Panic attack

Definition

A panic attack is a discrete, abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. During that surge, a cluster of physical and cognitive symptoms appears together.

The DSM-5-TR describes a panic attack as something that can occur across many different disorders, and sometimes in people with no disorder at all. That's why this is a symptom entry rather than only a part of panic disorder. A panic attack is an experience, not a diagnosis by itself.

The DSM-5-TR also distinguishes two types. An expected attack has a clear trigger, for example facing a feared situation. An unexpected attack comes out of the blue, with no obvious cue. That distinction matters for what the attacks point to.

Symptoms and key features

A panic attack typically includes a sudden cluster of symptoms such as:

• a pounding, racing, or skipping heart
• sweating, shaking, or trembling
• shortness of breath, or a feeling of choking
• chest pain or tightness
• nausea or stomach distress
• dizziness, lightheadedness, or feeling faint
• chills or heat sensations
• numbness or tingling
• feelings of unreality or detachment from yourself
• a fear of losing control or "going crazy"
• a fear of dying

An attack peaks within minutes and then eases. It can't keep escalating indefinitely, because the body's alarm response is self-limiting.

What it looks like

• You're sitting calmly and, within seconds, your heart is hammering and you can't seem to get a full breath.
• A wave of dizziness and a sense of unreality arrives, and your first thought is that something is medically wrong.
• The fear builds fast, peaks, and then, over several minutes, the body starts to settle.
• Afterward you feel drained, shaky, and watchful, half-expecting it to happen again.

When one is happening, try the Panic Reset, a step-by-step guide to stopping a panic attack on shrinkMD.

What people often confuse this with

A heart attack or other medical emergency. Panic attacks share symptoms with serious medical events, and chest pain or breathlessness should be medically evaluated, especially the first time. Once a medical cause is ruled out, recognizing the experience as a panic attack is part of what reduces the fear.

Panic disorder. A single panic attack isn't panic disorder. Panic disorder is defined by recurrent unexpected panic attacks plus persistent worry about having more of them, or a change in behavior because of them.

Ordinary anxiety. General anxiety tends to build and simmer. A panic attack is sharper and faster, a sudden surge that peaks within minutes rather than a steady state of worry.

What research says

Panic attacks are well described clinically. The evidence here is rated mixed because a panic attack is defined as a feature that appears across many conditions rather than studied as a standalone diagnosis with its own large outcome literature.

Because a panic attack is usually a symptom of an underlying pattern, treatment addresses that pattern rather than the single attack. Cognitive behavioral therapy has strong evidence, and interoceptive exposure, deliberately and safely bringing on the physical sensations of panic so the brain learns they're not dangerous, is a well-supported part of it. Medication is sometimes used as well, particularly when attacks are frequent or part of panic disorder. Understanding what a panic attack actually is, a false alarm that peaks and passes, is itself part of effective treatment.