How To Tell If You're Having A Panic Attack

Illustrated by: Tristan Offit.
As much as it sucks, anxiety doesn’t have to be a bad thing. Without a little bit of it, you wouldn’t make sure to show up on time to that job interview or to put in effort to impress your bosses. Ideally, the right amount of anxiety commands your attention and pushes you to get shit done.

An abundance of anxiety, however, is where the trouble starts. Anxiety disorders are the most common mental illness in the U.S., affecting almost 20% of the population. Panic disorder is considered an anxiety disorder and is characterized by episodes of panic attacks.

A panic attack happens when a sudden and sharp increase in anxiety causes intense symptoms like a pounding heart rate, shaking, and shortness of breath.

Anyone who has experienced one can tell you a panic attack can be terrifying. They’re also exceedingly common — and seemingly random. For example, you can still experience one without having panic disorder. Every year in the U.S., about one in four people experience a spontaneous panic attack, according to Simon Rego, PhD, director of Psychology Training at Montefiore Medical Center and the Albert Einstein College of Medicine.
If you’ve never had one before, you might not know what a panic attack is. The symptoms are diverse. Often, panic attacks send people to their nearest emergency room, thinking they’re having trouble breathing or having a heart attack, Dr. Rego says. Symptoms that really freak you out should always be investigated by a doctor, but it's still good to know what to expect. Ahead, we cover everything you should know about panic attacks.
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Illustrated by: Tristan Offit.
What's actually happening during a panic attack?

A panic attack is really just “a sudden burst of intense anxiety with an accompanying feeling of impending doom,” Dr. Rego explains. During an attack, your body pumps out the hormone epinephrine (a.k.a. adrenaline) in response to a threat — whether it’s real or perceived — putting you into fight-or-flight mode.

Panic attacks usually reach peak intensity within moments and last up to five or 10 minutes.
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What does it really feel like?

Instead of that impending doom feeling, you might feel like you're "going crazy" or that everything is out of control.

But the worst part of a panic attack is that the emotions you're feeling are so intense that your body can react with physical symptoms, according to Kenneth Abrams, PhD, associate professor of the Psychology Department at Carleton College.

These might include:

• Sweating
• Blurred vision
• Heart palpitations
• Trembling
• Shortness of breath
• The feeling of choking
• Muscle spasms
• Chest pain or discomfort
• Nausea or abdominal stress
• Dizziness or lightheadedness
• Chills or heat sensations
• Numbness or tingling
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Do you have to feel all the symptoms of a panic attack for it to be classified as a panic attack?

Nope. A panic attack, Dr. Rego says, typically involves at least four of the symptoms described previously, but experiencing less-intense symptoms does not invalidate your experience.

“Many people also experience what are called ‘limited symptom attacks’ in which [fewer] than four of the symptoms occur. These attacks can be just as scary and just as debilitating as ‘full symptom’ attacks.”

They also don’t always include the physical, feel-like-I'm-having-a-heart-attack kind of symptoms, either. For some people, the anxiety causes them to completely disengage from their surroundings, Dr. Rego says.

What do all of these attacks have in common? “Panic attacks almost always cause people to 'shut down,'” he adds.
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What triggers panic attacks?

Panic attacks can be caused by a variety of things, either a stressful event happening around you or an internal trigger, like a scary thought.

“Panic attacks occur in a variety of different conditions,” Dr. Abrams says. “For example, a person who has a fear of heights or spiders can have panic attacks in response to these situations. A person might have a panic attack while making a speech in front of a class.”

In short, panic attacks are usually a reaction to a conscious or even unconscious fear. They can, however, also be a response to a trigger that reminds you of something scary or traumatic that happened in the past — your body will anticipate the event happening again.

Dr. Abrams adds that if your family has a history of high anxiety, it also increases your chance of experiencing them, as there is a genetic predisposition to panic disorders
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What should you do if you think you're having a panic attack?

Panic attacks are scary as it is, but if you’ve never had one before — and therefore don’t know what’s happening and haven’t had the chance to speak to a doctor — it can be doubly frightening. If you're not sure what it is, there is nothing wrong with visiting the ER or urgent care to make sure it really is a panic attack.

If you know you're having a panic attack, the National Health Service recommends a breathing exercise: take deep breaths in through your nose and out through your mouth for three to five minutes. Try to inhale for five seconds and then exhale for five, though it’s okay if you can’t get to five counts at first.

Dr. Rego also recommends reminding yourself that there are no medical side effects or complications that come from having a panic attack. As scary as they are, they will peak and then gradually subside after a few minutes.

If you have recurring panic attacks, your doctor will likely recommend talk therapy. Anxiety medications may also be helpful for managing them.
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What’s the difference between panic attacks and panic disorder?

Although the two are related, having panic attacks doesn't necessarily mean you have panic disorder. While panic attacks are fairly common, true panic disorder is far less prevalent.

“Panic attacks are pretty normal and pretty frequent in the population,” Dr. Rego says, “but what makes them veer to the disordered category is when the fear of the attack coming on, or the fear of experiencing the attacks themselves, becomes so overwhelming that the person has difficulty functioning.”

Panic disorder is characterized by recurrent panic attacks that seemingly happen for no reason. For example, unlike having a singular attack in response to a trigger, panic disorder is basically brought on by attacks that are so frequent and unpredictable that the constant fear that they will happen becomes the cause of more attacks, Dr. Rego explains. If this vicious cycle is what’s happening to you, definitely consult your doctor or psychologist.

According to Dr. Rego, the good news is that treatments such as cognitive behavioral therapy and prescribed medication are very effective at treating panic disorder.
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When Should You See A Doctor?

If you’ve experienced one or two panic attacks that don’t seem to be be recurrent, you might be quick to write them off.

According to Dr. Rego, there’s no specific frequency of panic attack occurrence that dictates when you should see a doctor — it’s all about how much they affect you.

“I think the frequency is less important than how much the idea of having panic attacks [is] causing you [more anxiety,]” he says. “So if you’re really upset and you’ve had a couple [of panic attacks] and it’s starting to stress you out, or impact the way you’re living, then that’s worth getting on top of.”

Your primary care doctor or a mental health professional can help advise you about a course of treatment (with anxiety medications or talk therapy) if necessary.
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What Are Some Other Coping Methods?

Besides breathing exercises, another recommended method to cope with a panic attack is progressive muscle relaxation, in which you focus on slowly tensing and relaxing each muscle group in your body. PMR can help distract you from the attack while helping your body cope, and is often recommended to deal with stress symptoms (which can occur during panic attacks).

The steps involve:

1. Breathing. Take deep breaths inhaling through your nose and exhaling through your mouth.

2. Tighten and relax your muscles. Start by clenching your toes and relaxing them, then work your way up your body, flexing and relaxing.

3. Do this for a few seconds for each muscle group, repeating for any areas that feel especially stiff.

You can also try a guided relaxation here.
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