Panic Attacks & Panic Disorder

What is a panic attack?

A panic attack causes sudden, temporary feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations. When you’re having a panic attack, you may sweat a lot, have difficulty breathing and feel like your heart’s racing. It may feel like you’re having a heart attack.

Panic attacks are the main feature of panic disorder. But they can happen alongside other conditions, such as:

• Anxiety disorders.
• Mood disorders.
• Phobias.
• Psychotic disorders.
• Substance use disorders.
• Trauma- and stressor-related disorders.
• Certain medical conditions.

While panic attacks by themselves aren’t dangerous or harmful to your health, frequent attacks can lead to a decrease in your quality of life and other issues.

What’s the difference between a panic attack and an anxiety attack?

The main difference is that certain stressors often trigger anxiety attacks, and they may build up gradually. In contrast, panic attacks typically happen unexpectedly and suddenly.

Anxiety often causes physical symptoms, such as a racing heart or knots in your stomach. But these symptoms are generally less intense and last longer than a panic attack, which has very intense but brief symptoms.

What is panic disorder?

Panic disorder is an anxiety disorder that involves multiple unexpected panic attacks. A main feature of panic disorder is that the attacks usually happen without warning and aren’t due to another mental health or physical condition. There’s often not a specific trigger for them.

Not everyone who experiences a panic attack develops panic disorder.

How common are panic attacks?

Panic attacks are common. Every year, up to 11% of people in the United States experience a panic attack.

Approximately 2% to 3% of people in the U.S. have panic disorder. People assigned female at birth (AFAB) are two times more likely to have panic disorder than people assigned male at birth (AMAB).

What are the symptoms of a panic attack?

A panic attack happens suddenly. Symptoms usually peak within 10 minutes after it starts and then disappear soon after. Physical symptoms of a panic attack include:

• Chest pain.
• Racing heart.
• Difficulty breathing, such as hyperventilation.
• Trembling or shaking.
• Chills.
• Nausea.
• Sweating.
• Tingling or numbness in your fingers or toes.

You may feel:

• Intense terror.
• A choking or smothering sensation.
• Fear of losing control.
• Like you’re going to die.
• Derealization (feelings of unreality) or depersonalization (feeling detached from yourself).

Panic attacks are very unpleasant and can be frightening. If you’ve had symptoms of a panic attack, it’s important to see a healthcare provider. They can give you an official diagnosis and ensure there’s no underlying physical cause.

How long can a panic attack last?

Panic attacks usually last 5 to 20 minutes. But some people have reported attacks lasting up to an hour.

What causes panic attacks?

Experts don’t know exactly why some people experience panic attacks or develop panic disorder. Your brain and nervous system play key roles in how you perceive and handle fear and anxiety. Researchers think that dysfunction of your amygdala — the part of your brain that processes fear and other emotions — may be at the root of these conditions. They also think chemical imbalances in gamma-aminobutyric acid (GABA), cortisol and serotonin may play a large role.

Your risk of having panic disorder increases if you have:

• A family history: Anxiety disorders, including panic disorder, often run in families. You have a 40% increased risk of developing panic disorder if one of your first-degree relatives (biological siblings, children or parents) has the condition.
• Mental health conditions: People who have anxiety disorders, depression or other mental health conditions are more prone to panic attacks.
• Adverse childhood experiences (ACEs): ACEs are negative experiences that happen between the ages of 1 and 17. These experiences are usually traumatic events. ACEs can contribute to the development of panic attacks and panic disorder.

What triggers panic attacks?

There’s often no specific trigger for panic attacks. But people who have a phobia can experience phobia-related triggers that lead to a panic attack. For example, someone with trypanophobia (intense fear of needles) may experience a panic attack if they have to get their blood drawn for a medical test. For some people, the fear of having a panic attack is often enough to trigger one.

It’s important to note that one of the criteria for panic disorder is that the panic attacks don’t have a known trigger.

How are panic attacks diagnosed?

Your healthcare provider will ask about your symptoms and medical history. They may run tests to rule out medical conditions that cause similar symptoms as panic attacks, such as heart disease, thyroid disease and respiratory (breathing) problems.

If there’s no underlying physical cause, your provider may make a diagnosis according to your symptoms and risk factors.

How is panic disorder diagnosed?

Medical or mental health providers can diagnose panic disorder based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Your provider may diagnose panic disorder when you have repeated, unexpected panic attacks as well as one month or more of:

• Persistently worrying about having more panic attacks or their consequences.
• Changing your behaviors to avoid situations that you think may trigger an attack.

In addition, the attacks can’t be due to the direct effects of a substance or general medical condition. And they can’t be better accounted for by another mental health condition, like a phobia or PTSD.

How are panic attacks and panic disorder treated?

Psychotherapy, medications or a combination of both are very effective in treating panic attacks and panic disorder. How long you’ll need treatment depends on the severity of the condition and how well you respond to treatment.

Psychotherapy

Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors.

Specific types of psychotherapy that can help with panic attacks and panic disorder include:

• Cognitive behavioral therapy (CBT): In this type of therapy, you discuss your thoughts and emotions with a mental health professional, such as a licensed counselor or psychologist. This specialist helps identify panic attack triggers so you can change your thinking, behaviors and reactions. As you start to respond differently to triggers, the attacks may decrease and ultimately stop.
• Exposure therapy: This involves exposing you gradually and repeatedly — in your imagination and/or in reality — to whatever triggers a panic attack. Over time, you learn to become comfortable with the situation instead of it causing anxiety and panic. You’ll learn relaxation techniques, such as breathing exercises, to manage your anxiety throughout the process.

Medications

Medications that can help treat panic attacks and panic disorder include:

• Antidepressants: Certain antidepressant medications can make panic attacks less frequent or less severe. Healthcare providers may prescribe serotonin-selective reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs include fluoxetine (Prozac®) and paroxetine (Paxil®). SNRIs include duloxetine (Cymbalta®) and venlafaxine (Effexor®).
• Anti-anxiety medications: Providers most commonly prescribe benzodiazepines to treat and prevent panic attacks. They help with anxiety but have addiction potential, so it’s important to take them with caution. These medications include alprazolam (Xanax®) and lorazepam (Ativan®).

How can I prevent panic attacks?

Your healthcare provider can help you identify triggers that bring on panic attacks. During psychotherapy, you learn strategies to manage triggering events and prevent an attack. You can also take these actions to lower your risk of having a panic attack:

• Avoid caffeine, alcohol and smoking. These can make panic attacks worse.
• Exercise regularly to help you manage stress, relieve tension and boost your mood.
• Eat a healthy diet.
• Manage stress in healthy ways.
• Talk to your provider before taking herbal supplements or over-the-counter (OTC) medications. Certain substances can increase anxiety.

What’s the prognosis (outlook) for panic attacks and panic disorder?

With treatment, most people who experience panic attacks or have panic disorder get better.

Without treatment, people with panic disorder have a higher risk of suicidal ideation. It may also decrease your quality of life due to impaired social functioning.

How can I stop a panic attack?

While there’s no way to immediately stop a panic attack right after it starts, there are steps you can take to manage the symptoms until the attack resolves, including:

• Practicing deep breathing: Hyperventilating is a symptom of panic attacks that can increase fear. Deep breathing can reduce symptoms of panic during an attack. Breathe in as slowly, deeply and gently as you can through your nose and breathe out slowly through your mouth. Close your eyes and focus on your breathing.
• Acknowledging that you’re having a panic attack: Knowing that you’re having a panic attack — and not a dangerous health episode — can help manage the fear you’re experiencing. Remind yourself that the attack is temporary and will pass.
• Relaxing your muscles: Anxiety attacks can cause you to tense your muscles. Focus on relaxing one muscle group at a time to reduce tension and stay present.
• Practicing mindfulness: A panic attack can make you feel detached from reality or your body. Practice mindfulness and focus on the present to center your thoughts and ground yourself.

It’s important to seek medical treatment, like medication and psychotherapy, if you’re having frequent panic attacks.

How can I help someone having a panic attack?

If someone you know is having a panic attack, you can do the following to help them:

• Stay with them and remain calm.
• Ask them what they need.
• Speak to them in short, simple sentences.
• Help them focus on the present.
• Help them practice deep breathing by slowly counting to five for each inhale and exhale.
• Gently and confidently reassure them that they’re safe and that the attack is temporary.

When should I see my healthcare provider?

Some panic attacks have signs that can resemble a physical problem, like a heart attack. If you have chest pain, trouble breathing or lose consciousness, seek emergency medical care.

You should call your healthcare provider if you have panic attacks and experience:

• Chronic (long-lasting) anxiety that interferes with daily life.
• Difficulty concentrating.
• Extreme irritability.
• Fear of leaving your home (agoraphobia).
• Panic attack symptoms that last longer than 15 minutes.
• Sleep problems.

A note from Cleveland Clinic

Panic attacks can be extremely uncomfortable. Although they’re not physically harmful, they can take a toll on your mental health and stop you from doing the things you love. Don’t be embarrassed to tell your healthcare provider that you have panic attacks. Your provider can help you overcome fears and anxieties that trigger attacks. They can recommend treatments like psychotherapy and medications to treat the attacks.