What is a panic attack?
A panic attack is a sudden surge of fear or discomfort that peaks quickly and comes with strong physical sensations. The National Institute of Mental Health describes it as a sudden wave of fear or a sense of losing control even when there is no clear danger or trigger. It can happen anywhere, and sometimes during sleep.
NIMH notes that some researchers think of panic attacks as false alarms: the body's survival system fires too often or too strongly. Your heart pounds, you notice it, you fear something terrible is happening, and that fear pushes the alarm higher. Understanding that cycle does not stop an attack by itself, but many people find it makes the next one less frightening.
What does a panic attack feel like?
Descriptions vary, but NIMH and MedlinePlus describe a familiar set of physical and mental signs. NIMH's statistics page sums up the physical side as chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress:
- A pounding or racing heart, or chest pain.
- Shortness of breath.
- Trembling or tingling in the body.
- Dizziness, or an upset stomach.
- A sense of losing control, or a fear that you might die.
How long does it last?
NIMH says a panic attack can last from a few minutes to an hour or sometimes longer, and that while the feelings are distressing, panic attacks themselves are not life-threatening and the physical symptoms usually resolve with time.
Is it a panic attack or a heart attack?
This is the most important question on this page, and the honest answer is that you cannot always tell from the inside. The Centers for Disease Control and Prevention lists the main warning signs of a heart attack as chest pain or discomfort that lasts more than a few minutes or goes away and comes back, feeling weak, light-headed or faint, a cold sweat, pain in one or both arms or shoulders, and shortness of breath. Several of those overlap with panic.
So the rule is simple. If you have chest pain or pressure, especially if it is new, if you have heart disease or risk factors, or if you are simply not sure, call 911. Emergency staff would far rather see a panic attack than miss a heart attack, and nobody in the emergency room will think less of you. Once a doctor has checked you and ruled out heart problems, it becomes easier to recognize panic for what it is next time.
Panic attack or panic disorder?
NIMH is clear that a single panic attack, or an occasional one, is not a mental disorder. Many people have one or two in their lives, often during a period of heavy stress.
Panic disorder is different. NIMH describes it as repeated, unexpected panic attacks, together with at least a month of worrying about having more, fearing what they mean, or changing behavior to avoid them. An estimated 2.7% of U.S. adults had panic disorder in the past year, according to NIMH survey data, and it is more common in women than in men.
The avoidance part matters a great deal in a small place. If you had an attack at the grocery store in Columbus, it is natural to start shopping in Landrum instead, then to avoid the post office, then church. NIMH notes that some people with panic disorder develop agoraphobia, an intense fear of places where escape or help might be hard to reach. The world can shrink gradually without anyone noticing, including you.
What helps during an attack
These are general steps that many people find useful. They are not a substitute for medical care, and they are not a reason to skip calling 911 if you are unsure about your heart.
- Name it to yourself: this feels like a panic attack, it is very uncomfortable, and it will pass.
- Slow your breathing, with a longer breath out than in.
- Ground yourself in the room by noticing what you can see, hear and touch.
- Stay where you are if it is safe, rather than rushing out; leaving can teach the brain that the place was dangerous.
- Afterward, jot down when it happened and what was going on, to bring to a doctor or counselor.
How panic is treated
NIMH says treatment for panic disorder typically involves psychotherapy, medication or both. It describes cognitive behavioral therapy as a research-supported approach that teaches different ways of thinking about and reacting to the sensations of panic, and notes that attacks can become less frequent once a person learns to respond to those sensations differently. Exposure-based methods, done gradually and with support, help people return to places and activities they have been avoiding.
NIMH also lists antidepressants such as SSRIs and SNRIs, and benzodiazepines for short-term use, noting that the latter can lead to tolerance and dependence. Decisions about medication belong with your doctor. Our pages on how counseling helps anxiety and self-help for anxiety go further.
Laura Bass is a psychotherapist who works with adults, and anxiety is among the concerns she sees. She has a part-time office at The Healing Cottage in Columbus; call 704-706-3264 or use the contact page. If panic ever comes with thoughts of harming yourself, call or text 988 or call Vaya Health at 1-800-849-6127.
Common questions
Can a panic attack hurt me?
NIMH says panic attacks themselves are not life-threatening and the physical symptoms usually resolve with time. They can, however, feel exactly like a medical emergency, and some symptoms overlap with a heart attack. If you have chest pain or are not sure what is happening, call 911. Getting checked is never an overreaction.
Why do panic attacks happen at night?
NIMH notes that panic attacks can occur during sleep. Waking suddenly with a racing heart and fear is frightening, and the worry about it happening again can make it harder to fall asleep. Mention night attacks to your doctor, since other conditions can cause similar waking, and see our page on anxiety and sleep.
I had one panic attack. Do I need treatment?
Not necessarily. NIMH says an isolated panic attack is not a mental disorder. It is worth seeing a doctor to rule out physical causes, and worth talking to someone if you start worrying about the next attack or avoiding places because of it. Those are the signs that panic is beginning to shape your life, and they respond well to early help.
Will people in town notice if I am getting help for panic?
Not from your counselor, who will not confirm to anyone that you are a client without your written permission, apart from narrow legal exceptions. Who else knows is your choice. The page on what therapists can and cannot share explains the limits in plain terms.