Your heart pounds, your vision blurs—could you be having a panic attack? Let's dig into the science of why panic attacks happen and what to do to stop their debilitating cycle and get your life back.
Your heart pounds. Your vision blurs. You hear the blood rushing in your ears as everything becomes way too bright and and way too hot. You wonder if you’re going to faint or totally lose your senses. What’s going on?
Almost a quarter of Americans have had a panic attack. ABC News correspondent Dan Harris—poor guy!—even had a panic attack on Good Morning America in front of 5 million viewers. He described the experience like this:
I was overtaken by a massive, irresistible blast of fear. It felt like the world was ending. My heart was thumping. I was gasping for air. I had pretty much lost the ability to speak.
That sounds terrifying! Anyone who’s had a panic attack can probably relate to just how sudden, scary, and desperate it feels when you’re in the middle of one.
My experience with panic attacks
I’ve had only a handful of panic attacks in my life. The most intense one happened when I was pregnant and touring a daycare for the first time. Out of nowhere, my whole body got hot and tingly, a sense of dread began to well up, and my vision went bright white to the point where I almost couldn’t see.
Out of nowhere, my whole body got hot and tingly, a sense of dread began to well up, and my vision went bright white to the point where I almost couldn’t see.
But nobody else, including my husband and the multiple adults I was actively conversing with, even noticed that I was having a panic attack until a few minutes into it. And then, it was only because I told them. If you watch Dan Harris's ABC News footage, you’ll similarly notice a lack of drama. He’s not screaming, hyperventilating, or writhing around. There is some bewilderment in his eyes, and he looks a little sheepish, but the outside clearly doesn’t match the inside.
So let’s bust one common myth about panic attacks right off the bat. Panic attacks are not the same thing as “losing it” because you just realized their car was stolen or “freaking out” because you have a big project due tomorrow that you haven’t started. It’s not a hair-pulling, crying, hyperventilating, pacing frantically kind of experience.
A panic attack is an internal wave of extremely intense feelings that are likely invisible from the outside.
Instead, a panic attack is an internal wave of extremely intense feelings that are likely invisible from the outside. It might come out of nowhere, for no discernible reason at all, and it’s much less controllable than dramatic “freak outs." While you can, with difficulty, choose to sit down and stop pulling your hair, you can’t simply dial down a panic-level heart rate.
Let’s break down what a panic attack is like, what causes it, and what to do about it:
What do panic attacks feel like?
We’ll unofficially chunk symptoms into two groups: physical symptoms and cognitive symptoms (i.e., thoughts that race through your head).
Physical symptoms of a panic attack
- A fast heart rate or pounding heart
- Trembling or shaking
- Feeling like you’re choking, smothering, or can’t get air
- Chest pain or pressure
- Nausea or other stomach problems
- Feeling dizzy or like you’re going to faint
- Changes in your vision
- Numbness or tingling, often in your fingers or toes
Cognitive symptoms of a panic attack
- Thinking “this isn’t real”
- Thinking you’re going to pass out
- Thinking you’re having a heart attack
- Thinking you’re dying
- Thinking you’re about to lose control of yourself
- Thinking you’re going crazy
It takes a few minutes for symptoms to work up to a full-blown panic attack. After a panic attack peaks, it can subside over the course of a few minutes but could also last as long as a few hours. Afterward, people often feel tired. If they don’t understand what happened, they may continue to be scared and stressed.
What causes a panic attack?
There is no single reason for panic attacks, but in a nutshell, a panic attack happens when your body has an overblown reaction to a perceived threat. There might initially be a small trigger that, in itself, is not that big of a deal, but your fight-or-flight response goes haywire, like a kettle screaming just to tell you that the water has boiled.
The worst part of panic disorder is that the fire fuels itself.
Common triggers for a panic attack
- An uncomfortable sensation that your body interprets as dangerous. People with frequent panic attacks are often exquisitely attuned to their own inner workings. They’re in touch with their bodies, which is good, but sometimes it goes overboard: “Did my heart just skip a beat? Is there something wrong? Am I having a heart attack?” This escalating train of thought causes stress, which causes the heart rate to go up and breathing to get shallower. Those symptoms, in turn, fuel the worry that "something is wrong.” And so, a benign physical sensation begins a spiral that accelerates into a full panic attack.
- A frightening thought. On an old Sex and the City episode, Miranda buys a fancy new apartment. But then she realizes she could choke and die alone, with no one discovering her body for weeks, and has a panic attack. Nothing in reality changed when she had this thought, but the thought itself sent her body into DEFCON-3 mode, and the physical fight-or-flight that followed probably made it worse. If you've had a panic attack in the past, a similarly scary thought might have triggered this vicious spiral.
- No discernible trigger ("out of the blue"). Many panic attacks seem to come out of the blue, perhaps even while you’re asleep. In hindsight, they often occur during a stressful time, like when you're moving to a new home, in the midst of a divorce, or during the holidays. Or they might happen when there are stressors on your body, like heat, hormonal changes, drugs, or sleep loss. The accumulated stress explodes into panic after something small—say, being startled by a sudden noise-—lights the fuse.
- Fear of having another panic attack. The worst part of panic disorder, which is when panic attacks have become a big part of someone’s life, is that the fire fuels itself. Once you’ve experienced how terrifying a panic attack is, you may dread having another one. This state of being on edge, or even on the lookout for possible symptoms of an oncoming panic attack, stresses your body and gets it closer to panic symptoms. It also puts a microscope up to any unusual physical sensations. Although these sensations might have subsided on their own, now that you're scrutinizing them, they evolve into a full-blown panic attack.
What to do when you're having a panic attack
How can we prevent a swirl in a teacup from escalating into a storm?
The inconvenient news is that panic symptoms may not be 100% preventable, and if you’re prone to them, you may have some out-of-the-blue panic attacks no matter what you do. But the good news is that you can drastically reduce panic attacks—both in terms of how often they happen and how intense they get. Even the ones you don’t totally get rid of don’t need to affect or control your life.
You don’t have to live in fear of panic attacks. Here’s what to do.
Remember that panic sensations are not dangerous
Yes, it does feel like you’re about to black out, “lose it,” or even die. These feelings are no exaggeration.
Even if it takes what feels like forever, a panic attack will subside on its own.
But they do not actually indicate a heart attack, seizure, psychotic episode, or other danger. I promise you that what goes up must come down. Even if it takes what feels like forever, a panic attack will subside on its own, even without any intervention from you.
Allow yourself to fully feel the panic attack—don’t escape!
This is the most counterintuitive but also the most important tip. Shouldn’t you try whatever you can to bring down the panic symptoms while you’re having them?
Don’t rush to splash cold water on your face, get someone to “talk you down,” hide in the bathroom, or distract yourself by reciting a mantra. All of these are escape behaviors that teach you to fear panic symptoms, which actually fuels future panic attacks.
Rushing to quell panic attack symptoms is like giving candy to a toddler who's throwing a tantrum. You might succeed in stopping the tantrum now, but it teaches him to tantrum even harder next time. Your body, the toddler in this situation, won’t learn how to down-regulate itself. Instead, it will keep fighting against your escape attempts by cranking up the fight-or-flight system for the next panic attack.
Breath normally and breathe into the sensations.
Yes, I do mean breathe into the sensations.
This probably feels counterintuitive, but it does two important things. First, it slows down the vicious spiral of panicky behaviors like hyperventilating and keeps them from fueling physical symptoms. Second, it allows you to simply be with your sensations instead of fighting them.
The unknown is scary. When you look at your panic symptoms head-on, you take away some of that fear. This gives your fight-or-flight system time to regulate itself.
Keep living your life! Don’t let safety behaviors creep in
If your panic attacks escalate, over time you may start doing things you think will keep you safe. That could be sitting near the exit in a movie theater, or keeping your spouse or other support person on speed dial. Or, you may carry safety objects everywhere, like a bottle of water to drink from so your throat won't close up or an app that guides you through a breathing technique. You may find yourself in the habit of going to the hospital at the first sign of panic, or even sitting in the emergency room parking lot "just in case."
Given how scary panic attacks can be, these behaviors are so understandable. But don’t be like an ex-mafia member in witness protection, constantly on the lookout for threats and irregularities and hints of danger. This hyper-vigilance is what can turn one or two panic attacks into panic disorder.
Don’t avoid getting your heart rate up—exercise is healthy! Don’t avoid places or activities where you’re afraid you’ll have a panic attack. Chances are you won’t, and even if you do, you’ll survive just as you have before. Don’t avoid being with other people because you’re afraid a panic attack will embarrass you. Trust me, people notice it much less than you think they do. Besides, there’s nothing wrong with stepping off of a tennis court and saying to your rally partner, “I’m feeling a little off. I’m okay, but give me a minute to sit down.”
Then, just like with a tennis serve, the most important part is the follow-through. Get back to doing whatever you were doing once your panic symptoms have subsided. No matter the score at the end of your tennis match, know that you will have won the game against panic disorder simply by living your life.