Understanding Panic Attacks: Causes and Insights

Definition of Panic Attacks and Panic Disorder

A panic attack is a sudden, short-lived episode of intense anxiety and fear that occurs for no apparent reason and in the absence of any real danger.

A panic attack typically happens without warning or apparent trigger. It can last for a few minutes to half an hour. 

Panic attacks usually start in the teen years or early adulthood. They are twice as common in women compared to men. 

Some people have one or two panic attacks in their lifetime, and the attacks do not recur. Others have recurrent panic attacks and live in fear of having another unexpected panic attack. Such individuals may even change their behaviors, such as no longer leaving their homes. This is called a panic disorder. It is a type of anxiety disorder. Not everyone who experiences panic attacks will develop panic disorder.

Panic attacks are not life-threatening, but they can be very frightening. Severe and recurrent panic attacks can affect your quality of life and be disabling. Effective treatment can reduce symptoms of panic attacks and treat panic disorder.

Symptoms of Panic Disorder and Panic Attacks

Panic attacks may cause both mental and physical changes. 

Physical sensations

• Trembling or shaking

• Sweating 

• Tightness in the throat

• Racing heartbeat

• Shortness of breath 

• A smothering or choking feeling

• Chest tightness or discomfort

• Chills or hot flashes (feeling cold or hot)

• Headache

• Dizziness or lightheadedness

• Dry mouth

• Abdominal distress

• Nausea

• Tense muscles

• Numbness or tingling in the hands or feet

• Fatigue

Emotional sensations

• Intense fear and anxiety

• Heightened vigilance for danger

• A sense of losing control 

• Feeling like you’re going mad

• Feelings of dread or impending doom

• A sense of detachment or losing touch with reality

• Feeling like you’re having a heart attack or dying

• Fear of having another unexpected panic attack

Underlying Cause of Panic Attacks

The exact cause of panic attacks and panic disorder is unknown. Research suggests it is related to the body’s fight-or-flight response. When you are in obvious danger, and fear overwhelms you, your body has an instinctive reaction. Your breathing and heart rate become faster, and your muscles become tense to fight the danger or flee from it. Many of these same physical symptoms occur during panic attacks. However, they occur in the absence of any obvious danger.

Risk Factors for Panic Attacks and Panic Disorder

Genetics

Your risk of having a panic disorder is 40% higher if you have a family history, i.e., a first-degree relative (parent, siblings, children) with the condition.

Other mental health conditions

People with mental illnesses such as anxiety, depression, and post-traumatic stress disorder (PTSD) are more prone to develop panic attacks. Substance abuse (addiction to drugs and alcohol) can also increase the likelihood of experiencing panic attacks.

Major stressors

Your risk of experiencing panic attacks is increased if you’re going through a major life stressor, such as a divorce, sudden job loss, or the death of a loved one.

Traumatic events

Panic disorder may develop following a traumatic event, such as a serious illness, accident, or sexual assault. Physical abuse, sexual abuse, and childhood abuse can increase the risk of developing panic disorder.

Temperament

People who are more sensitive or prone to negative emotions are at a greater risk of experiencing panic attacks. 

Chemical changes in the brain

Changes in the levels of neurotransmitters (brain chemicals) such as serotonin, dopamine, and norepinephrine can affect how your brain functions and can increase your risk of panic attacks.

Habits and lifestyle factors

Habitual hyperventilation (rapid, deep breathing), intense exercise, smoking, and caffeine intake can increase your risk of panic attacks.

Environmental factors

Being in a hot, stuffy, or cramped environment can trigger a panic attack.

Common Triggers for Unexpected Panic Attacks

Panic attacks often occur without any known trigger. They usually come on suddenly without warning. Notably, one of the diagnostic criteria for a panic disorder is that the panic attacks don’t have an identifiable trigger.

However, some people with phobias may have sudden attacks triggered by specific things or situations. For example, someone with a fear of spiders may experience a panic attack upon seeing one. 

In some people with panic disorder, the anxiety and fear of having a panic attack can trigger one.

How to Prevent Panic Attacks 

It may not be possible for you to prevent panic attacks or panic disorder. But you can lower your risk by: 

• Eating a healthy diet and getting regular exercise to promote overall health and reduce your risk of anxiety

• Limiting alcohol and caffeine

• Quitting smoking if you smoke

• Managing stress with mindfulness and relaxation techniques

If you are already experiencing symptoms of panic attacks, you can reduce their severity and frequency by:

• Avoiding known triggers

• Seeking treatment for panic attacks as soon as possible to prevent them from worsening and progressing into a panic disorder

Treatment Options for Panic Attacks

It is important to have panic attacks and panic disorder diagnosed and treated. While these conditions are not dangerous by themselves, they can be very uncomfortable and frightening. Without treatment, panic attacks can worsen and progress to a panic disorder. If you don’t have a panic disorder treated by a mental health professional, it can affect your quality of life and become disabling. 

The two main components of a treatment plan for panic attacks and panic disorder are psychotherapy and medications.

Professional therapy 

Cognitive-behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps you understand how your thoughts, emotions, and actions are interrelated. CBT can help you build resilience, overcome fears, and cope with your panic symptoms.

Exposure therapy

This is a type of psychotherapy that involves recreating your panic disorder symptoms in a safe and controlled environment. The goal is to help you learn that your panic symptoms are not dangerous. This makes your panic attacks feel less threatening. Exposure therapy can also help you overcome a fear of places or situations that you have avoided because of your panic attacks.

Medications 

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are antidepressants that are usually the first choice of medications for treating panic disorders and preventing panic attacks. They are generally safe with a low risk of serious adverse effects. The U.S. Food and Drug Administration (FDA) approves the following SSRIs to treat panic disorders: fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs are another class of antidepressants. Venlafaxine (Effexor) is an SNRI that has been approved by the FDA to treat panic disorders.

Benzodiazepines

Benzodiazepines are sedatives that work by slowing activity in the central nervous system to treat anxiety disorders and panic attacks. They are usually prescribed for short-term relief because they are habit-forming. Benzodiazepines approved for the treatment of panic disorders include clonazepam (Klonopin) and alprazolam (Xanax). 

Beta Blockers

Beta-blockers work by slowing the heart rate and can improve anxiety and panic symptoms. Propranolol is used off-label for panic attacks and anxiety related to stage fright.

Recovery and Coping Strategies 

The following strategies can help if you feel a panic attack coming on, during a panic attack, and while you’re recovering from a panic attack:

Deep breathing exercises

Try breathing in through your nose and out through your mouth. Count slowly from 1 to 5 during inhalation and exhalation. 

Grounding techniques 

Grounding techniques help you regain control of your emotions. A common method is called the 5-4-3-2-1 method. It involves naming five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. Engaging your senses helps to redirect your focus away from distressing panic symptoms. Grounding techniques can promote calmness and a sense of control.

Support 

If you experience panic attacks, seeking support from friends, family, and support groups can help you feel less alone. Sharing your experiences and learning from others in a friendly, safe, and supportive environment can help you cope with your symptoms.

When to Be Concerned 

If you have an occasional panic attack triggered by a stressful situation, you may be able to manage it on your own. However, it’s important to seek medical care if you have:

• Recurrent or persistent panic attacks.

• Severe or worsening panic attacks that are affecting your ability to function in daily life.

• More panic attacks than before.

• Panic symptoms that are affecting your relationships.

• Changes in behavior because of the fear of having a panic attack. For example, avoiding certain places or social situations.

Note: The symptoms of a panic attack can resemble some other serious illness, including a heart attack. If you don’t know what is causing your symptoms, call 911 or go to the nearest emergency room for emergency medical care. 

Common Questions

What is the 3 3 3 rule for panic attacks?

The 3-3-3 rule is a common technique for dealing with a panic attack or anxiety attack. It involves identifying 3 objects and 3 sounds and moving 3 body parts. This serves as a grounding technique. It helps to redirect focus from panic symptoms and make the episode less overwhelming.

What are the 3 C's of a panic attack?

The 3 C’s refer to three panic attack symptoms - chills, chest pain, and choking.

What causes panic attacks out of nowhere?

Possible triggers for unexpected panic attacks include periods of stress, sudden changes in the environment, experiencing a traumatic event, excessive caffeine, and strenuous activity.

Why did I have 3 panic attacks?

The number of panic attacks you have depends on the severity of your condition. Some people with panic disorder have panic attacks several times a week. Others only experience panic attacks once or twice a year.