What is Panic attacks?

Panic attacks

What is panic disorder?

If you've ever had a panic attack, you'll know how frightening it is. But no matter how alarming your feelings are, it's important to know that they can't hurt you. They usually fade away after a few minutes.

If you get a panic attack, you suddenly feel terrified for no reason. You may even feel as though the world is going to end or you're going to die. Your heart may pound. And you may feel sweaty or find that it's hard to catch your breath. You may also feel dizzy and start to tremble.

If you worry all the time about having an attack and stop doing things you would normally do, you may have what doctors call panic disorder.

Getting treatment can help you feel better and start to live life normally again.

Key points for people with panic disorder

Panic attacks are scary but they won't hurt you.
If you get panic attacks often and worry all the time about when you'll have the next one, you may have panic disorder.
Panic disorder affects about 1 in 50 Americans. It's very common.
Women are more likely to get panic disorder than men.
People usually start having panic disorder in their late teens or early 20s.
Drug treatments and talking therapies (such as

cognitive behavioral therapy
Cognitive behavior therapy (CBT) is a type of talking treatment (psychotherapy). It is based on the idea that the negative thoughts and beliefs people have play an important role in how they feel and how they act. CBT helps people identify, look at and change unwanted thoughts, feelings and behaviors.

cognitive behavioral therapy) are often used to treat panic disorder.
Most people with panic disorder get better if they have treatment. But the condition may come and go.

Source:
Cowley DS, Flick SN, Roy-Byrne PP.
Long-term course and outcome in panic disorder: a naturalistic follow-up study.
Anxiety. 1996; 2: 13-21.

¹

It's normal to feel scared and panicky when you're in danger. For example, your heart will start to race if a truck looks like it's about to run you over. But a panic attack happens even when you're not in danger and there's nothing to be scared of. Doctors don't really know why some people get panic attacks when there is nothing for them to be afraid of.

Panic attacks can't hurt you, but they can affect your life. You may have one when you're out shopping or driving your car. You may worry all the time about having another attack and wonder when it will happen. You may stop going out at all just in case you have another panic attack.

Your body's normal response to fear or stress

Panic and fear are part of your body's built-in protection system. They're actually healthy emotions to have. They can save your life when you're in danger. When you're about to step into the road and see a truck rushing toward you, for example, it's fear that gets you to react quickly to get out of the way. And fear can also give you an extra drive when you're nervous or scared. For example, getting nervous before a test may give you the extra push you need to study harder to get a better grade.

If you're afraid, you may have several symptoms. Your response to fear involves many parts of your body, including your brain, the rest of your nervous system, your heart, your muscles and the network of blood vessels in your body. It can make your heart beat faster, make you sweat and shake, and make you feel queasy. To find out more, see What are the symptoms of panic disorder?

You won't have all of these symptoms every time you get scared. For example, if you're driving and suddenly have to swerve to avoid hitting a dog that has run into the road, your heart may race, you may feel breathless and your arms may feel weak. But your face may not go red and you may not get sweaty.

These reactions are the way your body responds to anxiety. The word anxiety covers a range of feelings from worry to absolute panic. We're not exactly sure how feeling afraid or nervous gives you these symptoms. But there seems to be a part of your brain that senses when you're anxious or scared and triggers these reactions in your body. Your body has these reactions to protect you from danger.

Source:
Krystal JH, Deutsch DN, Charney DS.
The biological basis of panic disorder.
Journal of Clinical Psychiatry. 1996; 57 (supplement 10): 23-31, discussion S32-S33.

Here's what happens in your body when you get anxious:

Source:
Spiegel DA, Barlow DH.
Generalized anxiety disorders.
In: Gelder MG, Lopez-Ibor JJ, Andreasen NC (editors). New Oxford textbook of psychiatry. 1st edition. Oxford University Press, Oxford, UK; 2000.

Part of your body is put on high alert. This happens automatically. You have no control over it
Your body gets ready to fight the danger or run away from it. When you're scared your brain tells your adrenal glands to pump out more of certain chemicals into your blood. Your adrenal glands are two small organs that sit in your lower back just above each of your kidneys. One of the chemicals that these

gland
A gland is any group of cells in the body that makes and releases something for use by another part of the body. For example, the thyroid gland makes a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

glands pump out is

epinephrine
Epinephrine is a chemical that makes your heart race and makes you feel alert. It is sometimes called the "fight-or-flight" hormone.

epinephrine. Epinephrine is sometimes called the "fight or flight"

hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone estrogen is made in a woman's ovaries. Estrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.

hormone, because it tells your body to get ready to deal with danger
Your heart beats faster. This is caused by the extra epinephrine in your blood. When your heart beats faster, more blood is pumped around your body. This gives your muscles the energy they need to help you run away from danger or fight it.
You may tremble or go pale. The extra epinephrine in your body draws blood away from your skin. This means more blood can go to your muscles in case you need to take action to deal with danger.
You may feel like you need to go to the bathroom. This is because epinephrine relaxes your bladder and bowels.
You also get distracted from everything else you're doing. Part of your brain senses that you're anxious and tells other parts of your brain how you are feeling. This makes you stop what you're doing and focus on the thing you're worried about. Two chemicals in your nervous system may be important in triggering this reaction. These chemicals are called epinephrine and

serotonin
Serotonin is a neurotransmitter, which is a chemical that helps to send information from a nerve cell to other cells. It is thought to play a role in learning, sleep and control of mood.

serotonin.
Other chemicals in your brain that may play a part in these responses are

norepinephrine
Norepinephrineis a neurotransmitter, which is a chemical that helps to send information between nerve cells. It is similar to epinephrine. Your body produces epinephrine when you're in stressful situations, which increases your blood pressure and heart rate.

norepinephrine and

dopamine
Dopamine is a neurotransmitter, which is a chemical that helps messages pass between brain cells and other cells. Dopamine plays a role in your mood, and your physical movements.

dopamine.

All of these reactions are a normal response to stress or fear. And while they're happening, another part of your brain checks to see whether the thing you were afraid of is actually happening. If it doesn't happen, or if the danger passes, your fear responses will fade away.

What happens if I have panic disorder?

If you get panic attacks, you suddenly feel absolutely terrified. The only difference between the feelings you have during a panic attack and a normal response to fear is that you get panic attacks when there's nothing to be afraid of.

You may have panic disorder if you start worrying all the time about when you're going to have another panic attack and if you change your usual routine in order to try to avoid having panic attacks.

Doctors aren't sure why the normal reaction to fear can be triggered for no reason in some people.
Panic attacks often start after you've been through a stressful life event, such as a divorce, the death of a loved one or the birth of a child.

Source:
Zal HM.
How to help the patient cope with a crippling problem.
Consultant. 1996; 36: 97-98, 103-104.

⁴ It may be that if you are afraid of stressful events, you are more likely to get panic disorder.

Source:
Zal HM.
How to help the patient cope with a crippling problem.
Consultant. 1996; 36: 97-98, 103-104.

⁴ Sometimes people shake off panic disorder only for it to return when they go through another stressful event. But not everybody who goes through a stressful time gets panic disorder.
We're all born with a tendency to be anxious.

Source:
Andrews G, Creamer M, Crino R, et al.
The treatment of anxiety disorders: clinician guides and patient manuals.
2nd edition. Cambridge University Press, Cambridge, UK; 2002.

⁵ People with a relaxed attitude toward life are less likely to get panic attacks. People who are worriers usually get this from one or both of their parents. These are the people who are more likely to get panic disorder.

Source:
Andrews G, Creamer M, Crino R, et al.
The treatment of anxiety disorders: clinician guides and patient manuals.
2nd edition. Cambridge University Press, Cambridge, UK; 2002.

⁵

Why me?

Some things increase your chances of getting panic disorder. Doctors call these risk factors. Some of the main risk factors for panic disorder are going through a stressful event, such as taking important exams.

Source:
American Psychological Association.
Anxiety. Answers to your questions about panic disorder.
Available at http://www.apa.org/topics/anxietyqanda.html (accessed on 17 November 2009).

⁶ Women are more likely than men to get panic disorder. Panic attacks tend to start in the late teens or early 20s, so being this age is another risk factor.

To learn more, see Risk factors for panic disorder.

What else can cause a panic attack?

Panic attacks aren't always caused by panic disorder. Sometimes there's a different cause. Drinking too much coffee or taking certain drugs (both legal and illegal ones) can cause panic attacks. Some medical conditions, such as an

overactive thyroid
If your thyroid gland works too hard, you may lose weight and feel anxious or jumpy. Your eyes may also stand out more than usual. Doctors call this hyperthyroidism.

overactive thyroid, may also make you panic. If your doctor finds a specific medical cause for your panic attacks, then you don't have panic disorder. Treating the cause usually makes the panic attacks go away.

If you only get panic attacks in certain social situations, such as when you're in a big group of people or traveling on a crowded bus or train, you may have another condition, such as a

phobia
If you have a phobia of something, you are much more afraid of it than would be expected. You could have a phobia about a thing (such as a dog) or an activity (such as going out in public). Phobias can make you feel panicked. They can also make your heart race or give you an upset stomach.

phobia,

obsessive-compulsive disorder
Obsessive-compulsive disorder is a psychological illness. People who have it can't keep certain thoughts out of their mind. Or they feel they have to do certain things all the time, such as washing their hands. This makes it hard for them to live a normal life.

obsessive-compulsive disorder or

post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a psychological illness. You may get post-traumatic stress disorder after something very distressing happens to you. Symptoms can include relieving the experience in your thoughts, avoiding things that remind you of what happened and becoming withdrawn.

post-traumatic stress disorder.

To find out more about other causes of panic attacks, see What else could it be?

Sources for the information on this page:

Cowley DS, Flick SN, Roy-Byrne PP.Long-term course and outcome in panic disorder: a naturalistic follow-up study.Anxiety. 1996; 2: 13-21.

Krystal JH, Deutsch DN, Charney DS.The biological basis of panic disorder.Journal of Clinical Psychiatry. 1996; 57 (supplement 10): 23-31, discussion S32-S33.

Spiegel DA, Barlow DH.Generalized anxiety disorders.In: Gelder MG, Lopez-Ibor JJ, Andreasen NC (editors). New Oxford textbook of psychiatry. 1st edition. Oxford University Press, Oxford, UK; 2000.

Zal HM.How to help the patient cope with a crippling problem.Consultant. 1996; 36: 97-98, 103-104.

Andrews G, Creamer M, Crino R, et al.The treatment of anxiety disorders: clinician guides and patient manuals.2nd edition. Cambridge University Press, Cambridge, UK; 2002.

American Psychological Association.Anxiety. Answers to your questions about panic disorder.Available at http://www.apa.org/topics/anxietyqanda.html (accessed on 17 November 2009).

This information was last updated on Dec 03, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2010. All rights reserved.

The information on ConsumerReportsHealth.org should not be viewed as a substitute for a consultation with a medical or health professional. The information is meant to enhance communication with your doctor, not replace it. Consumers Union can not be liable for any loss, injury, or other damages related to your use of this information.

Your use of this information is subject to our User Agreement available at www.ConsumerReportsHealth.org.