When we experience an involuntary high degree stress response, the sensations can be so profound that we think we are having a medical emergency, which anxious personalities can react to with more fear. And when we become more afraid, the body is going to produce another stress response, which causes more changes, which we can react to with more fear, and so on.
Poverty and low education level tend to be associated with anxiety, but it is unclear if those factors cause or are caused by anxiety. While some statistics suggest that disadvantaged ethnic minorities tend to suffer from internalizing disorders like panic disorder less often than the majority population in the United States, other research shows that may be the result of differences in how ethnic groups interpret and discuss signs and symptoms of intense fright, like panic attacks. Also, panic and other anxiety disorders are thought to persist more for some ethnic minorities in the United States. Difficulties the examiner may have in appropriately recognizing and understanding ethnic differences in symptom expression is also thought to play a role in ethnic differences in the reported frequency of panic and other internalizing disorders.
Panic attacks and panic disorder are treatable once the underlying cause of is identified. “Usually medical conditions and other factors (substance use or withdrawal from substances) are ruled out before making the diagnosis,” says Flo Leighton, psychiatric nurse practitioner, and therapist with Union Square Practice in Manhattan. Getting to the root cause typically takes a couple of sessions, says Leighton. Here are some options that may be recommended to you :
A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and during which time a variety of psychological and physical symptoms occur. These symptoms include rapid heart rate, sweating, shaking, shortness of breath, hot flashes, and lightheadedness—as well as a sense of impending doom, chills, nausea, abdominal pain, chest pain, headache, and numbness or tingling.
If you’ve ever experienced a sudden surge of overwhelming anxiety and fear then you’re familiar with the feeling of having a panic attack. Your heart pounds, you can’t breathe, and you may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With the right treatment and self-help, you can reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life
Simple Phobias and Agoraphobia: People with panic disorder often develop irrational fears of specific events or situations that they associate with the possibility of having a panic attack. Fear of heights and fear of crossing bridges are examples of simple phobias. As the frequency of panic attacks increases, the person often begins to avoid situations in which they fear another attack can occur or places where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Generally, these fears can be resolved through repeated exposure to the dreaded situations, while practicing specific techniques to become less sensitive to them.
For example, once you notice you are scaring yourself with anxious thinking, you can change your thinking to calming thoughts, which will stop stress responses and their physiological, psychological, and emotional effects. As you calm yourself down, your body will follow by stopping the flow of stress hormones. As stress hormones are used up or expelled, the sensations, symptoms, and feelings of panic will subside…in time.
An anxiety attack can be described as a sudden attack of fear, terror, or feelings of impending doom that strike without warning and for no apparent reason. This strong sensation or feeling can also be accompanied by a number of other symptoms, including pounding heart, rapid heart rate, sweating, lightheadedness, nausea, hot or cold flashes, chest pain, hands and feet may feel numb, tingly skin sensations, burning skin sensations, irrational thoughts, fear of losing control, and a number of other symptoms. (While other symptoms often do accompany anxiety attacks, they don’t necessarily have to.)
It is not unusual to experience only one or two symptoms at a time, such as vibrations in their legs, shortness of breath, or an intense wave of heat traveling up their bodies, which is not similar to hot flashes due to estrogen shortage. Some symptoms, such as vibrations in the legs, are sufficiently different from any normal sensation that they clearly indicate panic disorder. Other symptoms on the list can occur in people who may or may not have panic disorder. Panic disorder does not require four or more symptoms to all be present at the same time. Causeless panic and racing heartbeat are sufficient to indicate a panic attack.[9]
Medications — most often antidepressants and anti-anxiety drugs — can also be used to help treat panic disorder. Your doctor may initially prescribe you an anti-anxiety drug, such as Xanax (alprazolam), and then add an antidepressant, such as Effexor XR (venlafaxine). After a month or sooner, your doctor may stop the Xanax and have you remain on the antidepressant.
Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The mean age for onset of panic disorder is 22-23. Panic attacks may occur with other mental disorders such as depression or PTSD.
Experiencing a chronic medical condition or severe or frequent illness can also increase risk for anxiety disorders, as well as dealing with significant illness of a family member or loved one. Given that several medical conditions have been linked to significant anxiety, in some cases a physician may perform medical tests to rule out an underlying medical condition. For instance, thyroid disease is often characterized by experiencing significant symptoms of anxiety. Menopause, heart disease, and diabetes have also been linked to anxiety symptoms. Additionally, drug abuse or withdrawal for many substances is characterized by acute anxiety, and chronic substance abuse can increase risk for developing an anxiety disorder. Anxiety can also be a side effect of certain medications. Experiencing significant sleep disturbances, such as difficulty falling asleep or staying asleep, may also be a risk factor for developing an anxiety disorder.
Seek medical follow-up. For those who are diagnosed with panic disorder, depression, or another form of anxiety disorder, the news is encouraging when treatment is received. These disorders are usually well controlled with medications. However, many people suffer the effects of these illnesses for years before coming to a doctor for evaluation. These conditions can be extremely disabling, so follow-up after the initial visit to the doctor is crucial so that diagnosis and treatment can continue.
The theologian Paul Tillich characterized existential anxiety[23] as "the state in which a being is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority" even though such "undoubted certitude is not built on the rock of reality".[23]
Psychotherapy – often referred to as “talk” therapy is one treatment option. Cognitive behavioral therapy is a very common method of psychotherapy that has shown great results for people living with Generalized Anxiety Disorder. This form of therapy is geared toward helping you recognize and understand your thoughts and the pattern of any negative thoughts you may experience. Cognitive behavioral therapy focuses on teaching you coping skills or mechanisms you can use to help you return to normal functioning and ease your feelings of anxiety. It is normally a short-term therapy and people who undergo this type of psychotherapy have found great results.
While the use of drugs in treating panic attacks can be very successful, it is generally recommended that people also be in some form of therapy, such as cognitive behavioral therapy. Drug treatments are usually used throughout the duration of panic attack symptoms, and discontinued after the patient has been free of symptoms for at least six months. It is usually safest to withdraw from these drugs gradually while undergoing therapy.[14] While drug treatment seems promising for children and adolescents, they are at an increased risk of suicide while taking these medications and their well-being should be monitored closely.[59]
I was 34 before I knew anxiety was real. I had lived my life with these feelings, never knowing that everyone else wasn’t experiencing the same thing. I was 35 when I reached out to a friend, who is a nurse practitioner, to ask about my symptoms. That is when I began taking medication. I am on the lowest dose of anxiety medication and I have been taking it for six months. It has changed my life.
Cognitive behavioral therapy (CBT), is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. According to the National Association of Cognitive Behavioral Therapists the benefit of this therapy is that we can change the way we think to feel and act better even if the situation does not change. CBT focuses on determining the thought and behavior patterns responsible for sustaining or causing the panic attacks. CBT is a time-limited process (treatment goals—and the number of sessions expected to achieve them—are established at the start) that employs a variety of cognitive and behavioral techniques to affect change.
At some point in our lives, most of us will experience a panic attack in response to an actual danger or acute stress. But when panic attacks occur or recur for no reason and in the absence of danger or extreme stress, or when the fear of experiencing another attack is so strong that you change your behavior by avoiding certain places or people, you may have panic disorder.

Genetics and family history (e.g., parental anxiety) may predispose an individual for an increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[57] Genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[58] Although single genes are neither necessary nor sufficient for anxiety by themselves, several gene polymorphisms have been found to correlate with anxiety: PLXNA2, SERT, CRH, COMT and BDNF.[59][60][61] Several of these genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) which are implicated in anxiety. The epigenetic signature of at least one of these genes BDNF has also been associated with anxiety and specific patterns of neural activity.[62]


David D. Burns recommends breathing exercises for those suffering from anxiety. One such breathing exercise is a 5-2-5 count. Using the stomach (or diaphragm)—and not the chest—inhale (feel the stomach come out, as opposed to the chest expanding) for 5 seconds. As the maximal point at inhalation is reached, hold the breath for 2 seconds. Then slowly exhale, over 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale + 1 exhale). The point is to focus on the breathing and relax the heart rate. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming.
Medications — most often antidepressants and anti-anxiety drugs — can also be used to help treat panic disorder. Your doctor may initially prescribe you an anti-anxiety drug, such as Xanax (alprazolam), and then add an antidepressant, such as Effexor XR (venlafaxine). After a month or sooner, your doctor may stop the Xanax and have you remain on the antidepressant.
A form of psychotherapy called cognitive behavioural therapy (CBT) has been found by several studies to be the most effective treatment for panic attacks and panic disorder. During CBT, you will work with a therapist on relaxation training, restructuring your thoughts and behaviors, mindfulness, exposure treatment, and stress reduction. Many people that suffer from panic attacks start to notice a reduction within weeks, and symptoms often decrease significantly or go away completely within several months.
Some research shows that people who have close and supportive friendships have a greater ability to fight mental and physical diseases than people who are isolated. The mind can be our worst enemy when feeling anxious and having a supportive network that you can discuss and decompress your deepest worries to could help prevent anxiety from consuming your life. Find trusted friends during times of anxiety that you can open up to and know that they will provide a listening ear and supportive feedback about your experiences.
At some point in our lives, most of us will experience a panic attack in response to an actual danger or acute stress. But when panic attacks occur or recur for no reason and in the absence of danger or extreme stress, or when the fear of experiencing another attack is so strong that you change your behavior by avoiding certain places or people, you may have panic disorder.

Obsessive-Compulsive Disorder (OCD) is characterized by uncontrollable anxious thoughts or behaviors. Individuals with OCD are plagued by persistent, unwelcome thoughts and images or by the urgent need to engage in certain rituals. Some OCD sufferers may only have obsessive thoughts without the related rituals. The disturbing thoughts or images (e.g., fear of germs) are called obsessions, and the rituals performed to try to get rid of them (e.g., hand washing) are called compulsions. For example, people who are obsessed with germs may wash their hands excessively. The individual is not happy to be performing the ritual behaviors but finds this to be the only way to get temporary relief from the obsessive thought.
The last strategy — learning what triggers your anxiety — is important. Sometimes you can take small steps to conquer your anxiety instead of letting the trigger conquer you. For example, if meeting new people causes you high anxiety, consider going with a friend to meet the new neighbors. Once you do this with ease, you can move forward and meet people on your own. All the pent-up fear and anxiety attacks will start to resolve as you become accustomed to reaching out in your community.
Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives. . But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.
Warren: So if you’re walking down a dark alley, you are probably thinking that there could be potential danger; that anxiety of anticipation, the feeling in your stomach, the elevated heart rate. But if you’re walking down that alley and somebody jumps out with a knife, then you’re likely to have a panic attack — an overwhelming urge to escape a situation that is dangerous.
Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. People experiencing a panic attack may believe they are having a heart attack or they are dying or going crazy. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms:
Anxiety isn't always a bad thing. In fact, it can motivate you and help you to stay focused under pressure. But when worries, fears, or panic attacks start to get in the way of your life, you may be suffering from an anxiety disorder. Whatever form of anxiety you're dealing with, there are many things you can do to gain peace of mind and take back control of your life.

Obsessive-compulsive Disorder (OCD): In OCD, a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. Such rituals as counting, prolonged handwashing, and repeatedly checking for danger may occupy much of the person’s time and interfere with other activities. Like panic disorder, OCD can be treated effectively with medication and/or psychotherapy.
I think I had an anxiety attack the other day, but I’m not sure. I was at the movies and felt scared, like something or someone was going to attack me. I drove home and felt like I was scared of the dark and was having trouble breathing and focusing on driving. After dropping off my bf and driving home, I started crying and hyperventilating, and felt detached from the world, like nothing mattered, and felt like I was going to die. It took me two hours to fall asleep and I had nightmares. The episode was over by morning, but I’m concerned that it will happen again.
Butterflies in your stomach before an important event? Worried about how you will meet a deadline? Nervous about a medical or dental procedure? If so, you are like most people, for whom some worry about major events (like having a child, taking an exam, or buying a house), and/or practical issues (like money or health conditions), is a normal part of life. Similarly, it is not uncommon to have fears about certain things (like spiders, injections, or heights) that cause you to feel some fear, worry, and/or apprehension. For example, many people get startled and feel nervous when they see a snake or a large insect. People can differ in what causes them to feel anxious, but almost everyone experiences some anxiety in the course of their life.
The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank"[20] as well as "nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary."[21]
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Once you are under enough stress, almost anything can set off a panic attack. Suppose you are under a lot of stress, but still managing. If you add even more stress, your brain will begin to feel under siege. Your body will respond by releasing adrenaline as part of the fight or flight response. That will cause more anxiety, which will create a vicious feedback that will turn into a panic disorder.


Anxiety attacks that occur while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic symptoms during sleep tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and other psychiatric disorders compared to people who do not have panic attacks at night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.
Exercises to replace negative thoughts with positive ones: Make a list of the negative thoughts that might be cycling as a result of anxiety, and write down another list next to it containing positive, believable thoughts to replace them. Creating a mental image of successfully facing and conquering a specific fear can also provide benefits if anxiety symptoms relate to a specific cause, such as in a phobia.
In addition to the emotional turmoil and the physical manifestations that Caroline and Kirstie describe panic attacks can cause 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 overheating; numbness or tingling; feelings of unreality (derealization) or being detached from oneself (depersonalization); fear of losing control or “going crazy”; and fear of dying.
Behavioral choices can also significantly impact risk, as excessive tobacco or caffeine use can increase anxiety, whereas regular exercise can decrease anxiety. Specific temperament and personality traits also may confer risk of having an anxiety disorder. With regards to temperament, shyness and behavioral inhibition in childhood can increase risk of developing an anxiety disorder later in life. With regard to personality traits, the Five Factor Model of Personality consists of five broad trait domains including Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. An individual higher on trait Neuroticism or low on Conscientiousness is at a higher risk for all anxiety disorders, and an individual low on trait Extraversion is at a higher risk of developing social phobia and agoraphobia. Some more narrow personality traits have also been found to relate to risk for anxiety, including anxiety sensitivity, a negative or hostile attributional style, and self-criticism. Personality disorders have also been shown to relate to increased risk for anxiety disorders.
An anxiety or panic attack often comes on suddenly, with symptoms peaking within 10 minutes. For doctors to diagnose a panic attack, they look for at least four of the following signs: sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, feeling hot or cold, numbness or tingling, a racing heart (heart palpitations), and feeling unusually detached from yourself.
When taking medications, it is important for clients to be educated about potential side effects, the rationale for the type of medication prescribed, and other drugs or substances that may counteract or interact with the effects of the medications. Before stopping taking the prescribed drug, or if the medication does not seem to alleviate symptoms, the doctor should be consulted.
Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[12] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape. It occurs in situations only perceived as uncontrollable or unavoidable, but not realistically so.[13] David Barlow defines anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events,"[14] and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.[15] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[16]
Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.
It is important to note that genetic factors can also bestow resilience to anxiety disorders, and the field continues to pursue large-scale genomics studies to identify novel genetic factors that are associated with anxiety disorders in hopes of better understanding biological pathways that: 1) contribute to the development and maintenance of anxiety; and 2) may lead to better treatment for these disorders. Most people are not aware of what specific genetic markers they may have that confer risk for anxiety disorders, so a straightforward way to approximate genetic risk is if an individual has a history of anxiety disorders in their family. While both nature and nurture can be at play with family history, if several people have anxiety disorders it is likely that a genetic vulnerability to anxiety exists in that family.
Poverty and low education level tend to be associated with anxiety, but it is unclear if those factors cause or are caused by anxiety. While some statistics suggest that disadvantaged ethnic minorities tend to suffer from internalizing disorders like panic disorder less often than the majority population in the United States, other research shows that may be the result of differences in how ethnic groups interpret and discuss signs and symptoms of intense fright, like panic attacks. Also, panic and other anxiety disorders are thought to persist more for some ethnic minorities in the United States. Difficulties the examiner may have in appropriately recognizing and understanding ethnic differences in symptom expression is also thought to play a role in ethnic differences in the reported frequency of panic and other internalizing disorders.

Medication can be used to control or lessen symptoms related to panic disorder. It is most effective when combined with other treatments, such as the aforementioned cognitive behavioral therapy and exposure therapy. Medications used to treat panic attacks and panic disorder include antidepressants, though they take several weeks to reach effectiveness. Benzodiazepines such as Ativan and Xanax work quickly. However they are addictive and should only be used for a short time,
The theologian Paul Tillich characterized existential anxiety[23] as "the state in which a being is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority" even though such "undoubted certitude is not built on the rock of reality".[23]
As with most behavioral illnesses, the causes of panic attacks are many. Certainly there is evidence that the tendency to have panic attacks can sometimes be inherited. However, there is also evidence that panic may be a learned response and that the attacks can be initiated in otherwise healthy people simply given the right set of circumstances. Research into the causes of panic attacks is ongoing.

Without treatment, panic attacks tend to occur repeatedly for months or years. While they typically begin in young adulthood, the symptoms may arise earlier or later in life in some people. Complications, which are symptoms that can develop as a result of continued panic attacks and develop into other mental illnesses, may include specific irrational fears (phobias), especially of leaving home (agoraphobia) and avoidance of social situations. Other possible complications can include depression, work or school problems, suicidal thoughts or actions, financial problems, and alcohol or other substance abuse. For children and adolescents, panic disorder can even interfere with normal development. Panic disorder and other anxiety disorders also predispose sufferers to developing heart or gastrointestinal diseases, high blood pressure or diabetes, having more severe symptoms if they have a respiratory disease, and of dying prematurely.
In particular, the doctor will be concerned with the person's past medical history, past history of any mental illness, and any surgery the person may have had. In addition to exploring whether the person suffers from any other mental illness, the practitioner often explores whether the panic attack sufferer has a specific anxiety disorder in addition to or instead of panic disorder, like post traumatic stress disorder (PTSD), phobias, obsessive compulsive disorder, or generalized anxiety disorder.
Characterized by a suite of symptoms that persist for at least three days and up to one month after a traumatic experience (same diagnostic criteria for "trauma" as listed above). The specific symptoms of the disorder vary across individuals, but a common feature is intense anxiety in response to re-experiencing symptoms (e.g., recurrent intrusive recollections of traumatic event) of the trauma.
Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.
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