Panic Attack Symptoms

A panic attack is an episode of acute fear, discomfort, and anxiety that generally peaks within minutes but can last longer. There are a wide range of distressing symptoms associated with panic attacks, including a fast heart rate, nausea, and even chest pain that can feel like a heart attack.

Experiencing a panic attack can be very frightening, even if you've had one before. While it's certainly not normal to have panic attacks, you should know that you aren't alone if you have one. It's estimated that each year, about 11% of adults in the United States will experience a panic attack.

Familiarizing yourself with the symptoms of panic attacks can help you understand the experience better and develop strategies for coping with them.

Frequent Symptoms

For an episode to be classified as a panic attack, a person must reach their symptomatic peak within a few minutes. They also must experience at least four of the symptoms below.

Trembling or Shaking

Trembling, shaking, and tremors are primary symptoms of many anxiety disorders, and also symptoms that can occur during a panic attack.

You might feel your hands and fingers start to shake first, and find it difficult to hold small objects like a pen, utensils, or your phone. This shaking can then grow to full body trembling, making it difficult to stand.

It is believed that the shaking that occurs during a panic attack is an overreaction of the sympathetic nervous system, part of the fight-or-flight response. As your muscles tense to "take flight," or run away from the triggering situation, you will experience twitching and tremors.

Numbness and Tingling

Paresthesias, which is more commonly known as numbness and tingling, can also occur during a panic attack. You will most likely experience this as numbness, or "pins and needles," in certain areas, such as your lips, face, fingers, arms, feet, and legs.

This is another symptom that is thanks to a miscalculation of the evolutionary fight-or-flight response. During this response, blood rushes to important organs such as the heart, lungs, and central organs. This can leave "less important" body parts, in particular your extremities, lacking blood and subsequently feeling tingly. There might also be other metabolic changes that occur as part of panic attacks that contribute to these symptoms.

Chills or Hot Flashes

Many people also report experiencing thermal sensations, including chills or hot flashes, during a panic attack. The physiological mechanisms behind this are not totally understood, although one theory is that this is also a result of the fight-or-flight response.

Although hot flashes are included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, as symptoms of a panic attack, research shows that sometimes panic can actually be a response to a hot flash.

This may be the case for people who are in menopause, when hot flashes are often a result of hormone disruptions. Experiencing a sudden hot flash is uncomfortable and frightening, and may actually trigger a panic attack on its own.

Sweating

Sweating is a physical manifestation of panic attacks. Clammy palms, along with sweat in your armpits, back, or temples, are frequent symptoms of panic attacks and many anxiety disorders.

It can sometimes be hard to identify a panic attack in another person, since many of these symptoms are experienced internally. However, if you see a child, teen, or another adult excessively sweating, whether on their forehead or through their shirt, when there is no obvious physical or environmental cause, one explanation could be a panic attack.

Nausea

Nausea is another common symptom of panic attacks. In rare cases, the nausea may lead to vomiting, although this is less common.

This feeling of nausea may stem from the feeling of "butterflies in your stomach" that is often described by people who are experiencing anxiety. This is actually thanks to the fight-or-flight response, when the body overproduces adrenaline, which can make you feel sick to your stomach.

Heart Palpitations

Heart palpitations and tachycardia, or abnormally high heart rate, are additional symptoms of a panic attack. Feeling your heart skip a beat, or feeling an unusually high pulse, can be a scary experience that can exacerbate your panic attack.

Like nearly all symptoms of a panic attack, a high or irregular heart rate is linked to the fight-or-flight response. As your body is pumping out blood to important organs and large muscle groups to aid in your fighting (or running away), your heart will work overtime.

Shortness of Breath or Hyperventilation

The DSM-5 lists shortness of breath, or feelings of choking or being smothered, as symptoms of a panic attack. These respiratory symptoms can also present as hyperventilation.

Taking deep, diaphragmatic breaths can help your body and re-regulate your breathing. A benefit is that deep breathing can also activate the parasympathetic nervous system, calming the body's fight-or-flight response and reducing feelings of anxiety.

Dizziness

Dizziness is a common symptom of panic attacks you should be aware of. In some cases, this could be secondary to taking short, shallow breaths (which affect your blood chemistry).

If you start to experience sudden, intense dizziness, it's important to find a safe place to sit down. A panic attack is not dangerous by itself, but falling over or injuring yourself secondary to dizziness is a possibility.

If you are caring for a child who is feeling lightheaded or dizzy due to a panic attack, have them sit down and place their head between legs. If they feel faint, having them lie down and elevating their legs can help regulate blood pressure and reduce feelings of faintness. The same steps can help people of any age if they are experiencing these symptoms.

There are additional panic attack symptoms that can count toward the four necessary symptoms for an episode to be classified as a panic attack. These include:

• Fear of losing control
• Derealization or depersonalization
• Chest pain
• Fear of dying

Fear of Losing Control

Someone having a panic attack might be scared of losing control or "going crazy." A panic attack is defined as a discrete, time-bound episode of panic, and it is true that during that time you might lose control of your body and emotions.

It can help to remember that most panic attacks only last a few minutes, and once you're out of it you will be back in control.

A 2012 survey-based study found that the location of a person's first panic attack can impact their later development of agoraphobia, or fear of leaving their house or being in public places.

Results showed that people whose first panic attack occurred in public are most likely to develop agoraphobia, which is likely due to fear of having this experience in public again.

Derealization or Depersonalization

Derealization and depersonalization are additional, rarer symptoms of panic attacks. When someone experiences derealization, they have a feeling of unreality, or being disconnected from reality as it is occurring around them.

Depersonalization can be described as feeling detached from oneself, or as if you are observing your own behaviors but not identifying with them.

When in a panic attack, you might experience derealization or depersonalization by suddenly feeling like you are "floating above" your body or watching yourself panic.

Chest Pain or Discomfort

Chest pain is one of the most distressing symptoms of panic attacks. Panic attacks are often mistaken for heart attacks due to chest pain symptoms.

An older study found that approximately 25% of patients who present to their physician with symptoms of chest pain are ultimately diagnosed with panic disorder.

Fear of Dying

In the moment, a panic attack can be so terrifying and all-consuming that you may experience fear of dying. It is a scary thing to feel unable to control your body, and with symptoms such as heart palpitations, chest pains, and hyperventilation, it is not surprising that some people do fear for their lives while in the throes of a panic attack.

Research shows that people who experience their first panic attack at home are most likely to experience fear of dying during their attack. This is likely because they may be alone and feel unable to quickly call for help.

Know that if you are in this situation, a panic attack by itself cannot kill you. Additionally, most people react to non-dangerous stimuli that are only perceived as dangerous due to the an fight-or-flight response.

Complications

Unfortunately, there can be complications if a panic attack is not dealt with. These can include the following.

Panic Disorder

While, for some people, a panic attack might be a one-off occurrence, 2-3% of these people will go on to develop panic disorder.

Avoidance Behaviors

According to the DSM-5, panic attacks can be either expected or unexpected. Some people can identify triggers that lead to panic attacks.

These triggers might include driving, going out in public, speaking in public, going to the gym, hearing loud noises like fireworks or cars backfiring, and countless others. While avoiding triggers can reduce the occurrence of panic attacks, avoidance behaviors can also lead to limitations in life and relationships, along with feelings of dread.

Agoraphobia

Experiencing a panic attack in public or while driving leads to an increased chance of developing agoraphobia. Agoraphobia is an intense fear and avoidance of being in a situation where escape might be difficult if you have a panic attack.

For people with panic attacks, this is due to a fear of experiencing another attack in public. Agoraphobia can lead to functional disability and limit relationships, work, social life, leisure, and more.

Hospital Admission and Medical Costs

A 1996 study found that people who have panic attacks or panic disorder have a much higher rate of medical services utilization, along with higher medical costs. For instance, experiencing chest pain might lead you to believe you're having a heart attack, which could lead to hospital admission.

This elevated use of medical services can be expensive over time, for both the patient and the medical system. However, more recent demographic studies are required to update whether this is still the case for people who have panic attacks today.

Cardiac Conditions

People with panic disorder have higher rates of cardiac conditions, including hypertension (high blood pressure) and cardiomyopathy. Research is not definitive regarding the direction of causality, as it may be the case that people with these pre-existing cardiac conditions are more likely to experience panic as a result of their disease.

Nevertheless, this is one reason it is important to seek treatment for panic disorder or ongoing panic attacks.

When to See a Healthcare Provider

If you've experienced a panic attack, and especially if you're dreading another panic attack or changing your behavior to avoid one, it could be worth talking to your primary care provider. They may refer you to a psychiatrist for diagnosis or a psychotherapist for treatment.

Panic attacks are a symptom of a variety of anxiety disorders, such as panic disorder, post-traumatic stress disorder, phobia-related disorders, social anxiety disorder, and more. It's important to get the correct diagnosis so you can seek the most effective treatment for you.

Your healthcare provider will discuss your treatment options with you and help rule out other conditions.

A Word From Verywell

Having a panic attack, whether expected or unexpected, can be very scary. There is help and treatment available for panic attacks and panic disorder. In the moment, remember to take deep breaths and try to tell yourself that you are safe.

If you experience ongoing or regular panic attacks, treatment can include psychotherapy, such as cognitive behavior therapy, and medications such as anti-depressants or anti-anxiety medications.