Onpsych Blog

Panic Attacks: How to recognize them (Part 1)


You have a sudden sense of impending doom together with uncontrollable anxiety. Your chest feels tight, your heart starts pounding, you are dizzy, have shortness of breath and nausea. You may interpret these symptoms as signs of a heart attack or fear you are dying. You make late night calls to the doctor and visit the emergency room. Often the test results reveal nothing. You may however have had a panic attack. By educating yourself about panic attack symptoms you can decrease those fearful thoughts and begin to gain control of your problem.


Recognizing the symptoms


An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur according to DSM-V:

  • Palpitations, pounding heart, or accelerated heart rate

  • Sweating

  • Trembling or shaking

  • Sensations of shortness of breath or smothering

  • Feelings of choking

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Feeling dizzy, unsteady, light-headed, or faint

  • Chills or heat sensations

  • Numbness or tingling sensations

  • Feelings of unreality or being detached from oneself

  • Fear of losing control or “going crazy”

  • Fear of dying


Panic attacks can be expected (when there is an obvious trigger) or unexpected (when relaxing or out of sleep).


Research indicate that a combination of genetic, biological, psychological and environmental factors may make an individual more at risk to panic. Understanding how these work together can help you develop a way to manage and reduce your anxiety symptoms.


Panic attacks feature prominently within anxiety disorders as a particular type of fear response (either conscious or unconscious). There are a number of physical reactions as a result of your body reacting to this fear.

  • Your body goes on alert: Your brain sends a message to your body, triggering the automatic “fight-flight-freeze” response to protect it against the perceived danger. The adrenaline hormone is released suddenly to prepare the body by increasing the heart rate to circulate blood faster to vital organs, breathing rate accelerates to get more oxygen to the circulating blood, muscles tense in case of having to move quickly and eyes may dilate to improve vision. The sudden increase in adrenaline causes distressing feelings and sensation that are out of proportion with the actual danger.

  • Your breathing becomes more rapid: Inhaled oxygen reacts with your cells to produce carbon dioxide, which is then exhaled. During a panic attack, breathing rates increase so your body can absorb oxygen more quickly in preparation for any necessary action. During rapid, heavy breathing (also called hyperventilation), your lungs exhale more carbon dioxide than your cells produce, causing the level of carbon dioxide in your blood and brain to fall. The results (which may include dizziness and heart palpitations) can cause some people to panic further, thereby increasing breathing even more.

  • Your mind remains stuck on fearful thoughts: Rather than reacting to solve the problem or removing yourself from the event (which you would likely to do with an actual source of danger or threat), you remain unable to let go of the fear and get stuck on the perceived threat. Catastrophic thoughts may develop, such as “Something is wrong”, “I am having a heart attack”, or “I’m going to die”. These thoughts result in increased apprehension and fear and even more physiological changes in the body. A circular pattern develops as the amplified bodily changes now result in even more fearful thoughts.

Panic attacks can best be described as false-alarm reactions, triggered by the misconceptions of danger. Understanding how your body and mind work together to create this misconception and the escalation process that occurs during episodes of panic, can help you develop a healthier response to such frightening situations.


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