Signs of Panic Attack
Written by Ada’s Medical Knowledge Team
What is a panic attack?
A panic attack is an abrupt episode of intense anxiety or fear accompanied by a number of physical symptoms such as a racing heartbeat and shortness of breath, normally lasting between 5 and 20 minutes. Panic attacks can be highly distressing, but pose no serious physical health risks.
Many people will experience a panic attack or two during the course of their lifetime. They tend to occur more commonly when undergoing a stressful life event such as bereavement, a job change or separating from a partner. It is also common to be unable to identify a trigger.
If a person experiences recurrent spontaneous panic attacks, without an apparent trigger, this is called panic disorder, a condition which is usually treatable with psychological counseling and/or medication.
For more information on panic attacks, such as causes and common triggers, see the resource on panic attacks.
Signs of a panic attack
The signs of a panic attack involve intense mental symptoms as well as physical symptoms.
These include symptoms of mental distress, such as the sudden belief that one is dying, and concurrent physical symptoms, such as increased heart rate, sweating and trembling.
Panic attack warning signs
There are two main types of panic attack: expected and unexpected.
Unexpected panic attack warning signs
There are typically no perceptible signs of the onset of an unexpected panic attack. Many people report that they are hit by a rush of panic attack symptoms that occur out-of-the-blue, perhaps while doing an everyday task such as ironing or watching television.
It is believed that unexpected panic attacks occur in response to a stressful life experience. However, this stress is often outside the awareness of the person experiencing it. For instance, suppose a person has recently lost their job. While out shopping for groceries, the person experiences shortness of breath and a sense of impending doom - panic attack symptoms that seem to happen for no apparent reason. It is likely that such symptoms were brought about by the need to spend money on food without an income, even though the connection may not be obvious to the person experiencing symptoms.
Good to know: The occurrence of unexpected panic attacks is required for a diagnosis of panic disorder.
Expected panic attacks
Expected panic attacks may be divided into two types:
- Situationally bound or cued panic attacks: Expected to occur invariably in specific situations, such as in the case of a person with a social phobia having a panic attack entering into a public speaking engagement.
- Situationally predisposed: May be more likely in certain situations, but do not always occur on cue nor immediately after exposure, such as in the case of a person who sometimes finds that driving induces a panic attack, or that a panic attack occurs after driving for some time.
Expected panic attacks are often preceded by symptoms that may include:
- An elevated sense of threat or danger
- Distress about physical symptoms
- Physical signs of a panic attack, such as increased heart rate and shortness of breath
- Catastrophic thoughts, i.e. thinking about irrational, worst-case scenarios
Symptoms during a panic attack
During a panic attack, people may have a sense of impending doom, may feel as though they are dying from a heart attack or suffocation, or may feel that they are losing control or going crazy. However the exact experience, and how it is described, may vary from person to person.
A full-symptom panic attack is defined as including four or more of the following physical and psychological symptoms::
- Palpitations, pounding heart or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded or faint
- Chills or heat sensations
- Numbness or tingling sensations
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
A panic attack usually lasts between 5 and 20 minutes, with most panic attacks reaching their peak at around 10 minutes.
Nearly all panic attacks subside in under an hour. It is common to feel exhausted and shaken by the experience of having a panic attack, for minutes or hours after the attack itself is over.
Limited-symptom panic attacks
Panic attacks vary between people, and some people may experience fewer symptoms. If a person experiences less than four of the above symptoms, this is known as a limited-symptom panic attack.
People commonly experience limited symptom attacks while recovering from or undergoing effective treatment for panic disorder, as they learn to use therapeutic techniques to reduce the number and severity of the symptoms they experience during an attack.
The duration of limited symptom panic attacks can be variable. A limited symptom panic attack normally peaks in about 10 minutes — the same timescale as a full symptom panic attack. However, it may last only one to five minutes thereafter. Alternatively, it could be part of a panic episode of varying intensity that lasts several hours.
Nocturnal panic attack
It is possible to experience a full or limited symptom panic attack in one’s sleep. This is called a nocturnal panic attack and involves waking up in a state of panic. The signs of nocturnal panic attacks are the same as those of panic attacks that occur when one is awake, and they may also be the same in terms of their duration and possible triggers.
Nocturnal panic attacks are a common occurrence in people with panic disorder, but can also be one’s first or only experience of a panic attack.
Agoraphobia with panic disorder
Agoraphobia is a type of anxiety disorder in which a person fears and avoids places or situations that might cause them to panic and feel helpless, embarrassed, or unable to escape. This usually develops as a complication of panic disorder, and can reduce a person’s quality of life, as they may become afraid of doing everyday tasks. Treatment is normally effective in helping to manage this condition.
Management of panic attack symptoms
During a panic attack, various techniques can be used by a person to try to reduce their symptoms. For example:
- Deep, calm breathing: This can help reduce some of the physical symptoms of a panic attack. A panic attack tends to cause a person to breathe too fast, which can make them feel dizzy and lightheaded.
- Progressive muscle relaxation: This is a technique involving the conscious tensing and then relaxing of one’s muscles. This can help to reduce tension and overall stress levels.
- Realistic thinking: This involves a person identifying what the frightening thoughts are that can trigger physical feelings of panic, and then identifying whether these thoughts are actually realistic.
Good to know: Regular exercise, eating regular meals and avoiding caffeine may help in preventing some panic attacks.
Treatment of panic disorder
If panic attacks happen often and interfere with one's life, a psychiatric evaluation for an anxiety disorder might be recommended. Normally, the most effective form of professional treatment for panic disorder is psychological therapy. Even a short course can help. Such therapy commonly includes:
- Cognitive behavioral therapy (CBT): CBT focuses on thinking patterns and behaviors that are sustaining or triggering the panic attacks and helps a person to look at their fears in a more realistic light.
- Exposure therapy: This includes controlled exposure to the feared situations. It involves facing the feared situation until the panic begins to lessen. Through this experience, a person can learn that the situation isn’t harmful and that they have control over their emotions.
- Panic-Focused Psychodynamic Psychotherapy (PFPP): This form of psychotherapy helps a person recognize suppressed and painful emotions, allowing them to resolve such issues with the support of a qualified therapist.
Antidepressants have been demonstrated to be effective treatment for agoraphobia with panic disorder, as they help to prevent panic attacks, and improving anticipatory anxiety and avoidance behaviour. These must be taken consistently over time to be effective. The most frequently prescribed groups of antidepressants for panic disorder include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
Benzodiazepines, a type of anti-anxiety medication, may also be prescribed. These medications have a sedative effect that can help quickly reduce panic symptoms and put a person into a more relaxed state. However, Benzodiazepines may be addictive if used in the long term, so they are used cautiously.
Signs of a panic attack in a child
Panic attacks generally have the same symptoms in children as in adults. They may occur in younger children, but are more common in teenagers.
Panic attacks can be particularly difficult for children and young people to deal with. Severe panic disorder may affect their development and learning, as it may, for example, prevent them from studying.
Signs of a panic attack FAQs
Q: Signs of panic attack or anxiety – what is the difference?
A: Anxiety is the feeling of being nervous, uneasy, or worried. Anxiety exists on a scale, from mild to severe, and may be there all the time, in the background of other experiences. Anxiety is normally triggered by something that is perceived as stressful or threatening.
Panic is the most acute form of anxiety. A panic attack normally involves sudden, severe and disruptive symptoms. A panic attack may have no perceptible trigger, and may seem to occur out of the blue.
Q: Signs of panic attack vs heart attack – what is the difference?
A: Many people become convinced that they are having a heart attack when in fact they are experiencing a panic attack. A heart attack requires prompt medical attention and can be life threatening, so it is important for this diagnosis to be recognised. Many of the symptoms overlap so it can be difficult to tell the difference, however some characteristics which may help to differentiate between a panic attack and a heart attack include:
Tingling: If tingling is experienced in a panic attack, it may affect the entire body. In a heart attack, tingling is typically experienced in the left arm.
Pain: In a panic attack, pain may be felt as a sharp sensation in the heart, which gets worse when the affected person breathes deeply or puts pressure on the chest. This pain usually disappears within five to ten minutes. A heart attack may feel like a crushing or pressure sensation all over the chest that may extend into the shoulders, left arm, neck and back. Heart attack pain is not made worse by breathing or pressing on the chest. It may be a worsening pain, and normally lasts longer than ten minutes.
If you are concerned that you may be having a panic attack, a heart attack, or another problem that is causing you related symptoms, try consulting Ada to find out what the cause is. Download the free app or find out more about how the app works.
If in doubt about one’s symptoms it is important to always seek medical attention without delay as a heart attack is a medical emergency that requires immediate treatment.
NCBI. "Expected versus unexpected panic attacks: a naturalistic prospective study." Accessed 22 August 2018. ↩
NCBI. "Diagnosis and treatment of agoraphobia with panic disorder." Accessed 22 August 2018. ↩ ↩
Medscape. "The American Psychiatric Association Practice Guideline." Accessed 11 September 2018. ↩