What cause anxiety and panic attacks
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.
Products & Services
- Book: Mayo Clinic Family Health Book, 5th Edition
- Newsletter: Mayo Clinic Health Letter — Digital Edition
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
- Trembling or shaking
- Shortness of breath or tightness in your throat
- Hot flashes
- Abdominal cramping
- Chest pain
- 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.
Request an Appointment at Mayo Clinic
From Mayo Clinic to your inbox
Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.
To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.
It's not known what causes panic attacks or panic disorder, but these factors may play a role:
- 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.
- Nocturnal panic attacks: What causes them?
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
Products & Services
Panic disorder - NHS
Panic disorder is an anxiety disorder where you regularly have sudden attacks of panic or fear.
Everyone experiences feelings of anxiety and panic at certain times. It's a natural response to stressful or dangerous situations.
But someone with panic disorder has feelings of anxiety, stress and panic regularly and at any time, often for no apparent reason.
Symptoms of panic disorder
Anxiety is a feeling of unease. It can range from mild to severe, and can include feelings of worry and fear. Panic is the most severe form of anxiety.
You may start to avoid certain situations because you fear they'll trigger another attack.
This can create a cycle of living "in fear of fear". It can add to your sense of panic and may cause you to have more attacks.
During a panic attack you get a rush of intense mental and physical symptoms. It can come on very quickly and for no apparent reason.
A panic attack can be very frightening and distressing.
- a racing heartbeat
- feeling faint
- chest pain
- shortness of breath
- hot flushes
- shaky limbs
- a choking sensation
- numbness or pins and needles
- dry mouth
- a need to go to the toilet
- ringing in your ears
- a feeling of dread or a fear of dying
- a churning stomach
- a tingling in your fingers
- feeling like you're not connected to your body
Most panic attacks last between 5 and 20 minutes. Some have been reported to last up to an hour.
The number of attacks you have will depend on how severe your condition is. Some people have attacks once or twice a month, while others have them several times a week.
Although panic attacks are frightening, they're not dangerous. An attack will not cause you any physical harm, and it's unlikely you'll be admitted to hospital if you have one.
Be aware that most of these symptoms can also be symptoms of other conditions or problems, so you may not always be experiencing a panic attack.
For example, you may have a racing heartbeat if you have very low blood pressure.
When to get help
See a GP if you've been experiencing symptoms of panic disorder.
They'll ask you to describe your symptoms, how often you get them, and how long you have had them.
They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.
It can sometimes be difficult to talk about your feelings, emotions and personal life, but try not to feel anxious or embarrassed.
You may be diagnosed with panic disorder if you have regular and unexpected panic attacks followed by at least a month of continuous worry or concern about having further attacks.
Treatments for panic disorder
Treatment aims to reduce the number of panic attacks you have and ease your symptoms.
Talking therapies and medicine are the main treatments for panic disorder. Your treatment will depend on your symptoms.
You can refer yourself directly to a psychological therapies service for treatment based on cognitive behavioural therapy (CBT).
If you prefer, you can see a GP and they can refer you.
Your therapist may discuss with you how you react when you have a panic attack and what you think about.
They can teach you ways of changing your behaviour to help you keep calm during an attack.
You may need to see your GP regularly while you're having CBT so they can assess your progress.
If you and your doctor think it might be helpful, you may be prescribed:
- a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) or, if SSRIs are not suitable, a tricyclic antidepressant (usually imipramine or clomipramine)
- an anti-epilepsy medicine such as pregabalin or, if your anxiety is severe, clonazepam (these medicines are also beneficial for treating anxiety)
Antidepressants can take 2 to 4 weeks before they start to work, and up to 8 weeks to work fully.
Keep taking your medicines, even if you feel they're not working, and only stop taking them if your GP advises you to do so.
Referral to a specialist
If your symptoms do not improve after CBT, medicine and connecting with a support group, your GP may refer you to a mental health specialist such as a psychiatrist or clinical psychologist.
The specialist will carry out an assessment and devise a treatment plan to help you manage your symptoms.
Video: Psychological therapies for stress, anxiety and depression
Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.
Media last reviewed: 14 March 2022
Media review due: 14 March 2025
Things you can try yourself
What to do during a panic attack
The next time you feel a panic attack coming on:
- do not fight it
- stay where you are, if possible
- breathe slowly and deeply
- remind yourself that the attack will pass
- focus on positive, peaceful and relaxing images
- remember it's not life threatening
Preventing a further attack
It may help to:
- read a self-help book for anxiety based on the principles of cognitive behavioural therapy (CBT) – ask your GP to recommend one
- try complementary therapies such as massage and aromatherapy, or activities like yoga and pilates, to help you relax
- learn breathing techniques to help ease symptoms
- do regular physical exercise to reduce stress and tension
- avoid sugary food and drinks, caffeine and alcohol, and stop smoking, as all they can all make attacks worse
For more help, read how to deal with panic attacks.
Panic disorder can have a big impact on your life, but support is available. It might help to speak to other people with the same condition, or to connect with a charity.
You may find the following links useful:
- Anxiety UK
- Mind: understanding anxiety and panic attacks
- No Panic
- Triumph Over Phobia (TOP UK)
Ask your GP about support groups for panic disorder near you.
Find anxiety services in your area
Complications of panic disorder
Panic disorder is treatable and you can make a full recovery. But it's best to get medical help as soon as you can.
If you do not get medical help, panic disorder can escalate and become very difficult to cope with.
You're more at risk of developing other mental health conditions, such as agoraphobia or other phobias, or an alcohol or drug problem.
Having panic disorder may affect your ability to drive. The law requires you to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could impact your driving ability.
Visit GOV.UK for further information about driving with a disability or health condition.
As with many mental health conditions, the exact cause of panic disorder is not fully understood.
But it's thought to be linked to a combination of things, including:
- a traumatic or very stressful life experience, such as bereavement
- having a close family member with panic disorder
- an imbalance of neurotransmitters (chemical messengers) in the brain
Panic disorder in children
Panic disorder is more common in teenagers than in younger children.
Panic attacks can be particularly hard for children and young people to deal with. Severe panic disorder may affect their development and learning.
If your child has the signs and symptoms of panic disorder, they should see a GP.
After taking a detailed medical history the GP will carry out a thorough physical examination to rule out any physical causes for the symptoms.
They may refer your child to a specialist for further assessment and treatment. The specialist may recommend a course of CBT for your child.
Screening for other anxiety disorders may also be needed to help find the cause of your child's panic attacks.
Read more about anxiety disorders in children or find out about mental health services for children and young people.
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. nine0005
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. nine0005
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 (or rather, 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! nine0003 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! nine0005
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 treated empirically 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. nine0005
Then the tactics of treatment were somewhat changed: antidepressants were added to "light" or small doses of "medium-powered" 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. nine0005
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. nine0005
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. nine0005
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. nine0005
After eliminating panic attacks and the fear of their occurrence, it is extremely important to “develop” the underlying causes that led to their appearance. This will be a kind of "insurance" against the occurrence of panic attacks in the future. This requires 3-4 months on average (with the frequency of classes 1 time per week). But, having worked through these “deep roots”, a person not only completely gets rid of panic attacks, but also depression, solves many personal problems and begins to live a full life! nine0005
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. nine0053
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. nine0005
This anxious disorder is expressed by the following symptoms:
- Unreasonable fear or anxiety,
- insomnia, the inability to relax,
- pain, pressure in the chest,
- BRIGHT AND HAS
If normally such sensations occur during stress, then during an anxiety disorder they may appear suddenly, and the manifestations may be more severe. nine0005
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. nine0064
- 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. nine0005
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. nine0005
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. nine0005
Professional help from doctors allows you to get rid of panic attacks and groundless anxiety - do not delay contacting specialists!
Why patients choose ACME CenterOur 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.