Panic attack
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes.1 It comes with strong body symptoms such as a pounding heart, shortness of breath, chest pain or dizziness.2 It can feel like a heart attack or like you're losing control. Having one doesn't mean you have panic disorder: far more people have had a panic attack than have had panic disorder.3
If you have chest pain, or you're not sure whether this is panic or your heart, get emergency help now. Call 911 in the US or 999 in the UK.4,5 If this is your first panic attack and you have no chest pain, see a doctor soon to rule out other causes. In the UK, NHS 111 can advise you now.
If you're in one now, breathe along: in for 4, out for 6. Stop and breathe normally if it makes you dizzy.
Longer exhale: 10 rounds, about 1 min 40 sec.
If you feel dizzy, short of breath or more anxious, stop and breathe normally. A shorter count is fine. If you're thinking about harming yourself, call or text 988 in the US, or see crisis resources.
What a panic attack feels like
Doctors define a panic attack by its symptoms: four or more from a list of 13, arriving fast and peaking within minutes.1 NIMH's list includes a pounding heart, sweating, chills, trembling, trouble breathing, weakness or dizziness, tingly or numb hands, chest pain and nausea, and most people notice several at once.2
The heart and chest
A racing or pounding heart, a tight or painful chest.
"My heart was going so hard I could see my shirt move. I was sure something was wrong with it."
Breathing
Feeling short of breath, smothered, or like you can't get a full breath in.
"I kept trying to take a deep breath and it never felt like enough air."
The rest of the body
Dizziness, shaking, sweating, chills or hot flushes, nausea, numbness or tingling.
"My hands went pins and needles and my legs felt like they weren't mine."
The mind
A fear of dying, of losing control or "going crazy", or a sense that things aren't real.1
"Everything looked flat and far away, like I was watching it on a screen. I thought I was losing my mind."
Thirteen years ago I had a severe anxiety crisis, and I didn't understand what anxiety was; I felt like I was losing control of my mind and body, and the worst part was thinking it was my fault. Working with a mental health professional is how I learned it wasn't: it was a condition that could be addressed.
What helps during a panic attack
The NHS gives this advice for the moment it starts.6
- Stay where you are, if you can.
- Breathe slowly and deeply, in through your nose and out through your mouth. Count if it helps. The pacer above does a gentle 4 in, 6 out.
- Remind yourself that it will pass. A panic attack usually lasts 5 to 20 minutes.7
- Remind yourself that it isn't life threatening. Panic attacks are frightening, but the NHS says they are not dangerous.6
- Focus on something outside you, like the 5-4-3-2-1 grounding steps: five things you see, four you feel.
- The body: This is my body's alarm. It's uncomfortable, not dangerous.
- Time: This will peak and pass. I can wait it out.
- Place: I'm going to stay where I am and breathe out slowly.
- Attention: Five things I can see. One: the door.
Use these only once a doctor has checked you for anything else. If you aren't sure, get checked first.
When to get medical help
Panic attack symptoms overlap with heart attack symptoms, and you can't always tell them apart from the inside. Cleveland Clinic's advice: if you have chest pain and you're not sure whether it's a heart attack or a panic attack, get medical care right away. Don't take chances.5
Call 911 (or 999 in the UK) if:4
- you have sudden chest pain or discomfort that doesn't go away,
- the pain spreads to your arm, neck, jaw, stomach or back,
- you have chest pain and feel sweaty, sick, lightheaded or short of breath,
- you think you may be having a heart attack.
See a doctor soon if panic attacks keep coming back. The same goes if you're worrying about the next one, or avoiding places in case one happens. The NHS advises seeing a GP for symptoms of panic disorder.6 A doctor will usually do a physical exam to make sure an unrelated physical problem isn't causing the symptoms.2
Why it spirals so fast
The body has an alarm system that prepares you to fight or run, with a faster heart, faster breathing and tense muscles, and in a panic attack it goes off when there's no danger at all.
One explanation comes from psychologist David Clark. A normal sensation, like a skipped heartbeat or feeling a bit breathless, gets read as a sign of catastrophe: "I'm having a heart attack." That reading raises fear, fear raises the sensations, and the loop spirals up within minutes.8
"This is uncomfortable, not dangerous" works on the reading. The sensation can stay, and the spiral may still lose some of its fuel.
What the studies say
Panic attacks are far more common than panic disorder: of over 9,000 US adults asked about their lives so far, 28.3% had had at least one panic attack, while 4.7% had ever had panic disorder.3
Panic disorder has a first-line treatment. UK guidelines recommend cognitive behavioral therapy, usually 7 to 14 hours in total and finished within about four months, with antidepressants as the other recommended option.9
Breathing training is unsettled. A review of nine studies found the evidence too weak to judge whether it helps panic disorder, and too early to reject it.10 Slow breathing in the moment is reasonable, as long as "doing it right" doesn't become one more thing to panic about.
And skip the paper bag. It used to be standard advice, until a 1989 study found it lowered oxygen levels in healthy volunteers and linked it to three deaths in patients whose breathing problem turned out to be something else.11
After a panic attack
- Rest, drink some water, and let your body settle. If you feel drained afterward, that's okay.
- Write down what happened: where you were, what you noticed first, and what you thought it meant. Over a few entries, you may see the same first sensation, or the same place, turn up again.
- Notice if you start avoiding the place where it happened. Avoiding places where attacks happened is one of the signs of panic disorder.2 It's worth mentioning to a doctor.
- Talk to a doctor if it happens again. Panic disorder is treatable with therapy, medication or both.9
What was the first thing you noticed when the panic started: a sensation, a thought, or something around you? What did you think it meant at the time?
Answer this with JoyQuestions people ask
How long does a panic attack last?
Most last 5 to 20 minutes, the NHS says.7 Because the fear peaks within minutes, by definition, the worst usually comes early.1 It can still feel much longer from the inside.
Can a panic attack hurt you?
The panic itself, no: the NHS says panic attacks are not dangerous and should not harm you.7 The real risks are next to it. One is mistaking a heart problem for panic, which is why a first attack or uncertain chest pain needs a doctor.4 The other is the old paper-bag remedy, covered above.11
What is the difference between a panic attack and an anxiety attack?
"Panic attack" is a medical term with a set definition: a sudden peak of fear within minutes.1 "Anxiety attack" isn't, and people use it for anything from a panic attack to a slower build of worry and tension over hours.
What is the 3-3-3 rule for panic attacks?
See three, hear three, move three: three things you can see, three sounds, and three parts of your body to move. It's a quick form of grounding, and the grounding techniques page has a guided, longer version.
What causes panic attacks?
No one knows for sure. Panic disorder sometimes runs in families, and researchers are studying how stress and environment play a part.2 Some think of panic attacks as false alarms in the brain's fear system. Physical causes are a doctor's job to check.