Panic attacks

What are panic attacks?

A panic attack is a sudden onset of intense fear, usually with physical symptoms such as a pounding heart, hyperventilation and an upset stomach. Episodes can last between 5 and 20 minutes, although it may feel longer at the time, and symptoms will usually be at their worst at around 10 minutes.

If you’re having symptoms of a panic attack, it can be quite scary. All too often people find themselves in A&E thinking they’re having a heart attack. It’s important to note that panic attacks won’t harm you, but you may feel quite drained and unsettled afterwards.

Panic attacks are fairly common – about 1 in 10 people will experience one at some point in their lives.

What causes panic attacks?

Sometimes panic attacks can happen for no reason. Other times they can be triggered by stressful life events. There can be a few factors involved:

• Past or childhood experiences
• Traumatic events
• Your current life situation (e.g. relationship problems, work stress)
• Physical and mental health problems
• Drugs, alcohol and medication.

What happens when you have a panic attack?

When you experience stress or a perceived threat, chemicals are released into your bloodstream that increase your heart rate and breathing, among other physical changes. This natural ‘fight-or-flight’ stress response is an important survival mechanism that prepares us to either defend ourselves or run for our lives.

However, some people notice these physical changes more than others, and interpret them as dangerous (e.g. “I am having a heart attack”, or “I can’t breathe”). This can be very distressing, causing your heart to beat even faster and your breathing to increase further, with more negative thoughts and a sense of panic.

So, in essence, a panic attack is caused by fear of the physical symptoms of stress. This can prolong an attack, and mean that if you’re worried about having another panic attack, it’s more likely to happen.

Who is at risk of panic attacks?

Panic attacks typically start between the age of 18 and 35 and affect more women than men.

You’re more at the risk of developing panic attacks or panic disorder if:

• there are major changes in your life, such as a divorce or a new baby
• you’re going through major life stress, such as the death or serious illness of a loved one
• you’ve been through a traumatic event, such as sexual assault or a serious accident
• you have a history of childhood physical or sexual abuse
• you have a family history of panic attacks or panic disorder
• you smoke or have a lot of caffeine.

What are the symptoms of panic attacks?

Physical symptoms can include:

• fast, pounding heartbeat
• shortness of breath or difficulty breathing (hyperventilation)
• sweating
• trembling or shaking
• a choking feeling
• chest pain, pressure or discomfort
• stomach problems or sudden diarrhoea
• feeling sick
• feeling dizzy, lightheaded or faint
• hot flushes or chills
• numbness or tingling.

Psychological symptoms can include:

• feelings of intense terror or dread
• feeling like things around you are strange or feeling detached from your body
• feeling like you’re losing control or going crazy
• fear of fainting, having a heart attack or dying.

Most of these can be symptoms of other conditions or problems, so you may not always be having a panic attack. If you experience persistent physical symptoms speak to your GP.

How are panic attacks diagnosed?

A GP or psychiatrist can diagnose panic attacks. If you’ve been having panic attack symptoms, see your GP – they'll ask you about your symptoms, how often you get them and how long you’ve had them.

They may also examine you to rule out other conditions that can cause similar symptoms, such as low blood pressure.

You may be diagnosed with panic disorder if you’re having frequent and unexpected panic attacks, followed by at least a month of continuously worrying about having more panic attacks.

What is the treatment for panic attacks?

There are two main types of treatment for panic attacks – talking therapy and medication. Depending on the nature of your symptoms, you may need one of these treatments or a combination of the two.

The main, and most effective, talking therapy for panic attacks is Cognitive Behavioural Therapy. This will help you think and behave differently when you experience the physical symptoms, so that you can eventually become free from panic attacks.

How to manage a panic attack

Here are a few things you can do to calm yourself down when you’re having a panic attack:

• Recognise – notice that you’re having a panic attack, nothing worse, and remind yourself that you’ll be okay and that it’ll pass in a few minutes
• Breathe – focus on taking slow, deep breaths through your nose rather than your mouth, and breathe into your belly rather than your chest
• Practice mindfulness – bring your attention to what’s in the here and now by engaging your senses, like the sensation of your feet on the ground, or you could keep some lavender oil handy to sniff for a natural relaxant
• Close your eyes – this will help you block out extra stimuli, allowing you to focus on one thing: your breathing; what you can sense; a mantra (e.g. repeating ‘this will pass’); or you could even imagine yourself in a relaxing place.

Self-help for panic attacks

Here are a few things you can do to help prevent further panic attacks:

• Read a self-help book for anxiety based on the principles of Cognitive Behavioural Therapy (CBT)
• Try complementary therapies such as massage and aromatherapy, or activities like yoga and Pilates, to help you relax
• Exercise regularly to reduce any stress and tension
• Avoid sugary food and drinks, caffeine and alcohol, and stop smoking as all of these things can make panic attacks worse.

Related problems

• Stress: This is the feeling of being overwhelmed and unable to cope with demands due to a build-up of stressful situations, which can trigger panic attacks
• Anxiety: A feeling of unease, worry and dread, panic attacks can be a symptom of anxiety.

Reviewed by: Brendan Street