Signs of Panic Attack
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.
NCBI. "Expected versus unexpected panic attacks: a naturalistic prospective study." Accessed 22 August 2018. ↩