Have you ever experienced an intense feeling of terror, fear or apprehension, for no apparent reason? If you have, you may have experienced a panic attack. If you experience recurrent panic attacks, you may have a condition called panic disorder. Panic attacks can also be the sign of other underlying medical or mental health conditions, including sleep disorders, post-traumatic stress disorder (PTSD), or depression.


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.
I almost had a breakdown yesterday, I got mad at my sister. She told me we’d hang out then later she bailed me. I was so mad I poured all her body lotion in the sink, I was looking for her Victoria’s Secret perfume so I could break it into pieces but couldn’t find it. (Yes, I think I have anger issues too, might need anger management). I was already frustrated with my new job. I am slightly a perfectionist and I’m having a hard time with work I’m not too familiar with. I almost broke down or did broke down but hid it very well. My heart can’t stop pounding the whole day, whole night. I went to sleep since I was so tired but I woke up in the middle of the night with my heart beating so loud and fast. Until in the morning I can’t control it. I have a feeling I need to visit my psychiatrist again. I miss talking to her though. But the medications are so expensive it makes me depress more.
Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those suffering from this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorder.[37]
Have you ever worried about your health? Money? The well-being of your family? Who hasn’t, right? These are common issues we all deal with and worry about from time to time. However, if you find yourself in constant worry over anything and everything in your life, even when there should be no cause for concern, you might be suffering from Generalized Anxiety Disorder. People with this condition often recognize they are “over-worrying” about a lot of issues, but have no control over the worry and associated anxiety. It is constant and can interfere with your ability to relax or sleep well and can cause you to startle easily.
In people with anxiety disorders, the brain circuitry that controls the threat response goes awry. At the heart of the circuit is the amygdala, a structure that flags incoming signals as worrisome and communicates with other parts of the brain to put the body on alert for danger. Early life events, especially traumatic ones, can program the circuitry so that it is oversensitive and sends out alarms too frequently and with only minor provocations. Survival mandates a system for perceiving threats and taking quick, automatic action, but those with anxiety see threats where there are none, perhaps because emotional memories color their perceptions.
According to the American Psychological Association, "most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases."[50] The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they are "going crazy" or that the panic might induce a heart attack. Cognitive restructuring helps people replace those thoughts with more realistic, positive ways of viewing the attacks.[51] Avoidance behavior is one of the key aspects that prevent people with frequent panic attacks from functioning healthily.[14] Exposure therapy,[52] which includes repeated and prolonged confrontation with feared situations and body sensations, helps weaken anxiety responses to these external and internal stimuli and reinforce realistic ways of viewing panic symptoms.
Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief.
[2]DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.
CBT is a short-term treatment designed to help patients identify inaccurate and negative thinking in situations that cause anxiety like panic attacks. CBT can be used in one-on-one therapy or in a group therapy session with people facing similar problems. CBT primarily focuses on the ongoing problems in a patient's life and helps them develop new ways of processing their feelings, thoughts and behaviors to develop more effective ways of coping with their life. In patients who suffer from PTSD, CBT can take on a trauma-focused approach, where the goal is to process and reframe the traumatic experience that lead to the symptoms. On average, the length of treatment is around 10-15 weekly one-hour sessions depending on the type and severity of symptoms.
Panic Disorder occurs when people suffer from sudden, unexpected and uncontrollable panic attacks. These panic attacks aren’t caused by any obvious fear (e.g., having a panic attack because you’re afraid of heights and on top of a ladder or if you’re afraid of flying and about to board a plane). People with Panic Disorder also experience anticipatory anxiety (worrying about having another attack or the consequences of having another attack) and avoid going to places where a panic attack might happen.
More than shyness, this disorder causes intense fear about social interaction, often driven by irrational worries about humiliation (e.g. saying something stupid or not knowing what to say). Someone with social anxiety disorder may not take part in conversations, contribute to class discussions or offer their ideas, and may become isolated. Panic attacks are a common reaction to anticipated or forced social interaction.
Biological causes may include obsessive compulsive disorder, Postural Orthostatic Tachycardia Syndrome, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disturbances (labyrinthitis). Dysregulation of the norepinephrine system in the locus ceruleus, an area of the brain stem, has been linked to panic attacks.[13]
Be well-informed. Learn about Panic Disorder and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.

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.
Characterized by the development of certain trauma-related symptoms following exposure to a traumatic event (see "Diagnostic criteria" below). While most people experience negative, upsetting, and/or anxious reactions following a traumatic event, a diagnosis of PTSD is made when symptoms and negative reactions persist for more than a month and disrupt daily life and functioning. Symptoms are separated into four main groups: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal. The specific symptoms experienced can vary substantially by individuals; for instance, some individuals with PTSD are irritable and have angry outbursts, while others are not. In addition to the symptoms listed below, some individuals with PTSD feel detached from their own mind and body, or from their surroundings (i.e., PTSD dissociative subtype).

Unexpected Panic Attacks: These panic attacks occur suddenly without any obvious cause or indication. When an unexpected panic attack occurs, a person can be completely relaxed before symptoms develop. This type of panic attack doesn't accompany any conscious internal cues, such as having fearful thoughts, feelings of intense dread and anxiety, or uncomfortable physical sensations. Unexpected attacks also don't occur with external cues, such as specific phobias or being exposed to a frightening event or situation.


Panic attacks cause a variety of distressing symptoms that can be terrifying for the individual experiencing the attack. Some people mistake panic attacks for heart attacks and many believe that they are dying. Others feel a mixture of self-doubt or impending doom. Some can also find the episodes extremely embarrassing and refrain from telling their friends, family, or a mental health professional.

Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.
"The fight-or-flight system is hardwired for us humans to manage dangerous situations, and those of us with anxiety have an activated fight-or-flight response when the trigger is not really dangerous," says Beth Salcedo, MD, the medical director of The Ross Center for Anxiety & Related Disorders and board president of the Anxiety and Depression Association of America.

It’s normal to feel anxious when facing a challenging situation, such as a job interview, a tough exam, or a first date. But if your worries and fears are preventing you from living your life the way you’d like to, you may be suffering from an anxiety disorder. There are many different types of anxiety disorders—as well as many effective treatments and self-help strategies. Once you understand your anxiety disorder, there are steps you can take to reduce your symptoms and regain control of your life.


Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.
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.
“One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn’t get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn’t think straight.
Anxiety can be either a short-term "state" or a long-term "trait". Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.[10] Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.[11] Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.[12] Specific measured ‘environments’ that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.[13] Anxiety is also associated with drug use, including alcohol, caffeine, and benzodiazepines (which are often prescribed to treat anxiety).
When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased bloodflow in the amygdala.[92][93] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.
2.This exposure happened either by directly experiencing the event(s), witnessing the event(s) in person, learning that the event(s) happened to a close friend or loved one (note: for cases of death or near death, it must have been violent or accidental), or being repeatedly exposed to the aversive details from traumatic events (e.g., as an emergency room doctor or nurse who frequently sees dead and mutilated bodies).
Agoraphobia: This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or in which help would not be available if a person becomes trapped. People often misunderstand this condition as a phobia of open spaces and the outdoors, but it is not so simple. A person with agoraphobia may have a fear of leaving home or using elevators and public transport.
The problem with catastrophizing is that it is rigid thinking. Suppose you worry that you’re having a heart attack every time you experience some chest pain. It’s usually easy for a health professional to distinguish between anxiety and a heart attack. But catastrophizing resists new information. Even though, your doctor has done tests in the past and has reassured you many times, you worry that this time will be different. Your exaggerated fear is preventing you from changing your thinking, and is keeping you stuck.
We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.
If your child is experiencing separation anxiety, be supportive and caring when they are in distress but try to avoid changing behavior to overly accommodate the anxiety. If you notice the separation anxiety lasting for longer than four weeks, seek professional help from a psychologist or counselor in order to learn effective behavioral techniques to treat the anxiety.

Carbonell compares the type of breathing you’ll need with the breathing of infants, whose bellies rise and fall with each inhale and exhale. When an anxiety attack starts, exhale deeply, loosen your shoulders, and focus on some longer, deeper inhales and exhales that let your belly rise and fall. Place one hand on your belly if you need to feel this happening.


• Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Shortness of breath or a sensation of smothering • A choking feeling • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, lightheaded, or faint • Feeling detached from oneself or reality • Fear of losing control or of impending doom • Fear of dying • Numbness or a tingling sensation • Chills or hot flashes
You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to cope with the symptoms as well as effective treatments.
[2]DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.
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