Panic attacks are sometimes referred to as anxiety attacks, therefore these two terms are used interchangeably here. A panic attack is a distinct episode of extreme apprehension when individuals experience at least four of the following anxiety attack symptoms1:
- Heart palpitations, increased heart rate
- Dizziness, lightheadedness
- Shortness of breath
- Chest pain
- Tingling or numbing
- Feeling of choking
- Chills or hot flushes
- Derealization or depersonalization
- Fear of going crazy or losing control
- Fear of dying
Panic attacks can differ from one person to the next, and symptoms of panic attacks and their intensity can vary even within the same individual9. Generally, individuals experience more than four symptoms during a panic attack10, yet some people continue to have limited-symptom attacks where they notice less than four symptoms. Some of these limited-symptom attacks can be quite debilitating, but most of them tend to be less intense and the heart rate does not increase as much compared to “full-blown” panic attacks11.
Several of the symptoms of panic attacks involve physical sensations (such as heart pounding and shaking), whereas other anxiety attack symptoms are thoughts (such as fear of going crazy or dying). Panic attacks are often paired with agoraphobic behaviors, such as avoiding situations where escape may be difficult in case of an anxiety attack. Since a panic attack can consist of several physical symptoms, individuals often believe they have a physical condition for which they incorrectly seek medical attention.
Individuals who are prone to anxiety are likely to interpret their first panic attack or panic-like symptoms as threatening or harmful; therefore, incorrectly activating the fight-flight system in response to normal bodily sensations, as if to protect the body from danger. The fight-flight response is innate and automatic, and it includes autonomic arousal. This type of physical response in the body activates all parts of the sympathetic nervous system at the same time and really quickly, which might be the reason why most panic attacks come with lots of different sensations that happen immediately. When the sympathetic nervous system is active, the body releases hormones called adrenalin and noradrenalin that increase this physiological arousal for a while. However, the body cannot stay in this state forever, that is, panic will not continue forever and will not become dangerous, because the parasympathetic nervous system will be activated to return the body to a relaxed state. Adrenalin and noradrenalin often stay in the bloodstream for some time once the relaxing system has begun, thus keeping the individual from feeling fully relaxed while the hormones leave the bloodstream.