Symptoms and Causes of Panic Attacks (Guide)

Many people believe they are having a panic attack at the very first sign of one or two intense anxiety symptoms, like a racing heart or shortness of breath, but these signs on their own do not actually mean that.

This article is all about what the most common symptoms of a panic attack are, what can cause them, and how you can effectively manage or prevent these scary experiences.

Our main takeaway:

• A panic attack is intense, but it is not life-threatening in itself.

• With the right psychological support, self-awareness, and therapy if needed, it is highly treatable.

• It is important to recognise the symptoms and not be afraid to ask for help.

A panic attack is a sudden, intense episode of anxiety that often comes with physical symptoms like a racing heart, shortness of breath, sweating, and trembling.

Even though the attack itself is brief, it can feel incredibly scary and exhausting for those experiencing it, often bringing on a fear of dying or losing control. Panic attacks do not have to be just one-off events; if they keep happening, they can turn into panic disorder. It is important to understand that while they are frightening, panic attacks can be handled very effectively with the right help. 

A panic attack is not just unpleasant, it can really affect your quality of life - so it is important not to brush it aside, but to recognise the signs and deal with it in good time.

Symptoms and signs of a panic attack

A panic attack is a sudden surge of intense fear or discomfort. At least four of the 13 physical and psychological symptoms defined by the DSM appear at the same time, often accompanied by strong worry about misinterpreted physical sensations.

The symptoms of a panic attack can vary widely. This condition involves a sudden wave of intense fear or intense discomfort.

At least four or more of these symptoms must appear at the same time for the episode to actually be called a panic attack.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the "bible" for clinical psychologists, psychotherapists, psychiatrists, and psychologists. It clearly defines the 13 symptoms, where the simultaneous presence of four or more triggers a panic attack:

Palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed, or faint; chills or heat sensations; paresthesias (numbness or tingling sensations); derealisation (feelings of unreality) or depersonalisation (being detached from oneself); fear of losing control or "going crazy"; fear of dying.

As you can see, the list of symptoms includes both physical sensations and thoughts, making it a highly complex physiological phenomenon. Simply put, the issue is that the individual misinterprets their various bodily sensations. They attach thoughts to them that create serious further worry. Most commonly, people suspect a heart attack, a stroke, or some kind of stomach illness.

When do you need to see a doctor?

Many people mistakenly label themselves as having public panic disorder, even though other reasons are often behind the symptoms. A medical check-up is mainly to rule out physical illnesses. The long-term solution is usually cognitive behavioral therapy, not medical treatment.

Clients often label themselves as "panickers" and diagnose themselves with panic disorder. Yet, in many cases, it is about something completely different. These "panicking" clients love to visit both their GP and hospital emergency rooms. Some even laugh at themselves during sessions, sharing that they are practically banned from the hospital because they have shown up so many times diagnosing themselves with a terminal illness.

Since diagnosing a panic attack requires ruling out organic (physical) causes, it is indeed a good idea to visit a GP after an attack occurs. However, there is a good chance they will not be the one providing the ultimate solution to the problem, and it is important to accept and believe this.

An informed cardiologist or GP who recognises the symptoms of a panic attack will ideally refer the patient to a psychologist or psychiatrist, though in less ideal cases, they might send them home without any further plan of action.

Please note! In the case of panic attacks, cognitive behavioral therapy is essential for long-term recovery!

You can get this type of help from a properly trained psychologist, psychotherapist, or a psychiatrist who also offers psychotherapy. So, in most cases, you do not actually need medical help to treat panic attacks, but rather therapy. If a client does not receive the right support in the early stages and the attacks develop into panic disorder, that is when a psychiatrist and medical treatment are more frequently brought in.

How long does a panic attack last?

A panic attack hits the person like a sudden wave or surge, peaking within a few minutes. During these few minutes, at least four of the symptoms mentioned above must appear, and after the peak, they gradually fade away. How long it takes to pass depends on exactly what tools the person uses to try and get a handle on their condition. 

What causes a panic attack?

Genetic, biological, and psychological factors all play a role in the development of panic disorder. According to all studies, it affects 2 to 3 times more women than men, and most commonly starts between the ages of 20 and 30.

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

What is the difference between a panic attack and panic disorder?

Panic disorder develops when panic attacks keep recurring, leading to persistent fear or avoidant behavior, with no other underlying illness behind them.

Not everyone who experiences a panic attack has panic disorder, but everyone with panic disorder does experience panic attacks. This is a very important difference, as many clients tend to develop a sense of illness based on their own—non-actual—panic disorder, which only worsens their state.

When identifying a panic attack, the symptom list above provides the foundation. Another criterion is that the anxiety episode must come on suddenly. This wave, which peaks in 10 minutes at most, can start from a state of calm or a state of anxiety just the same.

We can talk about panic disorder when these panic attacks keep returning.

This is also joined by other symptoms. For instance, at least one attack is followed by a month or more of persistent worry about having more panic attacks or their consequences (like having a heart attack); and/or there is a significant change in the person's behavior as a result of the attacks (for example, if the first attack happened on public transport, they start avoiding that mode of transport).

It is also important that the disorder cannot be attributed to the effects of a substance (medication, drugs) or another medical condition (a physical illness). Plus, it is not better explained by another mental disorder (like phobia, social anxiety, etc.).

Overcoming and preventing panic attacks

The key to overcoming a panic attack is consciously managing your physical and mental state, mainly through breathing exercises, stress-relief techniques, and a healthy lifestyle.

One key to overcoming a panic attack is recognising what is happening inside us and reminding ourselves that the attack itself is not dangerous, and certainly not fatal. The first step is to manage your breathing: with slow, deep breaths, we can ease the physical symptoms and the fear.

The physiological mechanisms of breathing exercises are complex and closely linked. Activating the parasympathetic nervous system, stimulating the vagus nerve, restoring the oxygen-carbon dioxide balance in the body, lowering stress hormones, and releasing endorphins all help to reduce tension and anxiety.

It is also very important that during breathing exercises, your focus is entirely on your breath. This increases body awareness and brings you into the here-and-now. This mindfulness-like state lessens the impact of negative thoughts and worries that trigger anxiety. Shifting brain activity to the prefrontal cortex (responsible for conscious thinking) helps quiet the amygdala and limbic system (the center for emotional reactions).

When it comes to prevention, it is important to make anxiety management tools part of your daily routine. Relaxation practices like mindfulness, meditation, progressive muscle relaxation, or yoga help to lower overall stress levels.

We know, this is a lesson everyone has heard before, but we simply cannot ignore the power of a healthy lifestyle. This includes the supportive effects of regular exercise, good sleep, and a balanced diet on both your emotional and mental balance.

Panic attacks and psychologists: how can a professional help?

If you are experiencing panic attacks, it is highly recommended to seek the help of a psychologist as soon as possible. They will help prevent the symptoms from worsening and developing into panic disorder.

Cognitive behavioral therapy, which is an evidence-based psychotherapeutic method, is proven to be highly effective in treating panic attacks and panic disorder. Through various cognitive techniques, you can learn to realistically assess your body's signals, helping you prevent catastrophic thoughts from taking over. 

Panic attacks are scary, but you do not have to face them alone, we are here to help.

Frequently asked questions

What is the difference between a panic attack and anxiety?

A panic attack comes on suddenly with intense physical and mental symptoms, while anxiety tends to build up gradually.

Can a panic attack be life-threatening?

No, a panic attack is frightening, but it does not put your life in danger.

What should I do if I am having a panic attack?

Try to slow down your breathing, find a safe space, and ask for help if you need to.

When should I seek professional help?

If the attacks keep coming back or get in the way of your daily life, it is a good idea to reach out to a psychologist or psychiatrist.

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