Symptoms of anxiety and panic attack

Panic attacks and panic disorder - Symptoms and causes


A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.

Although panic attacks themselves aren't life-threatening, they can be frightening and significantly affect your quality of life. But treatment can be very effective.

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Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

  • Sense of impending doom or danger
  • Fear of loss of control or death
  • Rapid, pounding heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or tightness in your throat
  • Chills
  • Hot flashes
  • Nausea
  • Abdominal cramping
  • Chest pain
  • Headache
  • Dizziness, lightheadedness or faintness
  • Numbness or tingling sensation
  • Feeling of unreality or detachment

One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur.

When to see a doctor

If you have panic attack symptoms, seek medical help as soon as possible. Panic attacks, while intensely uncomfortable, are not dangerous. But panic attacks are hard to manage on your own, and they may get worse without treatment.

Panic attack symptoms can also resemble symptoms of other serious health problems, such as a heart attack, so it's important to get evaluated by your primary care provider if you aren't sure what's causing your symptoms.

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It's not known what causes panic attacks or panic disorder, but these factors may play a role:

  • Genetics
  • Major stress
  • Temperament that is more sensitive to stress or prone to negative emotions
  • Certain changes in the way parts of your brain function

Panic attacks may come on suddenly and without warning at first, but over time, they're usually triggered by certain situations.

Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's unknown why a panic attack occurs when there's no obvious danger present.

More Information

  • Nocturnal panic attacks: What causes them?

Risk factors

Symptoms of panic disorder often start in the late teens or early adulthood and affect more women than men.

Factors that may increase the risk of developing panic attacks or panic disorder include:

  • Family history of panic attacks or panic disorder
  • Major life stress, such as the death or serious illness of a loved one
  • A traumatic event, such as sexual assault or a serious accident
  • Major changes in your life, such as a divorce or the addition of a baby
  • Smoking or excessive caffeine intake
  • History of childhood physical or sexual abuse


Left untreated, panic attacks and panic disorder can affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.

Complications that panic attacks may cause or be linked to include:

  • Development of specific phobias, such as fear of driving or leaving your home
  • Frequent medical care for health concerns and other medical conditions
  • Avoidance of social situations
  • Problems at work or school
  • Depression, anxiety disorders and other psychiatric disorders
  • Increased risk of suicide or suicidal thoughts
  • Alcohol or other substance misuse
  • Financial problems

For some people, panic disorder may include agoraphobia — avoiding places or situations that cause you anxiety because you fear being unable to escape or get help if you have a panic attack. Or you may become reliant on others to be with you in order to leave your home.


There's no sure way to prevent panic attacks or panic disorder. However, these recommendations may help.

  • Get treatment for panic attacks as soon as possible to help stop them from getting worse or becoming more frequent.
  • Stick with your treatment plan to help prevent relapses or worsening of panic attack symptoms.
  • Get regular physical activity, which may play a role in protecting against anxiety.

By Mayo Clinic Staff


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Panic Attack vs. Anxiety Attack: What’s the Difference?

An anxiety attack tends to occur in response to certain stressors and may build gradually while panic attacks can occur unexpectedly and abruptly. Both may indicate an underlying health condition.

You might hear people talking about panic attacks and anxiety attacks like they’re the same thing. But they’re different conditions.

Read on to find out more about the differences between panic attacks and anxiety.

The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition” (DSM-5) does not mention anxiety attacks, but it does define anxiety as a feature of a number of common psychiatric disorders.

This includes the following conditions:

  • generalized anxiety disorder
  • panic disorder
  • separation anxiety disorder
  • agoraphobia without history of panic disorder
  • post-traumatic stress disorder
  • social anxiety disorder
  • obsessive-compulsive disorder
  • specific phobia

Anxiety is usually related to the anticipation of a stressful situation, experience, or event. It may come on gradually.

Symptoms of anxiety include:

  • worry
  • distress
  • fear

The lack of diagnostic recognition of anxiety attacks means that the signs and symptoms are open to interpretation.

That is, a person may describe having an “anxiety attack” and have symptoms that another person has never experienced despite indicating that they, too, have had an “anxiety attack.

Panic attacks come on suddenly and involve intense and often overwhelming fear. They’re accompanied by very challenging physical symptoms, like a racing heartbeat, shortness of breath, or nausea.

DSM-5 recognizes panic attacks and categorizes them as unexpected or expected.

Unexpected panic attacks occur without an obvious cause. Expected panic attacks are cued by external stressors, like phobias.

Panic attacks can happen to anyone, but having more than one may be a sign of panic disorder, a mental health condition characterized by sudden and repeated panic attacks.

Panic and anxiety attacks may feel similar, and they share a lot of emotional and physical symptoms.

You can experience both an anxiety and a panic attack at the same time.

For instance, you might experience anxiety while worrying about a potentially stressful situation, like an important presentation at work. When the situation arrives, anxiety may culminate in a panic attack.

A panic attack or anxiety attack can both cause physical and emotional symptoms, including:

  • apprehension and worry
  • distress
  • fear of dying or losing control
  • a sense of detachment from the world (derealization) or oneself (depersonalization)
  • heart palpitations or an accelerated heart rate
  • chest pain
  • shortness of breath
  • tightness in the throat or feeling like you’re choking
  • dry mouth
  • sweating
  • chills or hot flashes
  • trembling or shaking
  • numbness or tingling (paresthesia)
  • nausea, abdominal pain, or upset stomach
  • headache
  • feeling faint or dizzy

It may be difficult to know whether what you’re experiencing is anxiety or a panic attack. Keep in mind the following:

  • The cause: Anxiety is typically related to something that’s perceived as stressful or threatening. Panic attacks aren’t always cued by stressors. They most often occur out of the blue.
  • The level of distress: Anxiety can be mild, moderate, or severe. For example, anxiety may be happening in the back of your mind as you go about your day-to-day activities. Panic attacks, on the other hand, mostly involve severe, disruptive symptoms.
  • Fight-or-flight: During a panic attack, the body’s autonomous fight-or-flight response takes over. Physical symptoms are often more intense than symptoms of anxiety.
  • Speed of onset: While anxiety can build gradually, panic attacks usually come on abruptly.
  • Effect: Panic attacks typically trigger worries or fears related to having another attack. This may have an effect on your behavior, leading you to avoid places or situations where you think you might be at risk of a panic attack.

Unexpected panic attacks have no clear external triggers. Expected panic attacks and anxiety can be triggered by similar things. Some common triggers include:

  • a stressful job
  • driving
  • social situations
  • phobias, like agoraphobia (fear of crowded or open spaces), claustrophobia (fear of small spaces), and acrophobia (fear of heights)
  • reminders or memories of traumatic experiences
  • chronic illnesses, like heart disease, diabetes, irritable bowel syndrome, or asthma
  • chronic pain
  • withdrawal from drugs or alcohol
  • caffeine
  • medication and supplements
  • thyroid problems

Anxiety and panic attacks have similar risk factors. These include:

  • experiencing trauma or witnessing traumatic events, either as a child or as an adult
  • experiencing a stressful life event, like the death of a loved one or a divorce
  • experiencing ongoing stress and worries, like work responsibilities, conflict in your family, or financial woes
  • living with a chronic health condition or life threatening illness
  • having an anxious personality
  • having another mental health condition like depression
  • having close family members who also have anxiety or panic disorders
  • using drugs or consuming alcohol

People who experience anxiety are at an increased risk of experiencing panic attacks. But having anxiety does not mean you will experience a panic attack.

Doctors can’t diagnose anxiety attacks, but they can diagnose:

  • anxiety symptoms
  • anxiety disorders
  • panic attacks
  • panic disorders

A doctor will ask you about your symptoms and conduct tests to rule out other health conditions with similar symptoms, like heart disease or thyroid problems.

To get a diagnosis, a doctor may conduct:

  • a physical exam
  • blood tests
  • a heart test, like an electrocardiogram (ECG or EKG)
  • a psychological evaluation or questionnaire

Speak with a doctor about other treatments for anxiety and panic attacks. Here are some treatments they may discuss with you.

Counseling and psychotherapy

Talking therapies for anxiety and panic disorders can involve the following, often in combination.

  • Cognitive behavioral therapy (CBT): This type of therapy can help you see things that worry you in a new way. A counselor can help you develop strategies for managing triggers when they arise.
  • Cognitive therapy: This can help you pinpoint, reframe, and neutralize the unhelpful thoughts that often underlie an anxiety disorder.
  • Exposure therapy: This form of therapy involves controlled exposure to situations that trigger fear and anxiety, which can help you learn to confront those fears in a new way.
  • Relaxation techniques: These include breathing exercises, guided imagery, progressive relaxation, biofeedback, and autogenic training. A doctor can talk you through some of these.

A doctor may suggest attending individual sessions, group sessions, or a combination of the two.


Examples of medications your doctor may prescribe are:

  • Antidepressants: These medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
  • Beta-blockers: These medications can help manage certain physical symptoms, like a rapid heart rate.
  • Anti-anxiety drugs: This includes benzodiazepines, a sedative medication that can suppress symptoms quickly.

All these drugs can have adverse effects. SSRIs and SNRIs are for long-term use, and it can take time to feel the effects. Benzodiazepines are for short-term use only, as there is a high risk of dependence.

Oftentimes, a doctor will recommend a combination of treatments. They may also need to alter your treatment plan over time.

You should speak with a doctor or mental health professional to find out what you can do to both prevent and treat anxiety- and panic-related symptoms. Having a treatment plan and sticking to it when an attack happens can help you feel like you’re in control.

If you feel an anxiety or panic attack coming on, try the following:

  • Take slow deep breaths: When you feel your breath quickening, focus your attention on each inhale and exhale. Feel your stomach fill with air as you inhale. Count down from four as you exhale. Repeat until your breathing slows.
  • Recognize and accept what you’re experiencing: If you’ve already experienced an anxiety or panic attack, you know that it can be incredibly challenging. Remind yourself that the symptoms will pass and you’ll be alright.
  • Practice mindfulness: Mindfulness-based interventions are increasingly used to treat anxiety and panic disorders. Mindfulness is a technique that can help you ground your thoughts in the present. You can practice mindfulness by actively observing thoughts and sensations without reacting to them.
  • Use relaxation techniques: Relaxation techniques include guided imagery, aromatherapy, and muscle relaxation. If you’re experiencing symptoms of anxiety or a panic attack, try doing things that you find relaxing. Close your eyes, take a bath, or use lavender, which has relaxing effects.

Lifestyle changes

The following lifestyle changes can help you prevent anxiety and panic attacks, as well as reduce the severity of symptoms when an attack occurs:

  • Reduce and manage sources of stress in your life.
  • Learn how to identify and stop negative thoughts.
  • Get regular, moderate exercise.
  • Practice meditation or yoga.
  • Eat a balanced diet.
  • Join a support group for people with anxiety or panic attacks.
  • Limit your consumption of alcohol and caffeine as well as the use of drugs.

Panic attacks and anxiety attacks are not the same. Though these terms are often used interchangeably, only panic attacks are identified in the DSM-5.

Anxiety and panic attacks have similar symptoms, causes, and risk factors. But panic attacks tend to be more intense and are often accompanied by more severe physical symptoms.

You should contact a healthcare professional if anxiety- or panic-related symptoms are affecting your everyday life.

Read this article in Spanish.

Panic attacks and anxiety disorders

Sometimes a panic attack or unreasonable anxiety visits a person only once, and then does not recur. It happens that the problem manifests itself several times, and also disappears on its own. However, if you regularly encounter such disorders, you should not wait until they go away on their own, because this may not happen.

ACME Center has been helping patients overcome panic attacks and anxiety disorders for over 10 years. Using an integrated approach, we find the root cause and eliminate it, returning patients to a calm and comfortable life.

What are panic attacks? Normally, these states occur due to ongoing events; this is a normal reaction of the body to the stress experienced, which allows you to instantly mobilize forces to overcome it. Fear, panic is a reaction to a sudden threat. Anxiety, in turn, is associated mainly with the expectation of a dangerous event.

But sometimes these states arise completely without reason, pursuing a person in situations where there is not a single reason for fears and worries.

This anxious disorder is expressed by the following symptoms:

  • Unreasonable fear or anxiety,
  • insomnia, the inability to relax,
  • pain, pressure in the chest,
  • ,
  • and rabid breathing and rabbits,
  • Dizziness
  • Pre-syncope.

While these sensations normally occur during stress, in anxiety disorders they may appear suddenly, and the manifestations may be more severe.

Panic disorder is associated with the occurrence of panic attacks, psychophysical distress in the complex. In some cases, with a high intensity of the attack, a person can commit suicidal acts. Often, panic attacks are combined with other mental disorders, representing a complex disorder - depressive, post-traumatic.

Doctors - there are three types of panic attacks:

  • Spontaneous - characteristic of panic personality disorder, occurring suddenly and without reference to circumstances. A person may wake up from a panic attack that began in a dream. There is no binding to a place, circumstances, situations.
  • Situational. Panic disorder can manifest itself in some specific situations, without fear of a specific place or process. Sometimes a person experiences a panic attack just by walking in the park. Such attacks can become aggravated for periods or vice versa, subside.
  • Specific. With these attacks, a person reacts to specific situations. So, a patient with social phobia may experience panic if necessary to speak with the seller when it comes to his turn.

Anxiety syndrome is common among the population, it is typical for more than 13 percent of Russians. Panic attacks are also quite common. But these phenomena are curable, you can get rid of them. There are a number of techniques that allow you to forget about the problem forever.

Treatment of panic attacks and anxiety disorders

Panic attacks can worsen over time, leading to suicidal attempts, resulting in heart attacks and other serious consequences. Anxiety disorders are also not safe, they create a huge burden on the body, on the psyche and nervous system of a person, provoking other diseases. With these painful manifestations, as well as with any others, it is worth fighting in a timely manner, because all the possibilities for this exist today.

Doctors emphasize that complete and lasting relief is achieved by lowering the level of anxiety over a long period of time. At the same time, stabilization of the autonomic nervous system is achieved, the hypothalamus ceases to come into an excited state, adrenaline in the blood falls. A person not only parted with the symptoms of the disease, but also experiences general comfort and tranquility. His performance improves.

In order to receive a full-fledged treatment, it is necessary to consult a psychotherapist. These problems relate specifically to the sphere of the psyche, and therefore it makes no sense to isolate some part of the symptoms and refer to other specialists with it - for example, to detail only the sensations in the heart area, and contact a cardiologist.

Antipsychotics are also prescribed for severe cases of panic disorder. They are taken for a short period of time in order to suppress excessive symptoms - in this case, complete relief from the symptoms of a vegetative nature does not occur, and therefore it is necessary to use other categories of drugs. Tricyclic antidepressants may be prescribed.

Psychocorrection or hypnotic influence in panic disorder are of an auxiliary nature. These measures do not remove vegetative manifestations, but they allow you to endure the next attack more calmly, realizing that this does not threaten death. The effectiveness of the techniques is manifested only in mild forms of disorders, which often go away on their own even without it. However, activities aimed at relaxation and peace, such as meditation, spa visits or yoga, do help reduce the severity of symptoms. And therefore, psychotherapeutic techniques can also become part of the course of treatment of these pathologies.

Professional help from doctors allows you to get rid of panic attacks and groundless anxiety - do not delay contacting specialists!

Why patients choose ACME Center

Our specialists have been helping patients with panic attacks for more than 10 years. In our practice, we use proprietary methods and an integrated approach that allows us to most effectively carry out rehabilitation.
Tired of panic attacks and want to return to a calm life and healthy sleep? Call right now at +7 (495) 792-1202 and we will help you get back to a comfortable lifestyle!

Panic attacks

Panic attacks (episodic paroxysmal anxiety) - attacks of severe anxiety (panic) or fear (most often - fear of death, less often - fear of losing consciousness, loss of control, helplessness or fear of "going crazy"), accompanied by a rapid heartbeat and a feeling of " suffocation, shortness of breath. Sometimes there are additional symptoms such as increased blood pressure, a feeling of "internal trembling", trembling in the limbs, a feeling of "hot flashes" of heat or cold, numbness of the extremities, increased sweating, a feeling of "unstability" or dizziness, nausea, derealization or depersonalization, etc.

Panic attacks last on average 5 to 30 minutes. However, sometimes they can last several hours, and in rare cases - up to several days.

I must say that even 30 years ago this disease was extremely rare. But now the incidence of panic attacks is increasing exponentially every year! Especially in big cities. Alas, panic attacks are considered a “disease of megacities”. And they suffer, most often, people with increased anxiety and the so-called perfectionists.

Earlier, in Soviet medicine, this disorder was called " sympathoadrenal crises ". This name, more than the modern one, reflected the essence of the processes occurring in the body during panic attacks. Nevertheless, I will not bother readers with a description of biochemical processes and a list of the hormones and neurotransmitters involved in these reactions. Knowing this practically does not affect the fact of the occurrence of seizures. Because biochemical processes are just an "intermediate link" in the chain of cause and effect relationships occurrence of panic attacks . What then is the "primary link", so to speak, the root cause?

Panic attacks occur suddenly, and, as it often seems, without any external causes or under the influence of minor unpleasant factors (an ordinary quarrel in the family, another trouble at work, overcrowding and stuffiness in a subway or train car, a long “traffic jam” on the road, etc. ). etc.). In fact, panic attacks always occur against the background of an already long-term depression (most common), or after repeated or severe stress (more precisely, distress). Don't be surprised by this, because it is quite difficult for an ordinary person, not a specialist, to diagnose depression. Especially, at himself. Moreover, its mild or atypical forms. Especially if it lasts a year or several years (and for some people - since childhood!). In this case, they may not even remember how they felt without depression. In this variant, the body functions “with the last of its strength”, works “at the limit of its capabilities”; and some minor unpleasant event can be the “last straw” for him! Figuratively speaking, a panic attack is “hysteria of the body”, its “desperate cry: “I can’t do this anymore !!!”

Well, in the question "Who is to blame?" figured it out. Now let's move on to the equally important question "What to do?" The fact that no one in the world has yet died from panic attacks is little consolation for those suffering from this excruciating disorder. To say that panic attacks are an unpleasant state is an understatement! These are unbearable sensations, and in the most severe cases, a real feeling of approaching death, which a person is sometimes forced to experience daily! And most importantly, he does not understand what is happening to him, and how to stop it!

Panic attacks sharply reduce the quality of a person's life, subordinating her entire expectation of the next attack. And, accordingly, they affect social activity, sometimes making a person completely incapacitated.

When panic attacks first appeared in the clinical practice of physicians, they were empirically treated with various sedatives and tranquilizers. However, after their cancellation, the seizures reappeared, and with prolonged use of these drugs, tolerance (insensitivity) inevitably and rather quickly set in. Therefore, in order to stop panic attacks, it was necessary to constantly increase doses or resort to more “strong” tranquilizers. But everywhere there is a limit: the number of tranquilizers is not unlimited, especially their doses. It was necessary to remember another very important aspect: long-term use of these drugs causes dependence on them. And after the abolition of tranquilizers, the symptoms of mental and physical withdrawal joined the renewed panic attacks, which further worsened the patient's condition.

Then the tactics of treatment were somewhat changed: antidepressants began to be added to “light” or small doses of “medium power” tranquilizers. And it was a "breakthrough" in the treatment of panic attacks! Because antidepressants do not just "relieve" the symptoms, but they affect the foundation on which these attacks are based - depression itself! Of course, in modern medicine there are a huge number of antidepressants, and the effectiveness of their effect on panic attacks is very different. But an experienced psychotherapist or psychiatrist can quite accurately select a drug that is suitable for a particular person. It is important to note that antidepressants have a cumulative effect, so their therapeutic effect does not appear immediately after the appointment, but after a certain time (on average, after a month). And, here, the full duration of treatment with antidepressants is, at best, from 6 to 12 months, and sometimes up to several years.

At the same time, there are cases of especially severe courses of panic attacks, when the appointment of even "powerful" antidepressants for a sufficiently long time does not bring the desired effect, i.e. panic attacks do not stop completely, but only become less pronounced or occur less frequently. In this version, a person, anyway, does not feel healthy and constantly lives in fear of the next attack. In this case, doctors are forced to launch "heavy artillery" - to add NEUROLEPTICS to the treatment, which patients have to take for quite a long time. Antipsychotics have a large number of unpleasant side effects, which is why many patients refuse them.

However, there is another way to treat panic attacks. He is not a drug! That is, there is a REAL METHOD OF COMPLETE CURING FROM PANIC ATTACKS, ABSOLUTELY WITHOUT RESORTING TO ANY KIND OF MEDICINES !!! This method is PSYCHOTHERAPEUTIC.

In the modern world there are a lot of different types and directions of psychotherapy. But, it must be said bluntly that with panic attacks, most of them are not effective without medical support.

However, the method that I use in my psychotherapeutic work is unique. It often allows you to completely eliminate panic attacks in 1 session! One or two more sessions are required to eliminate the FEAR of the appearance of seizures (or their expectation).

But in order to begin the direct elimination of panic attacks, a certain “intellectual” preparation of the patient is necessary. It requires from 8 to 12 sessions (depending on the severity of the disease and the personal characteristics of the patient) with a frequency of 1-2 sessions per week.

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