Symptoms and signs of panic disorder

“I felt like I was going to die — even though, medically speaking, I was perfectly healthy.”

This article explains what panic disorder is, how to recognize it and what treatment options are available with the help of a professional.

A panic attack often looks like a heart attack or some serious physical illness. Strong palpitations, shortness of breath, chest pain, trembling, numbness and that hard-to-define but paralyzing feeling that “something terrible is happening”. Perhaps the scariest part is that it all happens apparently without any warning — and no one else really understands what is going on inside us.

Panic disorder is invisible, yet very real. In Hungary, thousands of people struggle with it every day, often for years without help, with feelings of shame or a wrong diagnosis. But what exactly does this condition mean? What happens in the body and in the mind? How does it develop, and — perhaps most importantly — is there a way out?

Panic disorder can cause strong physical and emotional symptoms, but with professional help and proper treatment, people affected can improve a lot.

• Panic disorder can cause intense physical and emotional symptoms, but it is not hopeless.

• A professional (psychologist/psychiatrist) can help recognize and treat the symptoms.

• Recovery is often a longer process, but it is possible with therapy and lifestyle changes.

What is panic disorder?

A core of panic disorder is that the person has recurrent, intense anxiety attacks that cannot be predicted in advance because they are not tied to a specific situation or circumstance. That is why these attacks hit suddenly.

During a panic attack, physical symptoms appear at the same time (such as strong palpitations, shortness of breath, dizziness) and mental symptoms (for example, fear of dying, uncertainty about reality, or the feeling as if you were watching yourself “from the outside”). The symptoms usually peak within 10 minutes, then — depending on whether the person gets help — slowly ease and finally disappear completely.

Over time, constant fear of panic attacks can also develop. In professional terms, this is called anticipatory anxiety. This can lead the person to start avoiding certain situations so they do not have another bad episode.

How common panic disorder is

In the development of panic disorder, genetic, biological, and psychological factors all play a role. According to every study, it affects 2-3 times more women than men, and it most often starts between the ages of 20 and 30.

Panic attacks can also appear as accompanying symptoms of some illnesses, for example in any other anxiety disorder, in other mental disorders (depressive disorders, post-traumatic stress disorder, substance use disorders), and also in the context of certain health conditions and illnesses (cardiac, respiratory, etc.).

Typical symptoms of panic disorder

One of the main signs of panic disorder is a recurrent panic attack, which comes on suddenly, apparently without any warning. 

A panic attack can involve many physical and emotional symptoms, and at least four of them must be present at the same time for it to truly be called a panic attack. The most common symptoms are:

• strong palpitations, fast pulse

• sweating, shivering or trembling

• shortness of breath, feeling of choking

• chest pain or tightness

• nausea or stomach upset

• dizziness, feeling faint

• chills or hot flashes

• numbness, tingling

• feeling detached from reality (derealization), or feeling detached from yourself (depersonalization)

• fear of going crazy or losing control

• fear of dying

If panic attacks are followed by ongoing worry — for example, fear about when the next attack will come — and/or the person starts avoiding certain situations, we may be talking about panic disorder. A typical example is when someone has an attack on a bus and later avoids public transport.

It is important to know that for a diagnosis of panic disorder, the symptoms must not be caused by substance use (for example, medication or drugs), a physical illness, or another mental disorder.

The most common causes of panic disorder

Several factors can play a role in the development of panic disorder. From a biological point of view, genetic predisposition is important too, since the condition often runs in families. Overactivity of certain areas of the brain, such as the amygdala, which works like an alarm system, can also contribute to panic attacks because it increases the tendency toward anxiety. 

In addition, major emotional stress, such as divorce, an accident, or losing a job, as well as earlier traumatic experiences — for example abuse, an accident, or a death in the family — often trigger panic attacks. In these situations, the body goes into a heightened state of alert, and the “alarm system” is more easily activated. 

Panic disorder can also be linked to other mental difficulties, such as generalized anxiety, depression or low self-esteem, and learned behavior patterns from childhood may also contribute to the development of the condition. 

Also, certain physical illnesses that can cause symptoms similar to panic attacks may contribute to the disorder if the person becomes overly afraid because of the symptoms, and panic attacks may then occur because of that fear. Too much caffeine, alcohol, or drug use can also trigger or intensify the symptoms of panic disorder.

The consequences of panic disorder

If panic disorder is left untreated, it can have a serious impact on quality of life in the long run. People often start avoiding certain situations where attacks have happened, which can shrink their everyday freedom of movement. This can lead to social isolation and damaged relationships. Work performance can also drop, because panic attacks can make both concentration and work very difficult.

Anxiety, fear, and constant worry can lead to depression, and some people may also use alcohol or medication to ease the symptoms, which can lead to dependence.

It is important to know that panic disorder is a treatable condition, and with timely help, the attacks can be eased and quality of life can improve.

How panic disorder is assessed

Panic disorder is an anxiety disorder. As a first step, other physical illnesses must definitely be ruled out, because they can cause symptoms similar to panic attacks. These may include heart disease, hormonal problems, or breathing difficulties. This requires medical tests, such as an ECG, blood pressure measurement, and laboratory tests.

Then a psychologist or psychiatrist has a detailed conversation with the client to assess how often the anxiety attacks happen, how intense they are, and how they affect everyday life. To confirm the diagnosis, psychological tests may also be used, for example self-assessment questionnaires, which help measure the presence of panic disorder accurately. 

How to manage panic disorder at home

One key to getting through a panic attack is recognizing what is happening inside us and becoming aware that the attack itself is not dangerous and is certainly not fatal. The first step is to regulate breathing: with slow, deep breathing, we can reduce physical symptoms and fear.

It is also very important that during breathing exercises, attention stays on the breath, which increases body awareness and the here-and-now state. This mindfulness-like state reduces the effect of negative thoughts and worries that trigger anxiety. 

For prevention, it is important to build anxiety-management techniques into everyday life. Relaxation practices such as the mindfulness already mentioned, meditation, progressive muscle relaxation, or yoga help reduce overall stress levels.

We know, this sounds familiar to everyone, but we cannot ignore the supportive effect of a healthy lifestyle, including regular exercise, enough sleep, and a balanced diet, on both emotional and mental balance.

When should you see a professional?

Many people experience a stronger anxiety episode or panic-like illness at some point in their lives, but that alone does not mean panic disorder is present. At the same time, there are signs where it is worth seriously thinking about whether to see a professional.

See a psychologist or psychiatrist if:

• panic attacks keep coming back, apparently without any warning,

• because of the intense physical symptoms (for example strong palpitations, shortness of breath, dizziness), you often fear that you have a serious physical illness,

• you start avoiding situations where you had an attack before (for example public transport, shopping, public places),

• you are constantly worried about another attack, and it affects your everyday life,

• you feel that anxiety controls your life and limits you at work, in relationships, or in your free time,

• medical tests found no physical cause for your symptoms, but the episodes do not go away.

Medication treatment for panic disorder

In the treatment of panic disorder, medication therapy often plays a role alongside psychotherapy, especially when the symptoms are so strong that they significantly affect quality of life, or when psychotherapy alone does not bring enough improvement.

The goal of medication is to reduce the frequency and intensity of panic attacks, ease ongoing anxiety, and improve the client’s quality of life. It is important to stress, however, that medicine does not solve the root causes — therapeutic support may also be needed to work through them.  The best results usually come when medication is combined with psychotherapy (for example cognitive behavioral therapy) as well.

Treating panic disorder with psychotherapy

If you experience a panic attack, it is a good idea to ask a psychologist for help as soon as possible, so the symptoms do not worsen and develop into panic disorder.

Cognitive behavioral therapy, which is an evidence-based psychotherapy method, helps very effectively and has been proven to help with panic attacks and panic disorder. With different cognitive techniques, you can learn to judge your body’s signals realistically, which helps you avoid letting catastrophic thoughts take over.  Panic disorder is not about “imagining things” or “weakness.” It is a real, treatable condition that you do not have to deal with alone,  we are here, to help you.

The sooner you ask for help, the sooner improvement can begin — and the sooner you can take back control of your life.

Frequently asked questions

Can you die from a panic attack?

Although the symptoms are eerily similar to a heart attack, a panic attack is not life-threatening in medical terms, and it does not cause cardiac arrest.

Can a panic attack happen during sleep or when waking up from a dream?

Yes, nighttime panic attacks are a real thing, when the body still produces sudden shortness of breath and strong palpitations while resting.

Do I have to give up coffee if I have panic disorder?

It is a good idea to cut back on caffeine, because the higher pulse it causes may be wrongly identified by your brain as a panic signal, which can trigger another attack.

Is it okay to drive if I have panic attacks often?

You can drive, but for your own safety it is a good idea to wait until therapy helps you learn to manage the symptoms while driving too.

How do I explain to my family what happens to me during a panic attack?

Tell them that your body gives a “false alarm” at those times, and what helps you most is if they simply stay calmly by your side.

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