Panic attacks and panic disorder

A panic attack is a sudden wave of intense fear. Your heart pounds, your breath feels short, and you may feel sure something terrible is about to happen. Then, within minutes to an hour, it passes.¹

Panic attacks are frightening, but they are common and very treatable. This page explains what is happening in your body, how to tell when chest pain needs 911, what panic disorder and agoraphobia are, and which treatments help most.

What a panic attack feels like

A panic attack is the body's alarm system going off when there is no real danger. The same "fight or flight" response that would help you run from a fire switches on all at once. It builds fast and reaches its worst point within minutes.⁴

Common body signs include:¹

• A racing or pounding heart
• Sweating, chills or trembling
• Feeling short of breath or like you are choking
• Chest pain or tightness
• Dizziness, lightheadedness or feeling weak
• Tingling or numb hands
• Nausea or stomach pain

Common thoughts and feelings include sudden terror, a sense of doom, fear of losing control or "going crazy," and fear of dying.¹

Attacks usually last a few minutes. Some last up to an hour, and a few last longer. Some people have several in a day. Others have only a few in a year.¹ Many people feel tired and shaky afterward.

Panic attack or heart attack?

This is the most important question on this page. Panic attacks and heart attacks can share signs: chest pain, a fast heartbeat, sweating, shortness of breath and nausea.^1,6 Women having a heart attack are more likely than men to feel less typical signs, including anxiety, upset stomach and unusual tiredness.⁶

You cannot reliably tell the two apart on your own. Doctors often need an ECG (a recording of your heart's electrical activity) and blood tests to be sure.

Sources for the table: NIMH, StatPearls, American Heart Association and NHLBI.^1,4,6,7 These are only general patterns. Overlap is common, so the table cannot rule out a heart attack.

After a heart problem has been ruled out, talk with your doctor about a plan. Once your doctor confirms your attacks are panic, you can learn to ride them out. Your doctor can tell you which signs should still send you to the emergency room.

Other medical problems can also cause panic-like symptoms. These include an overactive thyroid, some heart conditions, asthma, inner-ear balance problems, a blood clot in the lung, and some medicines or substances.⁴ This is why a checkup matters, especially if attacks start later in life. See what causes anxiety.

What is panic disorder?

Having a panic attack does not mean you have a mental health condition. Many people have one or two in their life and never again.¹

Panic disorder is diagnosed when:⁴

• You have repeated panic attacks that come "out of the blue," without a clear trigger.
• After at least one attack, you spend a month or more worrying about having another one or about what it means (for example, fearing a heart attack or "going crazy"), or you change how you live to avoid attacks.
• The attacks are not fully explained by a medical problem, a medicine, alcohol or drugs.

The fear of the next attack is often the hardest part. People may start avoiding coffee, exercise, driving or crowds because these bring on body feelings that remind them of panic. Over time, life can shrink.

How common is it?

In a large U.S. survey, about 23% of adults (nearly 1 in 4) had panic attacks at some point without ever developing panic disorder. About 5 in 100 had panic disorder.³ In a given year, about 3 in 100 U.S. adults have panic disorder. It is more than twice as common in women as in men.²

It most often starts in the late teens or early adulthood.¹ In the same survey, panic disorder was much less common in people 60 and older, at less than 1 in 100 in a year.² It can still happen in later life. See anxiety in later life.

Agoraphobia: when fear makes life smaller

Agoraphobia is fear of places or situations where it might be hard to escape or get help if panic or other embarrassing symptoms strike. Doctors diagnose it when a person strongly fears at least 2 of these 5 situations for 6 months or more:⁵

• Using buses, trains, planes or cars
• Being in open spaces, like parking lots or bridges
• Being in enclosed spaces, like stores or theaters
• Standing in line or being in a crowd
• Being outside the home alone

People with agoraphobia avoid these places, go only with a trusted companion, or endure them with great distress. In severe cases, a person may not leave home at all.⁵

Agoraphobia often goes along with panic disorder, but each can happen without the other.⁵ In the U.S. survey, about 1 in 100 adults had panic disorder with agoraphobia at some point.³ CBT and medicine can reduce agoraphobia symptoms and improve daily life, so it is worth getting help even after years of avoidance.⁵

For older adults, fear of falling can lead to a similar pattern of staying home. See phobias.

Treatment that works

Panic disorder is very treatable. Therapy, medicine or both help most people, though symptoms can come back.⁴ The main options are below.¹

How CBT for panic works

CBT for panic usually means weekly sessions over a few months, in person or by video.¹ It has several parts:

• Learning about panic. Knowing that a racing heart and dizzy head are the alarm system, not a disaster, takes away some of the fear.
• Catching scary thoughts. You notice thoughts like "My heart is pounding, so I must be dying," and you test them against the facts. Try our thought check tool.
• Interoceptive exposure. "Interoceptive" means sensations inside your body. With your therapist, you bring on feelings like the ones in an attack. You might spin in a chair to feel dizzy, breathe through a thin straw, or run in place to raise your heart rate. You stay with the feeling until your fear drops.¹ Your brain learns that these sensations are uncomfortable but safe. Your therapist should check that each exercise is safe for your health first.
• Facing avoided situations. You build a "fear ladder" of places you avoid and climb it one step at a time.
• Calming skills. Slow breathing and relaxation can help, used alongside exposure.¹

A large Cochrane review found CBT is the most studied therapy for panic and generally works better than no treatment. Some other talk therapies may help too. The quality of the research was rated low, so no single therapy has been proven best.⁸

Medicines

SSRIs and SNRIs are the most common medicines for panic disorder. They are taken every day, not just during an attack, and may take several weeks to help.¹ Beta-blockers can calm the pounding heart in some situations.¹

Benzodiazepines (such as alprazolam or clonazepam) work quickly. But in 2020 the FDA strengthened its boxed warning, its most serious warning, about misuse, addiction, physical dependence and withdrawal.⁹ Older adults face extra risks with these medicines. Never stop a benzodiazepine suddenly. Withdrawal can be dangerous, so any change needs a slow plan made with your doctor.⁹

Talk with your doctor or pharmacist before starting, stopping or changing any medicine. See medicines for anxiety.

Riding out a panic attack

Once a doctor has ruled out heart and other medical causes, these steps can help you get through an attack. The goal is not to fight the panic or make it stop instantly. It is to let the wave rise and fall without adding more fear.

1. Name it. Tell yourself, "This is a panic attack. It feels awful, but it will pass. I have been through this before."
2. Stay where you are if you can. Leaving teaches your brain that the place was dangerous. Staying teaches it that you were safe.
3. Slow your breathing. Breathe in gently through your nose, then breathe out slowly, longer than you breathed in. Try the cyclic sigh or box breathing.
4. Ground yourself. Notice 5 things you can see, 4 you can touch, 3 you can hear. See grounding.
5. Let the sensations be there. Notice your heart beating without trying to push it away. Sensations peak and then fade on their own, usually within minutes.^1,4
6. Carry on afterward. Go back to what you were doing when you feel able. This helps break the cycle of avoidance.

Some substances and medicines can bring on panic-like symptoms.⁴ Many people find that cutting back on caffeine and alcohol and getting enough sleep helps.¹ See sleep, mood and anxiety.

How family can help

If someone you love has a panic attack, stay calm and stay close. Speak in short, gentle sentences. Breathe slowly with them. Do not say "just relax" or "it's all in your head." The symptoms are very real.

If there is chest pain and any doubt about the heart, call 911. If panic is keeping them home or out of daily life, encourage them to see a doctor or therapist. Offer to go along to the first visit.

When to get help

• Call 911 for chest pain, pressure or shortness of breath that could be a heart attack, or any time you are unsure.^6,7
• Call or text 988 (the Suicide and Crisis Lifeline) if panic, fear or hopelessness feels like too much, or if you have thoughts of suicide.¹
• See your doctor if you have had more than one panic attack, you worry about the next one, or you are avoiding places or activities. Your doctor can check for medical causes and refer you to a therapist.
• Get help sooner if panic comes with heavy drinking, depression or using pills to cope.

You can take a quick check-in or see more ways to find help. Most people with panic disorder get better with treatment.⁴

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.