Panic attacks

A panic attack is the body's alarm system firing at full volume when there is no real threat. The fight-or-flight response floods the body with adrenaline, and within a few minutes the fear reaches its peak before gradually easing.

Many people have a single panic attack during a stressful period and never another. When attacks keep coming out of the blue and the person starts to live in fear of the next one, a mental health professional may talk about panic disorder. In panic disorder, the worry about having another attack, and the changes people make to avoid it, often cause as much disruption as the attacks themselves.

Panic attacks can also appear alongside other conditions, including generalized anxiety, social anxiety, phobias, depression, PTSD or health anxiety. Some people notice them at night, waking suddenly with a pounding heart and a sense of dread. A nighttime panic attack is uncomfortable, but it follows the same pattern and is treated in the same way.

People often describe a panic attack as feeling like they are having a heart attack, going crazy or about to die. Common panic attack symptoms include:

• Pounding or racing heart, chest tightness or chest pain
• Shortness of breath or a feeling of choking
• Sweating, trembling or shaking
• Dizziness, lightheadedness or feeling faint
• Nausea or stomach upset
• Tingling or numbness in the hands, feet or face
• Hot flashes or chills
• Feeling detached from yourself or from your surroundings
• Intense fear of losing control, fainting or dying

Because these sensations are so physical, many people go to an emergency room after a first attack. That is a sensible step: chest pain and breathing problems should always be checked by a doctor, especially the first time. Once medical causes are ruled out, the pattern of sudden fear that peaks and passes points toward panic.

"Anxiety attack" is not a formal diagnosis, but people use it in everyday language. Usually, a panic attack comes on abruptly, reaches its peak within minutes and involves intense physical symptoms. What people call an anxiety attack tends to build more gradually in response to a worry or stressor and may last longer at a lower intensity.

In practice, the line between the two is blurry, and both are forms of anxiety that respond to similar treatments. What matters more than the label is how often it happens, how much it frightens you and how much it changes your life. If you are avoiding places, activities or being alone because you fear an attack, it is worth talking to a professional.

There is rarely a single cause. Panic attacks tend to arise from a mix of factors:

• A family history of anxiety or panic
• Periods of high stress, loss or major life change
• A temperament that is very sensitive to bodily sensations
• Past trauma or difficult experiences
• Caffeine, alcohol, nicotine, some drugs and withdrawal from certain substances
• Medical conditions such as thyroid or heart rhythm problems, which a doctor should rule out

A key part of the cycle is how we interpret body sensations. A slightly faster heartbeat is read as a sign of danger, fear increases, the body reacts more strongly and the alarm escalates. Understanding this loop is the first step toward breaking it.

Panic disorder is one of the most treatable anxiety problems. Cognitive behavioral therapy (CBT) has strong evidence and is usually the first option. It helps you understand the panic cycle, challenge catastrophic thoughts about bodily sensations and gradually face the sensations and situations you have been avoiding, a process called exposure.

Interoceptive exposure, in which you deliberately bring on mild sensations like a raised heart rate in a safe setting, teaches the brain that these feelings are uncomfortable but not dangerous. Acceptance and commitment therapy (ACT) and mindfulness-based approaches can also help.

For some people, a psychiatrist or physician may recommend medication alongside therapy. That decision is made with a prescriber who can weigh benefits and side effects for your situation.

A licensed psychologist, clinical psychologist or therapist trained in CBT can treat panic attacks and panic disorder. A psychiatrist can help if medication is being considered or if symptoms are severe or combined with other conditions.

In a first appointment, expect questions about when the attacks started, what they feel like, what you avoid and how they affect your daily life. You will usually agree on goals and a plan together.

Seek support if attacks are frequent, if you are changing your routine to avoid them or if you are using alcohol or other substances to cope. If you ever have chest pain, trouble breathing or fainting and you are not sure what is happening, call 911 or your local emergency number.

These steps will not cure panic disorder, but they can make an attack easier to ride out:

• Remind yourself that this is panic, it will peak and it will pass.
• Slow your breathing: breathe in gently through your nose and make the out-breath longer than the in-breath.
• Ground yourself by naming things you can see, hear and touch.
• Let the sensations be there instead of fighting them; resisting tends to amplify them.
• Avoid leaving the situation in a rush if you can, as escaping teaches the brain the danger was real.

Between attacks, regular exercise, steady sleep and cutting back on caffeine and alcohol can lower your baseline anxiety.