Panic Attack Types and Symptoms


Panic Attack Types and Symptoms

A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself) Listen to this podcast.
  • Fear of losing control or “going crazy”
  • Fear of dying

Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer than four symptoms.

Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms.

Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside.

Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced they have a life-threatening issue.

Panic attacks can occur unexpectedly during a calm state or in an anxious state.

Although panic attacks are a defining characteristic of panic disorder, it is not uncommon for individuals to experience panic attacks in the context of other psychological disorders.

For example, someone with social anxiety disorder might have a panic attack before giving a talk at a conference and someone with obsessive-compulsive disorder might have a panic attack when prevented from engaging in a ritual or compulsion.  

Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. For example, avoiding exercise so as to keep their heart rate low, or avoiding certain places.

In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac.

Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don't know they have a real and highly treatable disorder.

It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.

ADAA Resources

  • Blog Post – Helping Your Anxious Teen Cope with a Panic Attack  by Sheila Achar Josephs, PhD
  • Blog Post – Panic Attack or Heart Attack? by Reid Wilson, PhD, and Mark Pollack, MD
  • Webinar – Managing Coronavirus Anxiety Part 3 – Expert Tips and Strategies – by Ken Goodman, LCSW, Debra Kissen, PhD, MHSA, David H. Rosmarin, PhD, ABPP
  • Webinar – Ataques de pánico/Panic Attacks
  • Webinar – Coping With Panic Attacks by Jenny Yip, PsyD, ABPP
  • ADAA members Stefan Hoffmann, PhD, Aleena Hay, PhD and their Boston University colleague Abigail Barthal, BA discusses panic attacks and panic disorder: symptoms, treatment, causes, and coping strategies in this in-depth article. 
  • Screen yourself or a family member for panic disorder.

ADAA Publication:

Facing Panic: Self-Help Facing Panic: Self-Help for People with Panic Attacks by Reid Wilson, ADAA Publication, 2019

Purchase Here


Panic disorder symptoms and treatments

Panic Attack Types and Symptoms

The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Depending on your individual circumstances, you may need one of these treatment types or a combination of the two.

If you're offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT). If this doesn't work, medication may be recommended.

Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects.

No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you. The treatment that's recommended will depend on your general level of health, the severity of your condition and your personal preferences.

It's important you understand what your treatment will involve. If you don't understand something your GP has told you, ask them to explain it in more detail.

Cognitive behavioural therapy

Psychological therapy has proven long-term benefits and it's recommended for treating panic disorder. It will usually take the form of cognitive behavioural therapy (CBT).

CBT is thought to be one of the most effective psychological treatments for panic disorder. It involves having regular sessions with a therapist.

The therapist may discuss with you how you react when you have a panic attack and what you think about when you're experiencing an attack.

Once you and your therapist have identified any negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways of changing your behaviour, making it easier for you to deal with future panic attacks.

For example, they may be able to show you breathing techniques that can be used to help keep you calm during a panic attack.

The National Institute for Health and Care Excellence (NICE) recommends a total of seven to 14 hours of CBT to be completed within a four month period. Treatment will usually involve having a weekly one to two hour session.

NICE also recommends that in certain situations a shorter programme of CBT may be appropriate. This can involve a reduced number of hours of CBT with ‘homework’ being set between sessions so that you can practice what you've learnt after each session.

You should visit your GP regularly while you're having CBT so that they can assess your progress and see how you're doing.

Support groups

Support groups can provide useful information and advice about how you can effectively manage your panic disorder. They're also a good way of meeting other people who've had similar experiences of the condition.

Panic attacks can sometimes be frightening and isolating, so it can be helpful to know that other people are experiencing the same feelings and emotions as you.

Anxiety UK and Triumph Over Phobia (TOP UK) are UK-based charities that provide information and support for people with anxiety disorders.

Support groups often involve face-to-face meetings where you can talk about your problems and difficulties with others. Many can also provide support and guidance over the telephone or in writing.

Ask your GP about support groups for panic disorder near you. You can also use the services directory to find anxiety services in your area.


Antidepressants are often associated with depression, but they can also be used to treat a number of other psychological conditions.

Antidepressants can take two to four weeks before becoming effective. It's therefore important to continue taking them, even if you feel they're not working. You should only ever stop taking prescribed medication if your GP specifically advises you to do so.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are two types of antidepressants that are often recommended for treating panic disorder.

When starting a new type of medication, you should be regularly assessed by your GP at two, four, six and 12 week intervals. This will allow you to discuss any issues that you have with your medication, and enables your GP to assess which treatment is most effective. It will also provide you with the opportunity to try a different type of medication if you want to.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that work by increasing the level of a chemical called serotonin in your brain.

They're the most commonly prescribed type of antidepressant for treating panic disorder. They're usually started at a low dose before gradually being increased as your body adjusts to the medicine.

Common side effects of SSRIs include:

  • nausea
  • headaches 
  • low sex drive (loss of libido)
  • blurred vision
  • diarrhoea or constipation
  • dizziness
  • dry mouth 
  • loss of appetite
  • sweating
  • feeling agitated
  • insomnia (sleep problems)
  • abdominal pain

When you first start taking SSRIs, your feelings of anxiety and panic may get slightly worse. In most cases, this is temporary and your symptoms will start to return to normal levels within a few days of taking the medicine.

Speak to your GP if you feel that your symptoms have got worse and that they're not showing signs of returning to normal levels after a few days.

After you start to take a SSRI, you should visit your GP after two, four, six, and 12 weeks so that they can check on your progress and see whether you're responding to the medicine. Not everyone responds well to antidepressant medicines, so it's important that your progress is carefully monitored.

If your GP feels it necessary, you may require regular blood tests or blood pressure checks when taking antidepressants. If after 12 weeks of taking the medication you don't show any signs of improvement, your GP may prescribe an alternative SSRI to see if it has any effect.

The length of time that you'll have to take a SSRI for will vary depending on how well you respond to the treatment. Even if you feel that your panic disorder has been successfully treated, it's ly that you'll need to keep taking the medication for at least six to 12 months.

If you stop taking your medication before this time, the risk of your symptoms recurring may be increased. Some people may have to take SSRIs for longer than the usual six to 12 month period.

When you and your GP decide that it's appropriate for you to stop taking SSRIs, you will gradually be weaned off them by slowly reducing your dosage. As with antidepressants, you should never stop taking SSRIs unless your GP specifically advises you to.

Stopping your medication straight away without being weaned off, or without seeking advice from your GP, may result in withdrawal symptoms such as:

  • dizziness
  • numbness and tingling
  • nausea and vomiting
  • headache
  • anxiety
  • sleep disturbances
  • sweating

These symptoms can also occur if you miss a dose of medication, or if your dose is reduced. The symptoms are usually mild, but they can be severe if the medication is stopped suddenly.

For some people, this means having to take SSRIs on a long-term basis. For others, a course of CBT can help to reduce the risk of their symptoms recurring.

Contact your GP if you experience troublesome side effects that don't ease.

Tricyclic antidepressants

If SSRIs aren't suitable, or if your symptoms don't improve after a 12 week course of SSRIs, your GP may try prescribing a different type of antidepressant.

Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of the chemicals noradrenaline and serotonin in your brain, which has a positive effect on your feelings and mood.

Imipramine and clomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants aren't addictive.

SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects. Common side effects of tricyclic antidepressants include:

  • constipation
  • difficulty urinating
  • blurred vision
  • dry mouth
  • weight gain or weight loss
  • drowsiness
  • sweating
  • lightheadedness
  • skin rash

The side effects should ease after seven to 10 days as your body starts to get used to the medication. However, see your GP if they become troublesome and don't ease.


Pregabalin is another medication that’s often used to treat panic disorder. It’s an anticonvulsant that's also used to treat epilepsy (a condition that causes repeated seizures). However, it's also been found to be beneficial in treating anxiety.

Side effects of pregabalin can include:

  • drowsiness
  • dizziness
  • increased appetite and weight gain
  • blurred vision
  • headaches
  • dry mouth
  • vertigo – the sensation that you, or the environment around you, are moving or spinning

Pregabalin is less ly to cause nausea or a low sex drive than SSRIs.


Clonazepam is another medication that’s often used to treat epilepsy and is also sometimes prescribed for panic disorder.

It can cause a wide variety of side effects including lethargy (lack of energy), abnormal eye movement (nystagmus), confusion and allergic reactions.


You may be referred to a mental health specialist if treatments such as attending a support group, CBT and medication don't improve your symptoms of panic disorder.

A mental health specialist will carry out an overall reassessment of your condition. They'll ask you about your previous treatment and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends.

The specialist will be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. The type of mental health specialist that you'll be referred to will depend on your individual situation. For example, you may be referred to a:

  • psychiatrist – a trained medical doctor who specialises in mental health; a psychiatrist is one of the only mental health specialists who is able to prescribe medication
  • clinical psychologist – who is trained in the scientific study of human behaviour and mental processes and focuses solely on the assessment and treatment of mental health conditions; a clinical psychologist will help you to find ways of effectively managing your anxiety and panic attacks


The Different Types of Panic Attacks and Criteria for Diagnosis

Panic Attack Types and Symptoms

Paul Viant / Caiaimage / Getty Images

A panic attack is a sudden and intense feeling of terror, fear or apprehension, without the presence of actual danger. The symptoms of a panic attack usually happen suddenly, peak within 10 minutes and then subside. However, some attacks may last longer or may occur in succession, making it difficult to determine when one attack ends and another begins.

One way that panic attacks have been characterized into different types is as follows:

  1. Spontaneous or uncued panic attacks occur without warning or “ the blue.” No situational or environmental triggers are associated with the attack. These types of panic attacks may even occur during one’s sleep.
  2. Situationally bound or cued panic attacks occur upon actual or anticipated exposure to certain situations. These situations become cues or triggers for a panic episode. For example, an individual who fears enclosed spaces experiences a panic attack when entering, or thinking about entering, an elevator.
  3. Situationally predisposed panic attacks don’t always occur immediately upon exposure to a feared situation or cue, but the individual is more ly to experience an attack in such situations. For example, a person who has a fear of social situations but who does not experience a panic episode in every social situation, or who experiences a delayed attack after being in a social environment for an extended period of time.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a panic attack is characterized by a “surge of intense fear or intense discomfort that reaches a peak within minutes” and includes four or more of the following symptoms:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Chills or hot sensations
  10. Numbness or tingling sensations (paresthesias)
  11. Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  12. Fear of losing control or going crazy
  13. Fear of dying

The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack.

It is important to note that many people may experience a panic attack once, or even a few times during their lives. In order for a diagnosis of panic disorder to be made, one must experience recurring unexpected panic attacks that are not caused by the effects of drugs, alcohol or another medical or psychological condition.

It is possible to have a few isolated panic attacks without recurrence. But, since panic- symptoms may mimic many other medical and psychological disorders, it is important to review your symptoms with your doctor.

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Anxiety Disorders and Anxiety Attacks –

Panic Attack Types and Symptoms

Anxiety is a normal reaction to danger, the body’s automatic fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a challenging situation, such as a job interview, exam, or first date. In moderation, anxiety isn’t necessarily a bad thing.

It can help you to stay alert and focused, spur you to action, and motivate you to solve problems.

But when anxiety is constant or overwhelming—when worries and fears interfere with your relationships and daily life—you’ve ly crossed the line from normal anxiety into the territory of an anxiety disorder.

Since anxiety disorders are a group of related conditions rather than a single disorder, symptoms may vary from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party.

Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything.

But despite their different forms, all anxiety disorders illicit an intense fear or worry proportion to the situation at hand.

While having an anxiety disorder can be disabling, preventing you from living the life you want, it’s important to know that you’re not alone. Anxiety disorders are among the most common mental health issues—and are highly treatable. Once you understand your anxiety disorder, there are steps you can take to reduce the symptoms and regain control of your life.

Do I have an anxiety disorder?

If you identify with any of the following seven signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder:

  1. Are you constantly tense, worried, or on edge?
  2. Does your anxiety interfere with your work, school, or family responsibilities?
  3. Are you plagued by fears that you know are irrational, but can’t shake?
  4. Do you believe that something bad will happen if certain things aren’t done a certain way?
  5. Do you avoid everyday situations or activities because they cause you anxiety?
  6. Do you experience sudden, unexpected attacks of heart-pounding panic?
  7. Do you feel danger and catastrophe are around every corner?

Signs and symptoms of anxiety disorders

In addition to the primary symptom of excessive and irrational fear and worry, other common emotional symptoms of an anxiety disorder include:

  • Feelings of apprehension or dread
  • Watching for signs of danger
  • Anticipating the worst
  • Trouble concentrating
  • Feeling tense and jumpy
  • Irritability
  • Feeling your mind’s gone blank

But anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety also involves a wide range of physical symptoms, including:

  • Pounding heart
  • Sweating
  • Headaches
  • Stomach upset
  • Dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Muscle tension or twitches
  • Shaking or trembling
  • Insomnia

Because of these physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is finally recognized.

Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand-in-hand. Since depression makes anxiety worse (and vice versa), it’s important to seek treatment for both conditions.

What is an anxiety attack?

Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger—getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come the blue.

Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, you may experience terror so severe that you feel as if you’re about to die or totally lose control.

The physical symptoms of anxiety attacks are themselves so frightening that many people think they’re having a heart attack.

After an anxiety attack is over, you may worry about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of an anxiety attack include:

  • Surge of overwhelming panic
  • Feeling of losing control or going crazy
  • Heart palpitations or chest pain
  • Feeling you’re going to pass out
  • Trouble breathing or choking sensation
  • Hyperventilation
  • Hot flashes or chills
  • Trembling or shaking
  • Nausea or stomach cramps
  • Feeling detached or unreal

It’s important to seek help if you’re starting to avoid certain situations because you’re afraid of having a panic attack. The truth is that panic attacks are highly treatable. In fact, many people are panic free within just 5 to 8 treatment sessions.

Types of anxiety disorders and their symptoms

Anxiety disorders and conditions closely related to anxiety disorders include:

Generalized anxiety disorder (GAD)

If constant worries and fears distract you from your day-to-day activities, or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD).

People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often manifests in physical symptoms insomnia, stomach upset, restlessness, and fatigue.

Panic attacks and panic disorder

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode.

Agoraphobia, the fear of being somewhere where escape or help would be difficult in the event of a panic attack, may also accompany a panic disorder.

If you have agoraphobia, you are ly to avoid public places such as shopping malls, or confined spaces such as an airplane.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may feel troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.

Phobias and irrational fears

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger.

Common phobias include fear of animals (such as snakes and spiders), fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the object of your fear.

Unfortunately, avoidance only strengthens the phobia.

Social anxiety disorder

If you have a debilitating fear of being viewed negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event.

PTSD can be thought of as a panic attack that rarely, if ever, lets up.

Symptoms of PTSD include flashbacks or nightmares about the incident, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.

Separation anxiety disorder

While separation anxiety is a normal stage of development, if anxieties intensify or are persistent enough to get in the way of school or other activities, your child may have separation anxiety disorder. Children with separation anxiety disorder may become agitated at just the thought of being away from mom or dad and complain of sickness to avoid playing with friends or going to school.

Self-help for anxiety

Not everyone who worries a lot has an anxiety disorder. You may feel anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much caffeine.

The bottom line is that if your lifestyle is unhealthy and stressful, you’re more ly to feel anxious—whether or not you actually have an anxiety disorder.

These tips can help to lower anxiety and manage symptoms of a disorder:

Connect with others. Loneliness and isolation can trigger or worsen anxiety, while talking about your worries face to face can often make them seem less overwhelming.

Make it a point to regularly meet up with friends, join a self-help or support group, or share your worries and concerns with a trusted loved one.

If you don’t have anyone you can reach out to, it’s never too late to build new friendships and a support network.

Manage stress. If your stress levels are through the roof, stress management can help. Look at your responsibilities and see if there are any you can give up, turn down, or delegate to others.

Practice relaxation techniques. When practiced regularly relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce anxiety symptoms and increase feelings of relaxation and emotional well-being.

Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days (broken up into short periods if that’s easier). Rhythmic activities that require moving both your arms and legs are especially effective. Try walking, running, swimming, martial arts, or dancing.

Get enough sleep. A lack of sleep can exacerbate anxious thoughts and feelings, so try to get seven to nine hours of quality sleep a night.

Be smart about caffeine, alcohol, and nicotine. If you struggle with anxiety, you may want to consider reducing your caffeine intake, or cutting it out completely.

Similarly alcohol can also make anxiety worse. And while it may seem cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety.

For help kicking the habit, see How to Quit Smoking.

Put a stop to chronic worrying. Worrying is a mental habit you can learn how to break. Strategies such as creating a worry period, challenging anxious thoughts, and learning to accept uncertainty can significantly reduce worry and calm your anxious thoughts.

When to seek professional help for anxiety symptoms

While self-help coping strategies for anxiety can be very effective, if your worries, fears, or anxiety attacks have become so great that they’re causing extreme distress or disrupting your daily routine, it’s important to seek professional help.

If you’re experiencing a lot of physical anxiety symptoms, you should start by getting a medical checkup.

Your doctor can check to make sure that your anxiety isn’t caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma.

Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you’re taking.

If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety disorders. The therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.

Treatment for anxiety disorders

Anxiety disorders respond very well to therapy—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity.

But in general, most anxiety disorders are treated with therapy, medication, or some combination of the two.

Cognitive-behavioral therapy and exposure therapy are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. They can help with issues such as panic attacks, generalized anxiety, and phobias.

Cognitive-behavior therapy helps you identify and challenge the negative thinking patterns and irrational beliefs that fuel your anxiety.

Exposure therapy encourages you to confront your fears and anxieties in a safe, controlled environment. Through gradual exposure to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control. As you face your fear without being harmed, your anxiety will diminish.

Medication for anxiety disorders

If you have anxiety that’s severe enough to interfere with your ability to function, medication may help relieve some anxiety symptoms.

However, anxiety medications can be habit forming and cause unwanted or even dangerous side effects, so be sure to research your options carefully.

Many people use anti-anxiety medication when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects and safety concerns. It’s important to weigh the benefits and risks of anxiety medication so you can make an informed decision.

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: October 2019.


Panic Attacks: Nature, Types, and Symptoms

Panic Attack Types and Symptoms

Source: blickpixel/Pixabay

This is part one of a four part series on panic attacks.

Panic attacks are disconnected episodes of intense fear. They begin abruptly and reach their peak in 5-10 minutes.

One in five people experience panic attacks at some point in their lives. That is over 65 million people in US alone.

If you have experienced panic attacks before, you know that they can feel very uncomfortable and unpleasant.

For those who have no experience with panic, let me give you an example of what an episode of panic can feel . The example comes from an actual patient. Pay special attention to the underlined symptoms:

I was 25 when I had my first attack….One night I went to sleep and I woke up a few hours later—I’m not sure how long—but I woke up with this vague feeling of apprehension. Mostly I remember how my heart started pounding.

And my chest hurt…I was so scared. I was sure that I was dying—that I was having a heart attack. And I felt kind of queer, as if I were detached from the experience.

It seemed my bedroom was covered with a haze. I ran to my sister’s room, but I felt I was a puppet or a robot who was under the control of somebody else while I was running.

I think I scared her almost as much as I was frightened myself. She called an ambulance.1

Panic attacks are typically associated with palpitations (pounding heart), sweating, shaking, shortness of breath, nausea, hot and cold spells, feeling lightheaded and dizzy, fears of going crazy or dying, derealization and depersonalization.

Derealization refers to the perception of one’s surrounding as dreamy and unreal (e.g., the haze-covered bedroom, from the above example). Depersonalization refers to detachment from one’s body (e.g., feeling a robot, from the example).

Source: Pexels /Pixabay

Because of the accompanying chest pain and accelerated heartbeat, many people who experience panic attacks fear that they are having a heart attack; a result some rush to the emergency room (ER).2

Medical check-up

First, ensure that no medical condition is responsible for the panic attacks.

The use or withdrawal from certain medications or drugs, asthma, thyroid problems, and other conditions can cause—or be mistaken for—panic attacks.

It would also be helpful to see a mental health professional, to make sure that the attacks are not part of a diagnosable medical or psychiatric illness. Indeed, panic attacks can occur in a number of mental disorders, such as social anxiety disorder, specific phobias, post-traumatic stress disorder, etc.

If there is an underlying medical or psychiatric condition, the proper medication and/or psychotherapy aimed at treating the condition can help control the panic attacks too.

Learning about panic

Let us now talk about the nature of panic a little more. During a panic attack, one is ly in the fight-or-flight mode. The fight-or-flight response is a physiological reaction that prepares the body to either fight the threat or flee the scene. This response can explain, at least in part, many of the symptoms of panic attack, as I explain below.

What happens in our body during the fight-or-flight response? Heart rate often increases in order to redistribute blood supply to the organs that will play a bigger role in managing the threat (e.g., skeletal muscles used in fighting or escaping the danger).  

Breathing rate accelerates as well, so that lungs can supply the additional demand for oxygen (as required by organs that are now more active).

Energy use is also increased; burning this energy produces heat, so the the body perspires in order to cool down.

Meanwhile, bodily functions that are not immediately useful (e.g., reproductive and digestive functions) are suppressed. That may explain why we feel the urge to empty our bladder/bowels when we are very afraid.

There are different kinds of panic attacks. An expected panic attack refers to a panic attack that occurs in situations previously known to cause anxiety. If you are socially anxious and are unexpectedly asked to dance by a stranger at a party, you might get a panic attack. One common response to such an expected panic attack, is to flee the scene. 

Of course, fleeing the scene may not be an option (e.g., if you are attending a mandatory work meeting and have a panic attack). Fleeing may also not be a good solution if you have an unexpected panic attack. In an unexpected panic attack (as often occurs in panic disorder), one is unable to point to a particular cue for the panic. 

Let’s say you are at work, putting the finishing touches on a project, and suddenly feelings of panic come over you. You tremble with anxiety and perspire heavily. What caused the panic? You do not know.

Perhaps that explains why some people with panic disorder fear that they might be going crazy or dying. They experience tremendous fear and yet can not find the source of that fear anywhere. They can not make sense of their body’s severe reaction.

Regardless of which type of panic you are experiencing, neither fight nor flight work. They prolong and intensify the current or future episodes. So what to do?

You might want to try leaning into the attack. Yes, lean into it.

I know this sounds counterintuitive. As a friend once said, this is being asked to put your head in the mouth of a hungry alligator.

It is true, this goes against our nature, against how we solve most other problems. 

So why do it? And how?

I will answer the first question in my next post, by using a few metaphors to help explain how to think of panic attacks. Then in my last post in the series, I will explain how to lean into panic.


Different Types Of Panic Attacks

Panic Attack Types and Symptoms

Experiencing panic is relatively normal, as pretty much everyone at some point in his or her lives will have a reason to panic.

Even though no one ever wants to feel this way, it’s simply just a part of life.

And, for most individuals, panic is not something that is part of their everyday lives, nor is it something that they experience very often at all. However, some people do not have it as simple.

Approximately 4.7% of American adults ages 18 and older experience panic disorder at some point in their lives, according to the National Institute of Mental Health (NAMI).

Panic disorder is a condition where an individual can experience crippling fear and anxiety that occurs for no reasonable cause.

This disorder, classified as one of the many types of known anxiety disorders, has negatively impacted the lives of several people across the country in ways that have caused them to struggle to carry out everyday functions.

3 Different Types

Not all people who have panic disorders experience the same types of panic attacks, as there is more than just one type.

While the symptoms associated with each type of panic attack are similar, the causes behind the panic attack are not.

For that reason, panic attacks are separated into three different types: unexpected (uncued) panic attacks, situational (cued) panic attacks, and situationally predisposed panic attacks.

1. Unexpected (Uncued) Panic Attacks

An unexpected panic attack seemingly occurs thin air, as there is truly no other internal or external cause for its rapid development. For example, someone who is experiencing an unexpected panic attack will suddenly go into a full-on state of panic for absolutely no reason.

In fact, he or she might not even be doing anything or around anyone or anything that could possibly insight a panic response. These panic attacks can easily cause someone to feel hot, experience a rapid heart rate, and even feel the physical need to remove themselves from an area.

Unexpected panic attacks are never able to be predicted and can happen at any time and in any environment.

2. Situational (Cued) Panic Attacks

Situational panic attacks are typically much more predictable than unexpected panic attacks, as they tend to occur when someone is exposed to something that knowingly insights panic in them. This type of panic attack is common in those who struggle with social phobia, which is a specific kind of anxiety disorder.

So, when someone has social phobia and is knowingly going into a public setting such as a work meeting, family gathering, or even a birthday party, he or she can have a panic attack.

And, being aware that having a panic attack is a possibility can make the odds of actually experiencing one much more ly, as the anxiety surrounding knowing what could happen can be extremely overwhelming.

3. Situationally Predisposed Panic Attacks

Situationally predisposed panic attacks are a little more tricky than others, as they will not always happen immediately upon being triggered, but instead, after the fact. And, in some instances, the individual can be exposed to the triggering event and then not have a panic attack at all.

The variation of whether or not a panic attack will occur is what makes this kind of panic attack a bit more complex.

An example of a situationally predisposed panic attack is when flying is a triggering event, but the individual does not panic while on the plane, but rather after he or she has landed and/or gotten off the plane.

Symptoms Of Panic Disorders

Panic disorders cause several different physical and psychological symptoms that can truly interrupt and disturb one’s wellbeing. According to the (NCBI), an individual must experience four of the following symptoms suddenly and hit a peak around 10 minutes:

  • Chills or hot flashes
  • Palpitations, pounding heart, or accelerated heart rate
  • Paresthesia (numbness or tingling sensations)
  • Sweating
  • Fear of dying
  • Trembling or shaking
  • Fear of losing control or going crazy
  • Sensations of shortness of breath or smothering
  • Derealization or depersonalization
  • Feeling of choking
  • Nausea or abdominal discomfort
  • Chest pain or discomfort
  • Feeling dizzy, unsteady, lightheaded, or faint

When someone is experiencing a panic attack, he or she typically feels the need to flee for fear of unrealistic thoughts of impending doom.

An individual can also feel as though they are dying or in extreme danger when in reality, neither of those things is occurring.

These are just some examples of common feelings associated with panic attacks, as there are several different emotions that can be produced through this specific type of anxiety disorder.

How Do I Know If I Am At Risk For A Panic Disorder?

As previously mentioned, everyone will experience panic in his or her lives. However, some people might be somewhere in between not having panic attacks and having them consistently. Those individuals should consider a handful of different factors as they move along in their lives. Some of these factors can include the following:

  • Family history of panic attacks
  • Major life stress (such as a loved one being terminally ill)
  • Traumatic events
  • Significant life changes
  • Excessive caffeine use
  • A history of childhood physical or sexual abuse

Many people develop panic disorders in their lives due to the fact that they have experienced several different upsetting life events.

Others might develop a panic disorder for no apparent reason, as sometimes, brain chemistry is simply just off.

However, no matter the reason for the development of a panic disorder, it is important to know that this condition is treatable and can be effectively managed so that it does not consume one’s life.

Treatment For Panic Disorders

The tried-and-true method of incorporating both therapy and medication is often the most successful way to treat someone who is experiencing panic disorder.

Psychotherapy is often the starting line for someone who is ready to get treatment for a panic disorder, because there, he or she can begin learning about panic disorder, how and why it occurs, and how it relates to his or her personal life.

In conjunction with consistent psychotherapy sessions, individuals might also receive a prescription for medications Ativan or Xanax that can help them better manage their panic attacks. When taken as prescribed and included in a comprehensive treatment plan, these medications can help individuals regain control over their panic attacks, and in turn, their lives.

Get Help

If you are struggling with panic disorders, you are not alone. Getting help is the very best thing you can do for yourself, and there is absolutely no shame in it. To get started on your very own treatment, contact us right now at 866-300-6955. We can help.