Panic Attacks and Panic Disorder

What a panic attack is

A panic attack is a sudden wave of fear or discomfort, or a sense of losing control, that can happen even when there is no clear danger or trigger. [1] The physical symptoms can include a pounding or racing heart, sweating, chills, trembling, difficulty breathing, weakness or dizziness, tingling or numb hands, chest pain, and stomach pain or nausea. [1]

Attacks can feel like a heart attack, and many people first seek help in an emergency room. [1][2] Because of that, a first episode should be checked by a health professional, who can rule out other medical causes. [2]

If you have chest pain, trouble breathing or any symptom that you think could be an emergency, call 911 (in the US) or your local emergency number. Do not wait to see whether it passes.

How long it lasts

NIMH says an attack can last from a few minutes to an hour or sometimes longer. [1] MedlinePlus says attacks most often peak within 10 to 20 minutes. [2] The NHS says they usually last 5 to 20 minutes and, although frightening, are not dangerous and should not harm you. [3] NIMH likewise says panic attacks themselves are not life-threatening and the physical symptoms usually resolve with time. [1]

Panic attack or panic disorder?

A panic attack is a one-time or occasional episode of intense fear, and an isolated attack is not a mental disorder. [1] Panic disorder may be diagnosed when someone has repeated, unexpected attacks and, for at least 1 month, worries about more attacks, fears what they mean or changes behavior to avoid them. [1] Some people avoid places where attacks happened. [1]

NIMH describes the cycle this way: a pounding heart may be read as a heart attack, which raises fear and fuels more symptoms. Some researchers think panic attacks are "false alarms" of the body's survival instincts. [1]

What can help in the moment

These are general coping ideas from health agencies, not a treatment plan.

• Slow breathing. The NHS offers a routine for stress, anxiety and panic: breathe low into your belly without forcing it, in through the nose and out through the mouth, with a steady count if that helps. [4] Full steps are on Breathing exercises for stress and anxiety. Breathing very fast is one of the panic symptoms the NHS lists, so slowing down is the aim. [3]
• Do not avoid every situation. The NHS advises slowly building up time in situations that worry you instead of avoiding them. [3]
• Regular exercise such as walking, swimming or yoga can help you relax. [3]

Proper evidence not found for the claim that a specific breathing pattern, such as box breathing, stops a panic attack. The sources checked (NHS, NIMH, NCCIH, MedlinePlus and PubMed reviews) describe breathing training in general, not that claim.

Established care

Treatment typically involves psychotherapy, medication or both. [1]

• CBT teaches different ways of thinking, behaving and reacting to the feelings before or during an attack, and attacks can become less frequent. [1]
• Exposure therapy and interoceptive exposure (practicing bodily sensations linked to panic in a safe setting) are CBT methods, sometimes used with relaxation and breathing training. [1]
• Medicines can include SSRI or SNRI antidepressants, beta-blockers (for physical symptoms in some situations) and benzodiazepines, which are generally limited to brief use because of tolerance and dependence. [1]

NCCIH notes that relaxation therapy may be less effective than CBT after one year for panic disorder. [5] See Therapy for anxiety and stress.

Substances and panic

Panic disorder is commonly associated with alcohol and substance misuse. [1] A provider will also consider substance use because symptoms can resemble panic attacks. [2] Caffeine, alcohol and drugs are covered on Stress and anxiety safety.