Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.
^ Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Health and Clinical Excellence. Clinical Guideline 22. Issue date: April 2007 "Archived copy" (PDF). Archived from the original (PDF) on 24 August 2009. Retrieved 2009-07-21. ISBN 1-84629-400-2
Panic disorder affects 2-3% of people every year in the United States and Europe, with varying rates depending on race and ethnicity. On average, Native American Indian populations experience panic disorder at higher rates than non-Latino white Americans. In contrast, African Americans, Latinos, Caribbean Blacks, and Asian Americans all experience the disorder at lower rates than non-Latino white Americans. In addition, it has been well established than females are twice as likely to be diagnosed with panic disorder than males (Asnaani, Gutner, Hinton, & Hofmann, 2009; McLean, Asnaani, Litz, & Hofmann, 2011). A number of factors (e.g., biological influences, temperament, exposure to stressors and trauma, cognitive factors, and environmental factors) have been identified as possibly influencing sex differences in rates of panic disorder (McLean & Anderson, 2009). However, no one theory has been determined so the underlying reason for sex differences in rates of panic disorder remains unknown.
Hyperventilation syndrome may occur when a person breathes from the chest, which can lead to overbreathing (exhaling excessive carbon dioxide in relation to the amount of oxygen in one's bloodstream). Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms, including rapid heart beat, dizziness, and lightheadedness, which can trigger panic attacks.[12]
Warren: With anxiety to the point where it’s part of a disorder — let’s say generalized anxiety disorder, mostly characterized by anxiety and worry about a whole bunch of different situations — we would treat it by teaching a patient about the role of worry in creating the symptoms and how to manage the worry. That sometimes involves challenging unrealistic thoughts or working to increase one’s ability to tolerate uncertainty, which is a big part of anxiety.
Yes, panic attacks can feel awful, intense, and threatening. But they aren’t harmful and generally pass when the body calms down. And yes, they can range in number, intensity, and frequency with each person experiencing a unique set of panic attack symptoms. But panic attacks and their symptoms can be overcome for good by getting the right information, help, and support. We provide more detailed information in the Recovery Support area of our website.
Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behaviour such as pacing back and forth, somatic complaints, and rumination.[1] It is the subjectively unpleasant feelings of dread over anticipated events, such as the feeling of imminent death.[2][need quotation to verify] Anxiety is not the same as fear, which is a response to a real or perceived immediate threat,[3] whereas anxiety involves the expectation of future threat.[3] Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[4] It is often accompanied by muscular tension,[3] restlessness, fatigue and problems in concentration. Anxiety can be appropriate, but when experienced regularly the individual may suffer from an anxiety disorder.[3]

In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac. Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don't know they have a real and highly treatable disorder. It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.
Once the panic attack is over and the person has returned to a calm state, encourage them to seek help from a mental health professional at their earliest convenience, if they haven’t already. You can help them further by assisting with the search for a licensed professional, researching coping techniques online, and looking for self-help books that might be useful.
These attacks are a symptom of panic disorder, a type of anxiety disorder that affects some 2.4 million U.S. adults. The disorder most often begins during the late teens and early adulthood and strikes twice as many American women as men. No one knows what causes panic disorder, though researchers suspect a combination of biological and environmental factors, including family history (panic disorder seems to run in families), stressful life events, drug and alcohol abuse, and thinking patterns that exaggerate normal physical reactions.
Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.
Kirstie Craine Ruiz, 46, has lived with anxiety, panic attacks, and panic disorder for about ten years. For a long time, she had full-blown attacks 2-3 nights a week. “I would usually awake to a racing heart or the feeling of my heart expanding in my chest…like it might explode… From there, I would begin to panic and my heart would go even faster….and my body would shake so hard that it felt like I was having a convulsion.  I could barely breathe and was usually pretty sure I was having a heart attack and that I was going to die. Sometimes I’d go the ER and they’d hold me overnight because my heart would be going so fast and they couldn’t get it to go down.”
Benzodiazepines are often used to provide short-term relief of panic symptoms. Clonazepam (Klonopin) and lorazepam (Ativan) are examples of this group of medications. Although another benzodiazepine, alprazolam (Xanax), is often used to treat panic attacks, the short period of time that it works can cause the panic sufferer to have to take it multiple times each day. Benzodiazepines tend to be effective in decreasing panic attacks by up to 70%-75% almost immediately; however, this class of medications has a strong addiction potential and should be used with caution. Additional drawbacks include sedation, memory loss, and after several weeks, tolerance to their effects and withdrawal symptoms may occur.

A person with panic disorder experiences sudden and repeated panic attacks—episodes of intense fear and discomfort that reach a peak within a few minutes—during which time the individual experiences physical symptoms such as chest pain, heart palpitations, breathlessness, vertigo, or abdominal distress, sometimes accompanied by the fear of dying or of going insane.  These symptoms may seem similar to those of a heart attack or other life-threatening medical conditions. Panic disorder is often diagnosed after medical tests or emergency room visits have ruled out other serious illnesses.


All human beings experience anxiety. In many cases, anxiety can have some beneficial and adaptive qualities such as pushing one to study for an upcoming difficult exam or propelling a person to flee from danger. Although experiencing some anxiety with life stressors and worries is normal, sometimes it can be difficult to manage and can feel overwhelming. Below we provide a list of tips and strategies to help individuals prevent anxiety from reaching a diagnosable level. Even though not everyone will struggle with a diagnosable anxiety disorder, learning strategies to aid in relief from anxiety and to manage the "normal" anxiety experienced in everyday life can help you live the life you desire.
There is a long list of signs and symptoms of an anxiety attack. But because each body is somewhat chemically unique, anxiety attacks can affect each person differently. Consequently, anxiety attack symptoms can vary from person to person in type or kind, number, intensity, duration, and frequency. If your symptoms don’t exactly match this list, that doesn’t mean you don’t have anxiety attacks. It simply means that your body is responding to them slightly differently.
People who have panic attacks typically spend a lot of time worrying about having more attacks and often make seemingly unreasonable lifestyle changes in an attempt to avoid circumstances that will trigger future attacks. They may avoid situations that, they feel, have precipitated previous episodes or environments where they would not be able to escape easily if another attack should occur.

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.
Post-traumatic stress disorder -- or PTSD -- was considered to be a type of anxiety disorder in earlier versions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. But in 2013, PTSD was reclassified as its own condition. It describes a range of emotional reactions caused by exposure to either death or near-death circumstances (such as fires, floods, earthquakes, shootings, assault, automobile accidents, or wars) or to events that threaten one's own or another person's physical well-being. The traumatic event is re-experienced with fear of feelings of helplessness or horror and may appear in thoughts and dreams. Common behaviors include the following:
While everyone experiences brief episodes of intense anxiety from time to time, and a great many people experience one or two anxiety attacks over the course of their lifetime, anxiety attack disorder occurs when these attacks become frequent or persistent, begin interfering with or restricting normal lifestyle, or when the individual becomes afraid of them. Once established, anxiety attack disorder can be very debilitating.
If constant worries and fears distract you from your day-to-day activities, or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue.
4) Ice, Ice Baby. For nighttime panic attacks, Kirstie Craine Ruiz keeps about 4 ready-to-go ice packs—2 big and 2 small– in her freezer.  When she feels panic coming she puts two small ones in her hand and the 2 large ones on my lower back.  “If your heart is really racing and your breathing is bad, I would suggest taking the one on your belly and rubbing it from the middle of your chest down to the bottom of your belly, slowly, and over and over until your heart rate starts to mellow (over your shirt, of course- you don’t want to make yourself freezing!).  I feel like when I do this, it literally moves the hyper energy down from my chest and alleviates any chest pain. This method always helps me when it feels like my heart is in my throat.  Once you feel as though you can breathe again, place the packs on your lower belly or lower back, and in the palms of your hands. I don’t know if it’s pressure points but holding small smooth ice packs in both hands with palms up, does wonders for my panic, to this day.”
Most people have experienced fleeting symptoms associated with anxiety disorders at some point in their life. Such feelings — such as having a shortness of breath, feeling your heart pounding for no apparent reason, experiencing dizziness or tunnel vision — usually pass as quickly as they come and don’t readily return. But when they do return time and time again, that can be a sign that the fleeting feelings of anxiety have turned into an anxiety disorder.
Approximately one-third of people with panic disorder will also develop agoraphobia. People with agoraphobia are afraid that they will have some anxiety symptoms or a full-blown panic attack in a place where it would be very challenging or embarrassing for them to flee. This condition can lead to avoidance behaviors, in which they try to stay away from all places or situations in which they may have a panic attack.
Most treatment providers for anxiety-related disorders can be found in hospitals, clinics, private or group practices. Some also operate in schools (licensed mental health counselors, clinical social workers, or psychiatric nurses ). There is also the growing field of telehealth in which mental health workers provide their services through an internet video service, streaming media, video conferencing or wireless communication. Telehealth is particularly useful for patients that live in remote rural locations that are far from institutions that provide mental health services. Mental health providers that work in telehealth can only provide services to patients currently located in the state in which the provider is licensed.
My grandparents, who I lived with my entire life, just passed away. One in june and the other in september. My girlfriend wants to spend the night with her sister and the thought of it scares me. I fear that I am pushing her away, thus for sending me into a state of anger at myself followed by a heavy cold sadness, panic and fear. Then I start to get a small headache, clammy feeling overcomea my body, I start feeling naucious and then the next thing I know, my girlfriend is waking me up trying to pick me up off the floor. Is this a simple anxiety attack that will go away?
If the person has a family history of seizures or symptoms that are not typical for panic attack, a neurologist may be asked to evaluate the person. There is some overlap between the symptoms of panic attack and what is known as "partial seizures." Distinguishing between the two is important because the treatment for each is quite different. A neurologist, if consulted, will order an EEG (electroencephalogram) to check for seizure activity in the brain. This is a painless test but does require some time to complete (typically overnight).
A first panic attack is usually unexpected, and comes "out of the blue." It may scare you so much that you start taking steps to protect yourself from future attacks. Maybe you start avoiding places that remind you of your first attack. Maybe you only go out after making sure you have your cell phone, a bottle of water, and other objects you hope will keep you safe. Maybe you try hard to "stop thinking about it." You work hard to keep the panic at bay.
Try to adopt a more casual attitude. so when you feel your heart start beating faster, say something to yourself like: Oops! Something set off my stress response, can’t see anything dangerous here. I’ll just wait for a few minutes for my brain and body to realize I’m not in any danger”. This type of self-talk is much better than “There’s something wrong with my heart! I’m having a heart attack, I’m dying!!”

“Panic disorder is diagnosed if the individual has recurrent panic attacks (minimum four in a four-week period), and at least one of the attacks is accompanied by one or more physical symptoms, including persistent concern about having another attack, worry about the implication or consequences of the attack (i.e., having a heart attack), and/or a significant change in behaviour due to the attacks, such as quitting a job.7 In addition, the panic attacks cannot be due to the physiological effects of a substance or another general medical condition.”[1]

For more information, please visit Mental Health Medications Health Topic webpage. Please note that any information on this website regarding medications is provided for educational purposes only and may be outdated. Diagnosis and treatment decisions should be made in consultation with your doctor. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration website for the latest information on warnings, patient medication guides, or newly approved medications.
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