A panic attack is not the hand-wringing worry we all have once in a while. It’s more like an anxiety bomb. It’s swift and powerful, and it can strike out of the blue.
Panic attacks activate the body’s fight-or-flight response, causing a cacophony of unpleasant psychological and physical sensations, especially extreme fear or discomfort. You might feel like you’re losing your mind or you’re on death’s door.
It can be so distressing that some people keep these episodes under wraps for fear of revealing their mental health struggle. Some people make repeated visits to the ER before eventually getting a referral to see a mental health professional.
The thing is, you’re not in any real danger, explains Russell Hunter, PsyD, a clinical psychologist in private practice in Manassas, Virginia, and author of Attacking Panic: The Power To Be Calm. He describes panic attack as “a false alarm.”
Here’s how to recognize when you’re having a panic attack.
A panic attack comes on quickly
One minute you’re fine and the next you’re in full-blown panic mode. What’s going on? It’s your body's fight-or-flight response kicking in. Hormones are released, your breathing accelerates, and your blood sugar spikes, Hunter explains.
Some people are even bolted awake at night from so-called nocturnal panic attacks.
There may be no obvious trigger
A panic attack is your body’s response to some perceived threat, albeit one that may not be readily apparent. So what triggers panic attacks? The exact cause isn’t clear, but a family history of panic attacks, stressful life events, and environmental factors are thought to play a role.
Panic attacks often begin in the teenage years or young adulthood, but anyone can have one.
It's short lived
A panic attack often peaks within 10 minutes, more or less, before symptoms begin to subside. After a certain amount of time, you might realize “there’s nothing dangerous happening,” Hunter says.
You might try to calm those anxious feelings by, say, stepping away to another room.
You may think you're having a heart attack
A racing or pounding heart is a common symptom of a panic attack. You might even have or discomfort. That’s why people having panic attacks often believe they’re having a heart attack. But once in the hospital, they start to feel better, Hunter explains, because “the danger is starting to go away.”
It can be hard to catch your breath
Shortness of breath and hyperventilation are clues that you could be in panic mode. “Breathing disruptions are one of the most universal symptoms of panic attacks,” says Lily Brown, PhD, director of research with the Center for the Treatment and Study of Anxiety at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.
You think you might faint
Lots of people report feeling or lightheaded when they’re in the throes of a panic attack. They’re often afraid they’re going to faint. When these feelings surface, a person typically will sit with her head between her legs.
“What happens is they never have the opportunity to learn if they just ride out that feeling, it will eventually subside,” Brown explains. “It’s extremely uncommon for a person to actually faint in the context of a panic attack,” she says.
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There's a feeling of doom
You might feel like you’re losing control or going crazy, you’re awash in dread, or you fear that you might die.
In a small study, Brown and colleagues examined differences in panic attacks in panic disorder (repeated panic attacks “tied to fears about the attacks themselves”) versus panic attacks that occur due to social anxiety disorder (the fear of being judged or rejected by other people). Turns out these awful cognitive sensations are much more common in people with panic disorder than with social anxiety disorder.
Your hands get tingly
Panic attacks can cause a pins-and-needles feeling or numbness in your extremities. In rare instances, Hunter says, you can have more severe symptoms, like pseudoseizures.
“People will literally fall down to the ground and convulse,” he explains. But there’s no abnormal functioning of the brain; rather, it’s brought on by severe psychological distress, he says, “which could happen during a panic attack.”
It's like an out-of-body experience
You might feel like you’re detached from yourself or your surroundings, an outsider to your own experience. It’s a feeling of unreality, like in a dream, Hunter says.
You get sweaty or have chills
With a panic attack comes a surge of adrenaline that boosts blood flow to the extremities, Hunter explains. All of a sudden, you’re hot. You sweat and shiver to cool the body down. Brown says patients will often report forehead sweating or palm sweating, and it can be localized or profuse.
You feel like you're choking
Stress hormones are released as your body prepares to flee. “People will get tense, their muscles will start to contract, including in the throat and the chest area,” Hunter says.
Your stomach might hurt
No surprise here: When you’re anxious, you can feel it in your gut. Stress and anxiety mess with your digestive tract. Nausea and abdominal distress, like stomach pain, are common symptoms.
You avoid situations that trigger similar symptoms
“A person who is very, very fearful about having the next panic attack might do a lot of things to prevent those panic attacks,” Brown explains. They begin to avoid activities like exercise, which raises their heart rate and quickens their breathing. They focus on those feelings, which makes them more anxious, ultimately leading them “down the rabbit hole of having more and more [panic attacks].”
But not everyone who has panic attacks goes on to develop panic disorder, she adds. Many people recognize it’s just a bodily reaction and that they’re in no real danger.
You feel exhausted afterwards
People who have panic attacks quickly deplete the resources their bodies have marshalled to fend off danger. Sooner or later, that burst of energy, fueled by a spike in blood sugar, will get spent and “they’re going to crash,” Hunter explains.
After the panic attack subsides, he says, they feel “wiped out.”
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