Many people experience their first panic attack due a build up of chronic stress. Anxious personalities often then become afraid of them, which further stresses the body. As fear and stress increase, so does the likelihood of a subsequent panic attack. This scenario is a common catalyst into Panic Attack Disorder: becoming afraid of the feelings and symptoms of a panic attack, which causes further panic attacks.
Those who experience panic attacks are often nervous about having additional episodes. To avoid having a panic attack in a public space, they may avoid places like shopping malls or other crowded spots where previous incidents may have occurred or places that they fear will not allow them immediate access to help, such as an airplane or movie theater. This avoidance when severe may lead to agoraphobia, the inability to leave familiar, safe surroundings because of intense fear and anxiety about having a panic attack outside the home.
Shortness of breath is a common symptom of panic attacks that can make you feel frantic and out of control. Acknowledge that your shortness of breath is a symptom of a panic attack and that this is only temporary. Then begin by taking a deep breath in for a total of four seconds, hold for a second, and release it for a total of four seconds. Keep repeating this pattern until your breathing becomes controlled and steady. Focusing on the count of four not only will prevent you from hyperventilating, but it can also help to stop other symptoms in their tracks.
I have occasional panic attacks, typically around one or two of what I consider minor panic attacks per month. A minor panic attack is one that I catch and manage to head off before it grows full-blown. I just have so much experience having and handling panic attacks that I’ve learned the curb them…usually. Sometimes, my coping mechanisms don’t work and I’m left suffering a full-blown panic attack and, of course, they’re terrible. I’m always on the lookout for new and better coping mechanisms to minimize the chances of one slipping through like that.

Comorbidity is more common than not with anxiety disorders, meaning that most individuals who experience significant anxiety experience multiple different types of anxiety. Given this co-morbidity, it is not surprising that many risk factors are shared across anxiety disorders, or have the same underlying causes. There is a lot of research identifying risk factors for anxiety disorders, and this research suggests that both nature and nurture are very relevant. It is important to note that no single risk factor is definitive - many people may have a risk factor for a disorder, and not ever develop that disorder. However, it is helpful for research to identify risk factors and for people to be aware of them, as being aware of who might be at risk can potentially help people get support or assistance in order to prevent the development of a disorder.

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
You do not need to be officially diagnosed with panic disorder to have an attack. Some people have only one or two panic attacks in their life and don't have panic disorder. Panic attacks are actually much more common than panic disorder. According to one Harvard Medical School survey, about 23 percent of people interviewed experienced at least one panic attack in their lifetime, while only about 3 percent of people experienced panic disorder in their lifetime. (1)
With regard to environmental factors within the family, parenting behavior can also impact risk for anxiety disorders. Parents who demonstrate high levels of control (versus granting the child autonomy) while interacting with their children has been associated with development of anxiety disorders. Parental modeling of anxious behaviors and parental rejection of the child has also been shown to potentially relate to greater risk for anxiety. Experiencing stressful life events or chronic stress is also related to the development of anxiety disorders. Stressful life events in childhood, including experiencing adversity, sexual, physical, or emotional abuse, or parental loss or separation may increase risk for experiencing an anxiety disorder later in life. Having recently experienced a traumatic event or very stressful event can be a risk factor for the development of anxiety across different age groups. Consistent with the notion of chronic life stress resulting in increased anxiety risk, having lower access to socioeconomic resources or being a member of a minority group has also been suggested to relate to greater risk.
When we are mildly concerned (worried, afraid), the stress response produces a mild reaction in the body. When we are greatly concerned/worried/afraid, the stress response produces a dramatic reaction in the body. Since the stress response is directly proportional to the degree of worry, a panic attack and its symptoms are generally the result of serious worry, concern, and fear.
Panic disorder is a separate but related diagnosis to panic attacks. People experiencing repeated panic attacks and who meet other diagnostic criteria may be diagnosed with this illness. Panic disorder is thought to have more of an inherited component than panic attacks that are not a part of panic disorder. Certain medical conditions, like asthma and heart disease, as well as certain medications, like steroids and some asthma medications, can cause anxiety attacks as a symptom or side effect. As individuals with panic disorder are at higher risk of having a heart-valve abnormality called mitral valve prolapse (MVP), that should be evaluated by a doctor since MVP may indicate that specific precautions be taken when the person is treated for a dental problem.
Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days (broken up into short periods if that’s easier). Rhythmic activities that require moving both your arms and legs are especially effective. Try walking, running, swimming, martial arts, or dancing.

Panic disorder is characterized by uncontrollable, recurrent episodes of panic and fear that peak within minutes. Panic attacks are accompanied by physical manifestations, such as heart palpitations, sweating, and dizziness as well as the fear of dying or becoming insane. Worry about having an attack may lead to additional anxiety and avoidance behaviors or to other problems in functioning.


Another important prevention strategy for anxiety is to incorporate exercise into your daily activities. Exercise has been shown to decrease stress hormones that influence anxiety and also improve overall mood. Exercise can also help you disengage from worry and stress and focus on the current task of exercising. Exercises such as light jogging or brisk walking that can be incorporated into your daily activities can help reduce the impact of anxiety when it occurs.

Some research suggests that people who have panic disorder might be very sensitive to sensory experiences (such as sunlight, smells and changes in the weather), but there's not enough evidence yet to say for sure. Also it's not clear whether having a high level of sensitivity to these sorts of things is something that might cause you to develop panic disorder, or whether it may be an effect of having it.


Psychologically, people who develop panic attacks or another anxiety disorder are more likely to have a history of what is called anxiety sensitivity. Anxiety sensitivity is the tendency for a person to fear that anxiety-related bodily sensations (like brief chest pain or stomach upset) have dire personal consequences (for example, believing that it automatically means their heart will stop or they will throw up, respectively). From a social standpoint, a risk factor for developing panic disorder as an adolescent or adult is a history of being physically or sexually abused as a child. This is even more the case for panic disorder when compared to other anxiety disorders. Often, the first attacks are triggered by physical illnesses, another major life stress, or perhaps medications that increase activity in the part of the brain involved in fear reactions.
Obsessive-compulsive and related disorders are characterized by obsessive, intrusive thoughts (e.g. constantly worrying about staying clean, or about one's body size) that trigger related, compulsive behaviors (e.g. repeated hand-washing, or excessive exercise). These behaviors are performed to alleviate the anxiety associated with the obsessive thoughts. These types of disorders can restrict participation in everyday life and/or generate significant distress, for instance, by making it difficult to leave the house without many repetitions of a compulsive behavior (e.g. checking that the doors are locked). Periodically experiencing worry or having a few "idiosyncratic" habits does not constitute an obsessive-compulsive or related disorder. Instead, these disorders are characterized by unusually high levels of worry and related compulsive behaviors, in comparison with a typical range of individuals.
A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.
I don’t know if I’m having anxiety attacks but every time I face a minor problem in my life, even if it us really stupid, I feel like I want to cry, to scream, and it’s like something is blocking my throat. I can’t control my anger during those moments, so I usually turn off my phone so I don’t say things I don’t mean to my friends or my family when I’m panicking and overthinking about any minor situation.
Panic attacks may also be caused by substances. Discontinuation or marked reduction in the dose of a substance such as a drug (drug withdrawal), for example an antidepressant (antidepressant discontinuation syndrome), can cause a panic attack. According to the Harvard Mental Health Letter, "the most commonly reported side effects of smoking marijuana are anxiety and panic attacks. Studies report that about 20% to 30% of recreational users experience such problems after smoking marijuana."[16]

Panic disorder is thought to have a psychobiological conceptualization (Craske & Barlow, 2007). This does not mean that panic attacks are due to a biological disease. What this does mean is that there are certain biological factors that may be inherited or passed on through genes, and thus may lead some people to be more likely than others to experience panic disorder symptoms. This is likely why panic disorder seems to run in families. In other words, if one family member has panic disorder, the other family members are more likely to experience panic symptoms or panic disorder compared to people without a family history of panic disorder. It is very important to note that just inheriting these vulnerabilities to panic does not make the onset of panic attacks inevitable or unalterable. In fact, it is possible to think and act in ways that prevent panic attacks.


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,

There has been recent interest in using psychoactive substances in conjunction with psychotherapy; the two that have received increased attention have been cannabis (marijuana) and methylenedioxymethamfetamine (MDMA, known as ecstasy or molly). These drugs are somewhat controversial, given that they also have psychoactive, i.e. "feeling high" effects. However, with increasing legalization of marijuana it is important to address whether these substances could be used to alleviate clinical symptoms of anxiety. While there have been only a few randomized clinical trials for these drugs, certain forms of cannabis have demonstrated positive effects on anxiety. Specifically, cannabidiol, a component of cannabis has been effective for Social Anxiety Disoder, and tetrahydrocannabinol (THC) has helped PTSD patients. However, the plant form of cannabis has not shown great efficacy and has potential to worsen symptoms, so should be used with caution and only under supervision of a provider. MDMA has shown some positive effects for PTSD, but should only be used as an adjunct to psychotherapy, again under clinical care.
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.
Panic disorder is a type of anxiety disorder that is characterized by fear and worry. One of the most salient symptoms is the experience of persistent and often unanticipated panic attacks. Panic attacks are typically experienced through a combination of frightening physical sensations and distressing thoughts and emotions. These attacks bring on severe apprehension and discomfort, despite a lack of actual threat or danger.
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.
It should be noted that finding the right strategy that works for you to control your anxiety is important. Maybe you feel that you do not have the time to schedule "me time" with your busy schedule or kids, and you need to find another way to reduce your anxiety. A friend or therapist could be a great resource to turn to if you believe you need help with finding the right strategies to reduce your anxiety.

During the day if she was out, the attack felt “like my head suddenly weighed a thousand pounds and my chest would get really heavy. It literally felt like something was pulling me down. I would usually have to head home immediately.  I would then experience foggy vision where it …actually looked like there was fog in the air. I also experienced double vision and parts of my body—like my neck or one arm or one entire side of my face– would go totally numb.”


In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.
Anxiety can be experienced with long, drawn out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[18] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems with anxiety.
Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. A panic disorder may also be accompanied by agoraphobia, which is the fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls, or confined spaces such as an airplane.
Anxiety disorders fall into a set of distinct diagnoses, depending upon the symptoms and severity of the anxiety the person experiences. Anxiety disorders share the anticipation of a future threat, but differ in the types of situations or objects that induce fear or avoidance behavior. Different types of anxiety disorder also have different types of unhealthy thoughts associated with them.
People with panic attacks often report a fear of dying or heart attack, flashing vision, faintness or nausea, numbness throughout the body, heavy breathing and hyperventilation, or loss of body control. Some people also suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the "fight-or-flight response", in which the hormone causing this response is released in significant amounts). This response floods the body with hormones, particularly epinephrine (adrenaline), which aid it in defending against harm.[9]

Connect with others. Loneliness and isolation can trigger or worsen anxiety, while talking about your worries face to face can often make them seem less overwhelming. Make it a point to regularly meet up with friends, join a self-help or support group, or share your worries and concerns with a trusted loved one. If you don’t have anyone you can reach out to, it’s never too late to build new friendships and a support network.

Anxiety disorders fall into a set of distinct diagnoses, depending upon the symptoms and severity of the anxiety the person experiences. Anxiety disorders share the anticipation of a future threat, but differ in the types of situations or objects that induce fear or avoidance behavior. Different types of anxiety disorder also have different types of unhealthy thoughts associated with them.
Obsessive-compulsive and related disorders are characterized by obsessive, intrusive thoughts (e.g. constantly worrying about staying clean, or about one's body size) that trigger related, compulsive behaviors (e.g. repeated hand-washing, or excessive exercise). These behaviors are performed to alleviate the anxiety associated with the obsessive thoughts. These types of disorders can restrict participation in everyday life and/or generate significant distress, for instance, by making it difficult to leave the house without many repetitions of a compulsive behavior (e.g. checking that the doors are locked). Periodically experiencing worry or having a few "idiosyncratic" habits does not constitute an obsessive-compulsive or related disorder. Instead, these disorders are characterized by unusually high levels of worry and related compulsive behaviors, in comparison with a typical range of individuals.
Panic Disorder: People with panic disorder have panic attacks with feelings of terror that strike suddenly and repeatedly with no warning. During the attacks, individuals may feel like they can't breathe, have lost control, are having a heart attack or even that they are dying. Physical symptoms may include chest pain, dizziness, nausea, sweating, tingling or numbness, and a racing heartbeat. Some people will have one isolated attack, while others will develop a long term panic disorder; either way, there is often high anxiety between attacks because there is no way of knowing when the next one will occur. Panic disorders often begin early in adulthood. Many people with panic disorder also suffer from agoraphobia (abnormal fear of open or public places.). See more on Panic Attacks.
The degree of accompanying stress response and its physiological, psychological, and emotional changes are directly proportional to the degree of anxiety. For example, if you are only slightly concerned, such as being slightly nervous about meeting someone new, the body produces a small degree stress response. The small degree stress response can be so slight that you don’t even notice it.
Generally, panic attacks are treated with reassurance and relaxation techniques. By definition, panic attacks last less than an hour, so many times a person already feels much better by the time he or she makes it to the doctor's office. Nevertheless, because the diagnosis is made by excluding more dangerous causes, people may be given medications during their attack.
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including anxiety disorders. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, new psychotherapies, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe.
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