being detached from one’s body or mental state.
Derealization: Distorted perception of surroundings, a sense that everything is unreal or unfamiliar.
A panic attack can occur due to many different causes. This condition is not linked to one specific factor, so its etiology is complex.
Biological factors:
Genetic predisposition: Scientists have found that people whose family members suffer from panic disorders are more likely to experience panic attacks themselves. Genetic factors may play a significant role in the development of this condition.
Neurotransmitter imbalance: Serotonin, dopamine, and norepinephrine are neurotransmitters that regulate mood. A decreased level of these substances can contribute to anxiety disorders.
Physiological reactions to stress: Some people’s bodies react too strongly to normal bodily signals (e.g., rapid heartbeat), causing an anxiety response that may trigger a panic attack.
Psychological factors:
Traumatic experiences: Traumatic events such as physical or emotional abuse, accidents, or a difficult childhood can increase the risk of panic attacks.
Chronic stress: Work, financial, or personal problems can cause constant stress, which may gradually lead to panic attacks.
Anxiety disorders: Individuals with other anxiety disorders, such as generalized anxiety disorder, are more likely to experience panic attacks.
A panic attack is often misunderstood as another health problem, so it is important to diagnose and treat this condition correctly. Diagnosis includes a detailed medical history, physical examination, and psychological assessment.
Physical examination: To rule out possible physical health problems, a doctor performs a physical exam, blood tests, and cardiac tests (e.g., ECG). This helps ensure that symptoms are not related to heart disease or other health conditions.
Psychological assessment: A psychiatrist or psychologist may perform a psychological evaluation, which includes questions about the patient’s feelings, fears, daily stress, and the frequency of panic attacks.
DSM-5 criteria: According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic disorder is diagnosed when a person experiences several unexpected panic attacks and then spends more than a month fearing repeated attacks or changes behavior to avoid them.
The treatment of panic attacks may include various interventions, including medication, psychotherapy, and lifestyle changes.
Psychotherapy
One of the most effective forms of psychotherapy for treating panic attacks is cognitive behavioral therapy (CBT). This therapy helps individuals understand and change the negative thoughts and behaviors that trigger or maintain panic attacks.
Changing thought patterns: CBT teaches people to recognize the onset of a panic attack and apply techniques to reduce anxiety. This includes examining destructive thinking patterns and replacing them with positive ones.
Behavior modification: Patients learn how to face situations that trigger panic attacks instead of avoiding them.
Breathing and relaxation techniques: Therapists often teach breathing exercises and relaxation methods to help manage physical symptoms.
Medication
Medication is often prescribed to treat panic disorders. The most commonly used medications include:
Selective serotonin reuptake inhibitors (SSRIs): Medications such as fluoxetine, sertraline, and citalopram help balance serotonin levels in the brain and reduce panic symptoms.
Benzodiazepines: These are fast-acting medications (e.g., diazepam or alprazolam) that can be used for quick relief during a sudden panic attack. However, they must be used cautiously due to their potential for dependence.
Beta blockers: Medications such as propranolol can help control physical symptoms like heart palpitations or trembling, but they do not directly affect anxiety.
Lifestyle changes
Preventing panic attacks and reducing symptoms can be achieved through lifestyle changes. Here are some key recommendations:
Regular physical activity: Research shows that moderate-intensity exercise can reduce anxiety levels and improve mood.
Healthy sleep routine: Lack of sleep can increase stress and anxiety, so it is important to ensure sufficient rest.
Healthy diet: A balanced diet supports optimal brain function, and reducing caffeine and alcohol may help decrease anxiety.
Stress management: Relaxation techniques such as meditation, breathing exercises, or yoga can help reduce daily stress.
When a panic attack occurs, it is important to know what to do to reduce symptoms. Here are several tips:
Breathe slowly and deeply: Mindful breathing can help decrease anxiety and control physical symptoms of panic.
Focus on the present moment: Using grounding techniques, try to focus on your environment and senses—for example, observe what you see, hear, or feel.
Tell yourself it is temporary: Remind yourself that a panic attack is temporary and not dangerous.
A panic attack is a serious condition that can significantly affect quality of life. By identifying it early and starting appropriate treatment, it is possible to reduce the intensity and frequency of panic attacks. A combined approach—including psychotherapy, medication, and lifestyle changes—can help manage this condition and improve daily life.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
National Institute of Mental Health. Panic Disorder: When Fear Overwhelms. 2020.
Craske, M. G., & Stein, M. B. (2016). Anxiety Disorders: The Epidemiology of Panic Attacks, Panic Disorder, and Agoraphobia. In Textbook of Anxiety Disorders.
