Panic attacks and panic disorder explained

What a panic attack feels like

A panic attack comes on quickly, often peaking within about ten minutes, and usually settles within half an hour. During it, people may feel a racing or pounding heart, chest tightness, breathlessness, sweating, shaking, dizziness, tingling, and a churning stomach. Many describe a sense of dread, a fear of dying, losing control or going mad, or a feeling of being detached from themselves or their surroundings. Because chest pain and breathlessness feel so alarming, people often fear they are having a heart attack, and many first attend A&E. Understanding that these are the body's alarm signals, not signs of physical harm, is an important first step. The feelings are real and unpleasant, but they are not dangerous and they do pass.

Why the body reacts this way

Panic is the body's fight-or-flight alarm going off when there is no real danger. When the brain senses a threat, it floods the body with adrenaline to prepare it to fight or flee. The heart speeds up to pump blood to the muscles, breathing quickens to take in more oxygen, and the senses sharpen. In a genuine emergency this is helpful. In a panic attack the alarm fires by mistake, so all these changes happen with nothing to run from. Rapid breathing can lower carbon dioxide in the blood, causing the tingling and dizziness that in turn feel frightening and fuel more panic. This is why panic can spiral: the fear of the symptoms makes the symptoms worse. Knowing the mechanism helps break the cycle.

When it becomes panic disorder

A one-off panic attack is common and does not mean someone has a disorder. Panic disorder is diagnosed when panic attacks happen repeatedly and unexpectedly, and the person spends a lot of time worrying about having another one or changes their behaviour to avoid them. People may start avoiding places or situations where they fear an attack, such as crowded shops, public transport or being far from home. Over time this avoidance can shrink someone's world and, in some cases, lead to agoraphobia. Panic disorder often overlaps with other anxiety problems and low mood. It can be exhausting and isolating, but it is a recognised and treatable condition, not a personal weakness or a sign of being unable to cope.

How panic is treated in the UK

Panic disorder responds well to treatment, and it is worth seeking help from a GP. The first step is often to check that physical causes have been considered, then to offer psychological therapy. Cognitive behavioural therapy (CBT) is the main recommended talking therapy: it helps people understand the panic cycle, face feared sensations and situations gradually, and drop unhelpful safety behaviours. In England, people can often refer themselves to NHS Talking Therapies without going through a GP. Self-help based on CBT, and support to reduce caffeine, alcohol and poor sleep, all help. Some people are offered medicine, usually an antidepressant of the SSRI type, when therapy alone is not enough; a clinician discusses the choices. Recovery is very achievable with the right support.

Helping yourself during an attack

During an attack, it helps to remember that it will pass and is not dangerous. Try not to fight the feelings or run away, as this teaches the brain there was something to fear. Slow, steady breathing can ease the physical symptoms — breathing out gently for a little longer than you breathe in helps rebalance the body. Grounding techniques, such as naming things you can see, hear and touch, can bring attention back to the present. Between attacks, cutting down on caffeine, keeping to a regular sleep routine, being active and staying connected to others all reduce how often panic strikes. If panic attacks are frequent, frightening or affecting daily life, see a GP or self-refer to NHS Talking Therapies. Effective help is available.