A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying.
You may have only one or two panic attacks in your lifetime. But if you have had several panic attacks and have spent long periods in constant fear of another attack, you may have a chronic condition called panic disorder.
Panic attacks were once dismissed as nerves or stress, but they’re now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment is very effective.
Symptoms of a Panic Attack
Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it’s important to seek an accurate diagnosis and treatment.
Panic attacks typically include a few or many of these symptoms:
- A sense of impending doom or death
- Rapid heart rate
- Shortness of breath
- Hot flashes
- Abdominal cramping
- Chest pain
- Tightness in your throat
- Trouble swallowing
Panic attacks typically begin suddenly, without warning. They can strike at almost any time — when you’re driving, at the mall, sound asleep or in the middle of a business meeting. Panic attacks have many variations, but symptoms usually peak within 10 minutes and last about half an hour. You may feel fatigued and worn out after a panic attack subsides.
One of the worst things about panic attacks is the intense fear that you’ll have another panic attack. If you have had four or more panic attacks and have spent a month or more in constant fear of another attack, you may have a condition called panic disorder, a type of chronic anxiety disorder.
With panic disorder, you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.
When to see a doctor
If you have any panic attack symptoms, seek professional help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it’s important to get evaluated by your health care provider if you aren’t sure what’s causing your symptoms.
Symptoms of panic disorder often start either in late adolescence or early adulthood and affect more women than men. Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.
Factors that may increase the risk of developing panic attacks or panic disorder include:
- A family history of panic attacks or panic disorder
- Significant stress
- The death or serious illness of a loved one
- Big changes in your life, such as the addition of a baby
- A history of childhood physical or sexual abuse
- Undergoing a traumatic event, such as an accident or rape
Diagnostic Criteria for Panic Disorder
Not everyone who has panic attacks has a full-blown panic disorder. To be diagnosed with panic disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
These are the diagnostic criteria for panic disorder:
- You have frequent, unexpected panic attacks.
- At least one of your attacks has been followed by one month or more of persistent worry about having another attack; persistent fear of the consequences of an attack, such as losing control, having a heart attack or “going crazy”; or a significant change in your behavior, such as avoiding situations that you think may trigger a panic attack.
- Your panic attacks aren’t caused by substance abuse or another mental health condition, such as social phobia or agoraphobia.
If you have panic attacks but not a full-blown panic disorder, you can still benefit from treatment. If panic attacks aren’t treated, they can get worse and develop into panic disorder or phobias. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities.
The main treatment options for panic attacks are medications and psychotherapy. Both are effective. Your doctor likely will recommend starting with just one type of treatment, depending on your preference and whether there are therapists with special training in panic disorders in your area. Your doctor may recommend a combination of medication and psychotherapy if you:
- Have severe panic disorder
- Have panic disorder along with another major mental health diagnosis, such as depression or post-traumatic stress disorder
- Have already tried one type of treatment and haven’t improved
Medications can help reduce symptoms associated with panic attacks, as well as depression if that’s an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks. It is important to have a psychiatrist conduct a medication evaluation as they are specifically trained in the medical treatment of mental health disorders.
Psychotherapy, also called counseling or “talk therapy,” can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Your doctor also may recommend a type of psychotherapy called psychodynamic psychotherapy.
- Cognitive behavioral therapy. Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks.
These may include breathing and relaxation techniques. In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don’t continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.
- Psychodynamic psychotherapy. Psychodynamic psychotherapy focuses on increasing your awareness of your unconscious thoughts and behaviors. Unlike cognitive behavioral therapy, this approach doesn’t intentionally re-create panic symptoms. Instead, your therapist helps you investigate your mind to identify internal emotional conflict that may play a role in your panic and avoidance reactions.
Based on your findings, your therapist will help you develop healthier ways to respond to conflict. Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.
As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.
Things you can do to help.
While panic attacks and panic disorder benefit from professional treatment, you can also help manage your symptoms on your own. Some of the lifestyle and self-care steps you can take include:
- Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you’re not a hostage in your own home.
- Join a support group for people with panic attacks or anxiety disorders so that you can connect with others facing the same problems.
- Avoid caffeine, alcohol and illegal drugs, all of which can trigger or worsen panic attacks.
- Practice stress management and relaxation techniques. Meditation, yoga and guided imagery may be good options.
- Get physically active, since aerobic activity may have a calming effect on your mood.
- Get sufficient sleep — enough so that you don’t feel drowsy during the day
There’s no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques may be helpful, too.
Bahareh Talei, Psy.D.