Panic attacks can cause intensely uncomfortable symptoms like heart palpitations, shortness of breath, and chest pain. When these symptoms begin suddenly, many people mistakenly believe they are having a heart attack. Panic attacks are frightening, but unlike cardiac emergencies, they are not life-threatening.
Panic attacks can be triggered by any highly stressful or scary situation but are more common in people with pre-existing anxiety disorders or other mental conditions. Anxiety attacks and panic attacks are highly treatable, often improving with therapy, medication, or a combination of the two.
What Is a Panic Attack?
Panic attacks are sudden and intense episodes of anxiety that usually peak within 10 minutes, subsiding shortly afterwards. Panic attacks are caused when the “fight or flight” response is activated, causing the release of stress hormones and chemicals designed to prepare the body to outrun or overpower a predator.1,3
Can Panic Attacks Kill You?
You can’t die from a panic attack, though during one it often feels that way, especially since some symptoms of panic attacks overlap with symptoms of heart attacks. In fact, feelings or fears of dying during a panic attack is such a common experience that it is listed as one of the symptoms used to diagnose panic attacks.1
One study found that 90% of people with panic disorder feel there is something medically wrong when they have a panic attack, despite knowing they have an anxiety disorder.2 This illustrates how common it is for people to mistake anxiety for a medical emergency, even when they know it is unlikely.
Normal Anxiety Vs. Panic Attacks
Anxiety can be experienced at different levels of intensity, and panic attacks represent the most extreme form of anxiety, involving severe physical discomfort and emotional distress. Panic attacks are typically short, peaking in intensity within 10 minutes and then subsiding, while normal anxiety fluctuates in intensity and can persist for hours or even days.
Normal anxiety is usually not acutely debilitating but when having a panic attack, people are unable to interact and function normally. Panic attacks tend to manifest as physical symptoms like chest pain, shortness of breath, and racing heart, while anxiety often manifests as worried thoughts, irritability, and feeling restless, edgy, or distracted.3
What Are the Symptoms of a Panic Attack?
Panic attacks are diagnosed using standardized criteria from the DSM-5, the reference guide health and mental health professionals use to diagnose all mental illnesses.
Panic attacks include four or more of the following symptoms:2
- Racing heart
- Shortness of breath
- Sweating
- Shaking or trembling
- Feelings of choking
- Discomfort, tightness, or pain in the chest
- Nausea or gastrointestinal pain
- Feeling dizzy or disoriented
- Hot flashes or chills
- Numbness or tingling sensations
- Feeling disconnected from reality or from oneself (derealization)
- Fear of losing control or going crazy
- Fear of dying
How to Differentiate Between a Heart Attack & Panic Attack
Heart attacks and panic attacks have many of the same symptoms, making it easy for patients to confuse the two. A heart attack is usually triggered by physical exertion, while a panic attack can happen at any time and is triggered by anxiety. Also, heart attack symptoms, like crushing chest pain and tingling the arm, continue to worsen over time, while panic attacks usually subside after about 10 minutes.3
Health history often provides essential information that helps to differentiate between a panic attack or heart attack. Having an existing heart condition places people at higher risk for heart attacks and strokes, while having an existing mental illness (especially an anxiety disorder) increases the likelihood of panic attacks. Because verifying a heart attack is costly and invasive, many doctors rely on health history and current symptoms to identify patients more likely to be experiencing anxiety.
What Causes Panic Attacks?
The most common cause of panic attacks are existing mental health conditions, especially anxiety disorders. Any anxiety disorder can cause a person to experience occasional panic attacks, even if they have not had one in the past, but conditions like PTSD and OCD can also lead to panic attacks.
Panic Attacks Due to Anxiety Disorders
The majority of panic attacks are caused by an underlying anxiety disorder or other mental health condition.
Panic attacks are common in people with any of these anxiety conditions:1,2
- Generalized Anxiety Disorder: A common anxiety disorder characterized by feeling persistently worried or nervous most of the time. People with generalized anxiety who have panic attacks are not always able to pinpoint the cause of their symptoms.
- Panic Disorder: An anxiety disorder characterized by recurrent panic attacks and a debilitating fear of recurrent attacks. The fear of having a panic attack causes a person to avoid situations where they feel one is likely to occur or in places that they could not easily escape or get help in the event they did have a panic attack.
- Agoraphobia: A deep fear and avoidance of certain (or all) public places. Often, people with agoraphobia avoid leaving their homes at all. Most people with agoraphobia are also diagnosed with panic disorder because the fear of having a panic attack in a public place is often a central fear driving the avoidance.
- Social Anxiety Disorder: An anxiety disorder where people are afraid of specific social settings, interactions, or situations because they feel self-conscious and worry about being judged. People with social anxiety disorder can experience panic attacks before or during a social event.
- Specific Phobias: Phobic disorders are anxiety disorders centered around a very specific fear like a fear of heights, flying, public speaking, spiders, or small spaces. People with phobias avoid situations where there is a possibility of encountering their fears, and may experience panic attacks when they do encounter them.
- Post-Traumatic Stress Disorder: People with PTSD have residual anxiety about a traumatic experience in the past. They often suffer from nightmares, flashbacks and intrusive memories of the experience which can trigger panic attacks.
- Obsessive Compulsive Disorder: People with OCD struggle with high levels of anxiety and cope by performing certain repetitive behaviors or mental acts. They can experience panic attacks when they encounter a feared situation or have a certain obsessive thought, especially when they are unable to perform the compulsive behavior or mental act they normally rely on to relieve anxiety.
Biological & Environmental Risk Factors
Certain people may be more at risk for panic attacks. People with a family history of anxiety disorders may be genetically predisposed, as are those who experienced stress or trauma in childhood. Panic attacks are much more common than panic disorder, but research suggests that women are twice as likely as men to develop this condition. Young people also are more susceptible, with an average age of onset being 24 years old, and the risk of developing panic disorder steeply declining after the age of 60.1
Normal Stress Response to a Scary Situation
Having a panic attack is not always an indication of a mental illness. Panic attacks are normal when they occur in response to dangerous, scary, or stressful situations. When panic attacks are situational or stress-related, they can usually be traced back to identifiable stressors or circumstances.
For example, a person who was recently in a car accident may experience a panic attack when driving, or a person who is about to have surgery may have panic attacks leading up to their procedure. In these instances, panic attacks are usually isolated episodes that resolve on their own with time or as a situation improves.
Are Panic Attacks Dangerous?
Isolated panic attacks are not physically harmful, but when they occur too often, they can worsen existing health problems or even contribute to new health problems. The fight or flight response is also the body’s stress response, causing the release of cortisol and adrenaline, activating the nervous system, and placing additional stress on the heart. While a panic attack can’t kill you, chronic and severe anxiety does take a toll on the heart, making it more likely that a person will develop coronary heart disease and other cardiac problems.5
Long-Term Health Complications From Panic Disorder & Anxiety
Experiencing panic attacks increases the risk for a number of mental health conditions, including anxiety disorders, mood disorders, substance use disorders, and struggling with more than one mental illness.4,5 People who develop panic disorder are at higher risk for suicide and report lower levels of marital satisfaction, financial independence, and poorer overall quality of life.5
Frequently experiencing high levels of stress and anxiety can also lead to toxic stress which is known to contribute to health problems like:6,7
- Higher rates of mental illness and addiction
- Weakened immune system and more frequent infections
- Higher likelihood of chronic illness
- High blood pressure
- Insomnia and sleep problems
- Changes in appetite, eating habits, and weight
- Poorer memory and cognitive functioning
- Higher rates of physical pain and ailments
Why It’s Bad to Overreact About Anxiety Symptoms
Some people unknowingly respond to their anxiety in ways that worsen their symptoms, even leading to panic attacks. Becoming overly concerned and watchful for physical signs of anxiety (like a racing heart or shortness of breath) can sensitize people to these sensations, making them more likely to overreact to them.
Overreacting to symptoms also worsens anxiety by reinforcing the idea that the anxiety is dangerous. People who avoid feared situations can bypass immediate anxiety, but often make it more likely to return the next time they are in this situation.
5 Ways to Manage Panic Attacks & Anxiety At Home
Panic attacks can be challenging to manage, especially because the instinctive responses are usually ones that worsen anxiety and make future attacks more likely. For example, canceling or changing plans, calling off of work, or going to the ER might provide temporary relief, but might actually make the anxiety more likely to return.
Some of the more effective methods of responding to panic attacks include:
1. Use Grounding Techniques
During a panic attack, focusing on the symptoms that are most concerning to you tends to increase anxiety. Instead, try shifting your focus to your surroundings by using a skill called grounding. Grounding involves using one or more of your five senses to fully tune in to the things you can see, hear, smell, taste or touch, helping you feel more present and in control.
2. Change Your Relationship With Fear
Fear is a normal part of being human and will be something you can’t fully stop, avoid or control. Since it won’t be possible to completely get rid of your fear, learning to accept and tolerate it will save a lot of time and mental energy. While it’s ironic, being willing to sit with and experience your fear instead of doing something to stop or avoid it sometimes makes it more manageable.
3. Gradually Face Your Fears
Avoidance feeds into fear, making it grow bigger and stronger. The more you avoid situations that scare you, the less confident you become in your ability to face and overcome your fear. One of the fastest and most effective ways to overcome a fear is to repeatedly face it, which desensitizes you to it, giving it less power over you.
4. Pause Before Reacting
Fear impairs rational areas of the brain, so you can’t always trust the thoughts you have when you are scared—and acting on them also isn’t a good idea. Panic attacks often come with urgent thoughts like, “I need to call 911,” “My heart is going to explode,” or “Run!” Give your rational mind a chance to catch up in these moments by pausing instead of immediately rushing into action.
5. Keep Your Plans, Even When You’re Anxious
When you have a panic attack, you might want to call off of work, cancel plans, and change your routine, but doing so reinforces anxiety and gives it more power over you and your life. Instead, challenge yourself to keep your plans and stick to your normal routine, even when you are anxious or have had a panic attack. If your panic attack happens during work or an activity, take a break to collect yourself, but make sure to return to what you were doing.
What Are the Long-Term Treatments for Panic Attacks?
Panic disorder responds very well to treatment, and people with panic attacks can often greatly reduce or even resolve their symptoms with therapy, medication, or a combination of the two. With treatment, people can learn to better understand, cope with, and improve their symptoms.
Effective treatments for anxiety and panic attacks include:8
Cognitive Behavioral Therapy (CBT)
CBT for panic disorder is often considered the “gold standard” treatment.8 In CBT, people will typically meet with a licensed therapist for weekly sessions that last about an hour, although some providers also offer group CBT treatment. In sessions, people will learn skills to interrupt the unhelpful thoughts that feed into and worsen their anxiety, and will learn new, more effective ways of coping.
Exposure Therapy
Exposure therapy is a specific kind of CBT used by licensed counselors to treat people with specific phobias, panic disorder, and panic attacks. In exposure therapy, people will gradually expose themselves to feared situations and objects that they normally avoid, which results in becoming desensitized to these triggers. These exposures are often paired with relaxation training, which teaches people how to use breathing and other relaxation techniques to reduce their anxiety. Results can often be seen after just a few sessions of exposure therapy, and it can also be done virtually.8
Medication
Some people with panic attacks seek anxiety medication from a psychiatrist, doctor, or other prescriber to help reduce their symptoms. Typically, medication is only recommended to people who are also receiving therapy. Some of the more commonly prescribed medications for anxiety and panic disorder include SSRI’s and SNRI’s, which are classified as antidepressants, but can also treat anxiety disorders.
Benzodiazepines are also commonly prescribed for panic attacks, and while effective in the short-term, can lead to dependence when used long-term.8 They are best used when attacks are infrequent.
How to Get Help for Panic Attacks
Therapy is usually the recommended starting place for those seeking treatment for anxiety and panic attacks. Most people begin their search for a therapist online by conducting a google search or using an online therapist directory that allows people to narrow their search according to their needs and preferences. Those with mental health benefits can often get therapy partially covered by their insurance or EAP benefits, and should go through the company to get a list of participating providers.
Finding a therapist who is a good match is important, so people are recommended to contact more than one therapist before scheduling an appointment. Many therapists offer a free consultation to answer questions and help potential clients determine if they would be a good match for their needs.
Panic Attack Statistics
Consider the following statistics about panic attacks:
- 1 in 3 Americans will have a panic attack in their lives9
- In 2007, 28% of Americans reported at least one prior panic attack9
- In 2007, 11.2% of Americans reported having a panic attack within the past month9
- 90% of people diagnosed with panic disorder mistake panic attacks for a medical emergency1
- Panic disorder is the cause in 18-25% of patients who go to the ER for chest pain5
- Due to high rates of ER treatment, panic disorder is more expensive to America’s healthcare system than any other mental illness1
- In two studies, ER doctors overlooked panic disorder in 98% of people seeking emergency medical care for a panic attack1
- In a 3.5 year follow up study of patients who went to the ER for chest pain that was diagnosed as panic disorder, 67% had returned to the ER for chest pain at least once1
- People with specific phobias usually only need 1-5 sessions of exposure therapy to see their symptoms improve8
- Despite the known risks, a 2017 study found that 55-94% of Americans seeking treatment for an anxiety disorder were prescribed a benzodiazepine8
For Further Reading
Can You Die From a Panic Attack Infographics
