13 Panic Attack Symptoms: Complete Guide to Panic Disorder Signs

Panic attacks are sudden episodes of intense fear or anxiety that trigger severe physical reactions when there is no real danger or apparent cause. When panic attacks become recurrent and you live in persistent worry about having another attack, you may have panic disorder. Understanding the symptoms of panic attacks is crucial for early recognition and appropriate management of this condition.

Panic attacks can be frightening and overwhelming experiences that strike without warning. They typically reach their peak within minutes and can leave you feeling exhausted and anxious afterward. While anyone can experience a panic attack, panic disorder is a specific anxiety disorder characterized by repeated panic attacks and ongoing fear of future episodes.

In this comprehensive guide, we’ll explore the most common symptoms of panic attacks and panic disorder, helping you recognize these signs and understand what’s happening in your body during these intense episodes.

1. Rapid or Pounding Heartbeat (Palpitations)

One of the most common and alarming symptoms of a panic attack is a racing or pounding heart. During a panic attack, your heart rate can increase dramatically, sometimes feeling like your heart is beating out of your chest. This occurs because your body’s “fight or flight” response is activated, releasing stress hormones like adrenaline that cause your heart to pump faster.

Many people experiencing this symptom for the first time fear they’re having a heart attack, which can intensify the panic. The palpitations may feel like:

• Your heart is racing uncontrollably
• Irregular or skipped heartbeats
• A pounding sensation in your chest, neck, or throat
• An uncomfortably strong awareness of your heartbeat

This symptom, while distressing, is generally not dangerous in healthy individuals, though it’s important to rule out cardiac issues with a healthcare provider if you’re experiencing it for the first time.

2. Excessive Sweating

Profuse sweating is another hallmark symptom of panic attacks, occurring even when you’re not physically active or in a warm environment. This sweating is triggered by your nervous system’s response to perceived danger and can be quite intense.

During a panic attack, you may experience:

• Sudden onset of heavy sweating
• Cold sweats or clammy skin
• Perspiration on your palms, face, or throughout your body
• Feeling both hot and cold simultaneously

This excessive sweating can contribute to feelings of discomfort and embarrassment, particularly if you’re in public or social situations, which may further fuel anxiety about future attacks.

3. Trembling or Shaking

Uncontrollable shaking or trembling is a common physical manifestation of panic attacks. Your hands, legs, or entire body may shake visibly, or you might experience internal trembling that only you can feel. This occurs as your muscles tense in response to the surge of adrenaline coursing through your system.

The trembling can range from subtle to severe and may:

• Make it difficult to hold objects or perform fine motor tasks
• Affect your legs, making you feel unsteady
• Involve your voice, causing it to quaver
• Continue for several minutes even after other symptoms begin to subside

4. Shortness of Breath or Feeling Smothered

Difficulty breathing is one of the most frightening symptoms of a panic attack. You may feel like you can’t get enough air, as though you’re suffocating or being smothered. This sensation can trigger intense fear and make the panic attack worse, creating a vicious cycle.

During a panic attack, breathing difficulties may include:

• Rapid, shallow breathing (hyperventilation)
• Feeling like you can’t take a deep breath
• A sensation of your throat closing or being constricted
• Gasping for air
• Feeling like you’re choking

Ironically, hyperventilation during panic attacks often means you’re actually taking in too much oxygen, not too little, which can lead to dizziness and tingling sensations in your extremities.

5. Chest Pain or Discomfort

Chest pain during a panic attack is extremely common and often the symptom that causes people to seek emergency medical care, as it can mimic the symptoms of a heart attack. The pain or discomfort typically results from muscle tension, hyperventilation, or heightened awareness of normal bodily sensations.

Chest discomfort during panic attacks may feel like:

• Sharp, stabbing pains in the chest
• Tightness or pressure, as if something is sitting on your chest
• Aching or burning sensations
• Pain that moves or radiates to other areas

While panic-related chest pain is not dangerous, it’s essential to have chest pain evaluated by a medical professional to rule out cardiac problems, especially if you’re experiencing it for the first time or have risk factors for heart disease.

6. Nausea or Abdominal Distress

Gastrointestinal symptoms are frequently reported during panic attacks. The stress response diverts blood flow away from your digestive system, which can cause various uncomfortable stomach sensations. Some people with panic disorder become particularly sensitive to these abdominal symptoms and fear them intensely.

Digestive symptoms during a panic attack include:

• Nausea or feeling like you might vomit
• Stomach cramping or pain
• Butterflies or a fluttering sensation in your stomach
• Diarrhea or urgent need to use the bathroom
• Loss of appetite

These symptoms can be particularly distressing in public settings and may lead to avoidance behaviors characteristic of panic disorder.

7. Dizziness, Lightheadedness, or Feeling Faint

Feeling dizzy, lightheaded, or like you might faint is a common symptom that often results from hyperventilation and changes in blood flow during a panic attack. While you might feel like you’re about to pass out, actually fainting during a panic attack is quite rare because the increased heart rate and blood pressure typically prevent it.

This symptom manifests as:

• Sensation that the room is spinning (vertigo)
• Feeling unsteady or off-balance
• Lightheadedness or wooziness
• Feeling disconnected from your surroundings
• Visual disturbances or tunnel vision

The fear of fainting in public can become a significant concern for people with panic disorder, potentially leading to avoidance of certain situations or places.

8. Tingling or Numbness (Paresthesia)

Tingling sensations or numbness, medically known as paresthesia, commonly occur during panic attacks, typically in the hands, feet, face, or around the mouth. This symptom results from hyperventilation, which alters the balance of oxygen and carbon dioxide in your blood.

Paresthesia during panic attacks may involve:

• Pins and needles sensation in your extremities
• Numbness in your fingers, toes, or lips
• Tingling that spreads up your arms or legs
• A feeling like your limbs have “fallen asleep”

While harmless, these sensations can be quite alarming, especially if you don’t understand their connection to anxiety and breathing patterns.

9. Chills or Hot Flashes

Sudden and intense temperature fluctuations are characteristic of panic attacks. You might experience waves of heat that make you feel like you’re burning up, followed immediately by chills that leave you shivering. These temperature changes are caused by your autonomic nervous system’s response to stress.

Temperature-related symptoms include:

• Sudden hot flashes or feeling overheated
• Cold chills or feeling freezing
• Alternating between hot and cold
• Flushed or reddened skin
• Goosebumps or shivering

Women experiencing panic attacks may find these symptoms particularly confusing if they’re also going through menopause, as hot flashes can be a symptom of both conditions.

10. Feelings of Unreality or Detachment (Derealization/Depersonalization)

Many people experiencing panic attacks report strange sensations of unreality or detachment from themselves or their surroundings. Derealization is feeling that your environment is strange, dreamlike, or unreal, while depersonalization is feeling detached from yourself, as if you’re observing yourself from outside your body.

These dissociative symptoms may feel like:

• The world around you seems foggy, distant, or artificial
• Objects appear distorted in size or shape
• Feeling disconnected from your own body or thoughts
• Sensing that you’re in a dream or movie
• Feeling like you’re watching yourself from the outside

These symptoms can be particularly disturbing and may make you fear you’re “going crazy” or losing your mind, though they’re temporary and harmless manifestations of extreme anxiety.

11. Fear of Losing Control or “Going Crazy”

An overwhelming fear of losing control, doing something embarrassing, or losing your mind is a psychological symptom that often accompanies the physical sensations of a panic attack. This intense fear can be just as debilitating as the physical symptoms.

This cognitive symptom includes thoughts such as:

• Fear that you’re losing your sanity
• Worry that you’ll lose control of your actions
• Concern that you’ll embarrass yourself publicly
• Fear that you’ll be unable to escape or get help
• Feeling that something terrible is about to happen

It’s important to understand that despite these frightening thoughts, panic attacks do not cause you to lose control, go insane, or act irrationally.

12. Fear of Dying

An intense and overwhelming fear of dying is one of the most distressing symptoms of a panic attack. The combination of severe physical symptoms—particularly chest pain, difficulty breathing, and heart palpitations—can convince you that you’re having a life-threatening medical emergency.

This fear manifests as:

• Absolute conviction that you’re dying or about to die
• Belief you’re having a heart attack or stroke
• Fear of sudden, imminent death
• Panic about not receiving help in time
• Urgency to seek emergency medical care

Many people experiencing their first panic attack visit the emergency room believing they’re having a serious medical event. While panic attacks themselves aren’t dangerous, it’s always appropriate to seek medical evaluation if you’re uncertain about your symptoms.

13. Persistent Worry About Future Panic Attacks

For those with panic disorder, the fear doesn’t end when the panic attack subsides. A defining feature of panic disorder is persistent anxiety about having another panic attack, which can be just as limiting as the attacks themselves. This anticipatory anxiety can last for weeks or months and significantly impact your quality of life.

This symptom includes:

• Constant worry about when the next attack will occur
• Hypervigilance to bodily sensations that might signal an attack
• Anxiety about being in situations where escape might be difficult
• Fear of being alone or far from help during an attack
• Preoccupation with the possibility of future attacks

This ongoing worry often leads to avoidance behaviors, where you begin avoiding places, situations, or activities where you fear a panic attack might occur or where help might not be available.

What Causes Panic Attacks and Panic Disorder?

The exact causes of panic attacks and panic disorder aren’t fully understood, but research suggests that multiple factors work together to trigger these conditions. Understanding these potential causes can help you better comprehend your experience and seek appropriate support.

Biological Factors

Genetics: Panic disorder tends to run in families, suggesting a hereditary component. If you have a close family member with panic disorder or other anxiety disorders, you may have an increased risk of developing the condition yourself.

Brain Chemistry: Imbalances in neurotransmitters—the chemical messengers in your brain—may play a role in panic disorders. Changes in how your brain regulates serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) may contribute to panic symptoms.

Brain Structure: Research suggests that the amygdala, the part of your brain responsible for fear responses, may function differently in people with panic disorder, making them more sensitive to anxiety-triggering situations.

Psychological Factors

Stress: Major life transitions, significant stress, or traumatic events can trigger the onset of panic attacks. This might include experiences like the death of a loved one, divorce, job loss, or having a baby.

Temperament: People who are more sensitive to stress or have a tendency toward negative emotions may be more susceptible to panic disorder. Those who are particularly sensitive to anxiety-related sensations may also be at higher risk.

Learned Behaviors: If you’ve had panic attacks in certain situations, you may develop anxiety about those situations, which can paradoxically trigger more attacks—a cycle known as conditioned fear response.

Environmental Triggers

Substance Use: Caffeine, alcohol, recreational drugs, and even certain medications can trigger or worsen panic attacks in susceptible individuals. Withdrawal from certain substances can also precipitate panic symptoms.

Medical Conditions: Certain health conditions can cause symptoms similar to panic attacks or may trigger actual panic attacks. These include thyroid problems, heart arrhythmias, respiratory conditions, and inner ear disorders. It’s essential to rule out these medical causes with proper evaluation.

Phobias: Specific phobias or agoraphobia (fear of places or situations where escape might be difficult) can be associated with panic attacks.

Prevention and Management Strategies

While it may not be possible to prevent panic attacks entirely, especially if you have a genetic predisposition, there are several strategies that can help reduce the frequency and intensity of attacks and prevent the development of panic disorder.

Early Intervention

Seeking help early after experiencing your first panic attack or when symptoms begin can prevent the condition from worsening. Early intervention can help you develop coping strategies before avoidance behaviors and persistent worry become established patterns.

Lifestyle Modifications

Regular Exercise: Physical activity is one of the most effective natural anxiety reducers. Regular exercise helps regulate stress hormones, improves mood, and can reduce the frequency of panic attacks. Aim for at least 30 minutes of moderate exercise most days of the week.

Limit Stimulants: Reduce or eliminate caffeine, nicotine, and other stimulants that can trigger anxiety symptoms and panic attacks. Be mindful of caffeine in coffee, tea, energy drinks, chocolate, and some medications.

Avoid Alcohol and Recreational Drugs: While some people use alcohol to cope with anxiety, it can actually worsen panic disorder and may trigger panic attacks, especially during withdrawal.

Prioritize Sleep: Lack of sleep can increase anxiety and make you more vulnerable to panic attacks. Establish a regular sleep schedule and practice good sleep hygiene.

Stress Management Techniques

Breathing Exercises: Learning proper breathing techniques can help you manage hyperventilation during panic attacks and may even prevent attacks from escalating. Practice slow, diaphragmatic breathing regularly, not just during panic episodes.

Mindfulness and Meditation: Regular mindfulness practice can help you become less reactive to anxiety symptoms and bodily sensations, reducing the likelihood that they’ll trigger a full panic attack.

Progressive Muscle Relaxation: This technique involves systematically tensing and relaxing different muscle groups, which can reduce overall anxiety levels and help you recognize and release tension before it escalates.

Cognitive Strategies

Education: Learning about panic attacks and understanding that they’re not dangerous can reduce the fear of symptoms, which often fuels the attacks themselves. Understanding what’s happening in your body during a panic attack can make the experience less frightening.

Challenge Catastrophic Thinking: Panic attacks are often fueled by catastrophic interpretations of bodily sensations. Learning to recognize and challenge these thoughts can prevent anxiety from spiraling into a full panic attack.

Professional Support

Working with a mental health professional, particularly one trained in cognitive-behavioral therapy (CBT) or exposure therapy, can provide you with effective tools for managing and preventing panic attacks. These evidence-based therapies have strong success rates for panic disorder.

If you’re experiencing recurrent panic attacks, don’t try to manage them alone. Professional support can make a significant difference in your recovery and quality of life.

Frequently Asked Questions

What does a panic attack feel like?

A panic attack feels like a sudden wave of intense fear and physical discomfort. Most people describe it as feeling like they’re having a heart attack, losing control, or dying. Physical sensations include racing heart, difficulty breathing, chest pain, sweating, trembling, and dizziness. The experience peaks within minutes and typically subsides within 20-30 minutes, though you may feel exhausted afterward.

How long do panic attacks last?

Most panic attacks peak within 10 minutes and rarely last longer than 30 minutes. However, some symptoms, particularly fatigue and worry, may persist for hours after the attack. Some people experience waves of panic attacks or multiple attacks within a short period.

Can you die from a panic attack?

No, you cannot die from a panic attack. While panic attacks feel extremely frightening and can mimic serious medical conditions like heart attacks, they are not physically dangerous or life-threatening. However, if you’re experiencing symptoms for the first time, it’s important to seek medical evaluation to rule out other conditions.

What’s the difference between a panic attack and an anxiety attack?

Panic attacks are intense, sudden episodes with specific physical symptoms that peak quickly, often without an obvious trigger. They’re defined in diagnostic criteria and can occur as part of panic disorder. “Anxiety attack” is not a clinical term but generally refers to periods of intense anxiety that build gradually in response to a stressor and may be less intense than panic attacks.

Are panic attack symptoms different in women?

While panic attack symptoms are generally similar across genders, some research suggests women may be more likely to experience shortness of breath, feeling smothered, and digestive symptoms. Women are also diagnosed with panic disorder about twice as often as men. Hormonal fluctuations related to menstruation, pregnancy, or menopause may influence panic attack frequency and intensity in some women.

Can panic attacks happen during sleep?

Yes, nocturnal panic attacks can occur during sleep, waking you suddenly with panic symptoms. These typically happen during the transition between sleep stages, not during dreams. Waking up to a panic attack can be particularly frightening and may lead to fear of sleeping.

When should I see a doctor about panic attacks?

You should see a healthcare provider if you’ve experienced a panic attack, especially for the first time, to rule out other medical conditions. Seek help if panic attacks are recurrent, if you’re developing avoidance behaviors, if you worry constantly about having another attack, or if panic symptoms are interfering with your daily life, work, or relationships.

Can panic disorder be cured?

While panic disorder is a chronic condition for some people, it is highly treatable. Many people achieve complete remission of symptoms with appropriate treatment, which may include therapy, lifestyle modifications, and sometimes medication. Even those who continue to experience occasional panic attacks can learn to manage them effectively and live full, unrestricted lives.

Is panic disorder a mental illness?

Yes, panic disorder is classified as a mental health condition, specifically an anxiety disorder. It’s a recognized medical diagnosis with specific criteria. Having panic disorder doesn’t mean you’re “crazy” or weak—it’s a legitimate medical condition that responds well to treatment.

Can children have panic attacks?

Yes, children and adolescents can experience panic attacks and develop panic disorder, though it’s less common than in adults. Panic disorder typically begins in late adolescence or early adulthood. Children may have difficulty describing their symptoms, so panic attacks might manifest as unexplained physical complaints or behavioral changes. If you suspect your child is having panic attacks, consult a pediatrician or child mental health specialist.

References:

• National Institute of Mental Health – Panic Disorder
• Mayo Clinic – Panic Attacks and Panic Disorder
• American Psychological Association – Panic Disorder
• NHS – Panic Disorder
• Anxiety and Depression Association of America