What is a panic attack?

A panic attack can be described as experiencing a sudden rush of fear and anxiety, sometimes without warning signs, and for no obvious reason. They can also happen even when you don’t feel anxious or afraid. Panic attacks are more common than you may think -  about 1 in every 10 people experience occasional panic attacks.

What is the difference between anxiety attacks and panic attacks?

Panic attacks and anxiety attacks usually refer to the same thing. However, panic attacks are the medically accepted term for these episodes. People with anxiety may refer to periods of particularly intense anxiety as an anxiety attack, but this is not the same as a panic attack.

Panic and anxiety are related: both cause feelings of unease, worry, and fear in response to everyday situations, especially those that can be unfamiliar or distressing. Panic is a more severe form of anxiety, when these feelings are at their worst or most debilitating.

What is the difference between a panic attack and a panic disorder?

Panic attacks are usually not a frequent problem for most people, and occur only during particularly stressful or distressing times. While some people may have this experience only a few times due to certain triggers, others may experience panic attacks more frequently and without any cause. A panic disorder is when these panic attacks become more common or happen regularly, and start having an impact on your day-to-day life.

People diagnosed with a panic disorder may constantly feel stressed and live in fear of experiencing panic attacks. They may sometimes avoid socialising or being in public places (agoraphobia) for fear of triggering a panic attack. 

If you find that you are having frequent panic attacks, with or without a particular cause, you should seek medical help, to find out if you have a panic disorder and discuss how to better manage the condition.

What are the symptoms of a panic attack?

What does a panic attack feel like?

Panic attacks feel like an intense wave of fear coming over you unexpectedly, which can cause you to freeze up. You may feel your heart thumping like it’s about to jump out of your chest, and you may feel unable to breath. This can cause you to take quick and shallow breaths, which can result in dizziness or confusion. For some people, this can also feel similar to a heart attack - which can be very distressing in the moment.

Some people will also feel a sense of impending doom, like they are about to die or something terrible is about to happen. Some people may feel like they are losing their sense of self, or are losing their mind, and shut out everything and everyone around them.

The experiences of panic attacks can be very frightening and it is important to recognise the symptoms, so you can develop a personalised way of coping and managing sudden attacks.

How do I know if I’m having a panic attack?

Panic attacks can cause a rush of both physical and mental symptoms that can be frightening. 

Some physical symptoms of panic attacks are:

• Racing and pounding heartbeat (strong palpitations)
• Nausea, vomiting
• Chest pain, as the muscles in your chest become tensed during an attack
• Light headed or dizzy
• Confusion
• Trembling, shaking legs
• Sweating, hot flushes or feeling very cold
• Difficulty breathing and then breathing very fast to compensate
• Dry mouth
• Numbness or tingling in your fingers

Some psychological or mental symptoms of panic attacks are:

How do I know if I am having a panic attack or heart attack?

The symptoms of chest pain, pounding heartbeats, sweating and difficulty breathing can happen both during a panic attack and a heart attack. However, some unique symptoms of a heart attack are:

• Chest pain which may travel to your jaw, neck or arms
• The pain in your chest may feel like indigestion or heartburn, usually compared to a squeezing sensation on the chest
• Your skin may look pale

What happens in a panic attack?

When you have a panic attack, your brain is triggering an exaggerated response from your body due to a perceived threat or danger. The purpose of this reaction, often called “fight or flight,” is to help you react quickly to danger.

Your brain does this by sending an overdrive of nerve signals to other parts of the body. Your body releases large amounts of adrenaline and cortisol, which are chemicals that can provide a burst of energy and alertness. This causes your heart rate to increase, your blood sugar to spike and your breathing rate to go up. These symptoms then lead to other symptoms of panic attacks like dizziness, shaking, nausea, and sweating.

What causes panic attacks?

Panic attacks can happen suddenly, without any warning signs or triggers, but there are some factors that can increase your risk of experiencing panic attacks. There are also cases where specific triggers can lead to a panic attack episode.

What increases your risk of getting panic attacks?

• Family history of panic attacks or panic disorder
• Difficult past experiences such as neglect, abuse or bullying
• Having financial problems like excessive bills or increasing debt
• Smoking or taking too much caffeine
• Recreational drugs and drinking too much alcohol
• Being unemployed, retired or a stressful work environment

What can trigger a panic attack?

• Major life changes such as a recent divorce or having a baby
• Sudden death of a loved one, injury or ill health diagnosis
• A serious accident or a traumatic event such as sexual assault

How do you stop a panic attack?

Panic attacks usually last from 5 to 20 minutes, but can sometimes even last up to an hour during a single episode. There are some techniques you can try to help you deal with a sudden panic attack episode, or if you feel an attack about to start.

1. Breath slowly and deeply
During panic attacks, you may start breathing very fast, making your breaths very shallow. This means your brain may not get enough oxygen and you could start feeling dizzy and confused. 

Doing a breathing exercise during a panic attack can help improve your symptoms, after a few minutes. You should try the following:

• Breathe in slowly and deeply through your nose, using your stomach muscles, then hold for a few seconds
• You should then breathe out slowly and fully through your mouth, then hold for a few seconds
• You should try to keep your eyes closed during this exercise and focus on your breathing
• Repeat this for a few minutes

It helps to keep reminding yourself that this attack is temporary, so you can focus on your breathing and improve your symptoms. 

3. Stay grounded
To help keep your mind from being overwhelmed with fear and panic during an attack, you should try to stay grounded by focusing on your physical senses. Some good examples are finding something to cuddle, tasting something sweet, stomping your foot on the ground or feeling the texture of clothes on your body.

4. Confront your fear
Riding out a panic attack episode helps you confront the fear and panic, to prove to yourself that you are fine and you are not in any danger. You can ride out a sudden panic attack by carrying on with your tasks as much as you can. Keep doing things and stay in the moment, controlling your breathing, until it passes.

5. Picture a relaxing thought or image
Positive, peaceful and relaxing thoughts, images or memories can help distract your mind from panic and overwhelming anxiety. Try focusing on one thing at a time by taking time to think about the details. This can help to calm your symptoms and improve your breathing. 

6. Use muscle relaxing techniques
Just like the breathing exercises, muscle relaxing techniques can help keep your symptoms controlled during a panic attack. You should aim to focus on one muscle group at a time, for example, starting with each finger on your hand, then moving up to your arm, and so on. These techniques are more effective if you practice them regularly, before you experience a panic attack.

7. Taking medicines (benzodiazepine)
Medicines like benzodiazepine can help improve the symptoms of panic attacks, if taken just before the attack begins. However, they are usually prescribed for people who have been diagnosed with ‘panic disorder’, which is when you experience panic attacks more frequently than the general population. Never take these medications without a prescription from a doctor, as they can cause major side effects and can even be fatal if taken incorrectly.

How to help someone having a panic attack

If you are with someone experiencing a panic attack, there are a few things you can do to support them in the moment till it passes, usually in about 5 to 20 minutes.

1. Try to keep calm
Even though you may feel afraid watching someone experience a panic attack, you should try to stay calm and focussed, to help them get through the attack. 

2. Help them with breathing exercises
You can help by guiding them through slow and deep breathing exercises, which should help improve their symptoms within minutes. 

3. Ask them what they need
People experiencing panic attacks may require different approaches to help manage their symptoms, so it is better to ask them how you can be of help, first. 

4. Help them with medication
People who experience panic attacks frequently may have a panic disorder diagnosis and prescribed medication. You can help them get their medicines quickly if an attack is coming on, to help manage their symptoms. 

5. Keep them grounded
You can help keep them grounded by working with them to engage their senses of touch and taste, doing various relaxation exercises. These could include marching on the spot, tasting something sweet or feeling an object in their hands. It is important to try one activity at a time and go through the details, as this would redirect their minds from panic and fear, which would help improve their symptoms. 

How to prevent panic attacks in the future

There are measures you can practice regularly to help reduce and possibly prevent panic attacks.

1. Practice relaxation techniques including breathing and muscle relaxation exercises
2. Make lifestyle changes. You should avoid alcohol, smoking and caffeine as they can worsen panic attacks
3. Read self help books on therapies for dealing with panic attacks and anxiety
4. Join panic support groups. Your GP can help you find a suitable support group where you can learn from the experiences of others and develop strategies to manage your symptoms better during a panic attack
5. Eat healthy meals to keep your blood glucose in check, and regularly exercise to improve your physical and mental health

Should you see a doctor about panic attacks?

If your panic attacks are becoming more frequent and affecting your daily life activities, you should seek help from your local GP without further delay, to protect your mental and physical health. 

Your GP will discuss your panic attack experiences and management plans which may include lifestyle modifications, coping strategies, therapy (CBT - Cognitive Behavioural Therapy) and medication, to help manage your symptoms.

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