Panic attacks: symptoms, causes and when to get urgent help
CareOps editorial team · · Updated · 13 min read
Mental wellness information and service guidance published by CareOps.
About the CareOps editorial team
The CareOps editorial team publishes these guides. Sources are linked at the end of each article; examples are illustrative, not customer stories. Product descriptions refer to CareOps Maeumi. Publication and revision dates appear above.
Read our full editorial standards →A racing heart, breathlessness, and a sudden rush of fear can feel overwhelming, whether you are on a train, in a meeting, or getting ready for bed. Understanding panic can help you respond, while recognizing that new or severe physical symptoms need medical assessment.
At a glance
- A panic attack is a sudden surge of intense fear that peaks within minutes. Many last about 5–20 minutes, though some last an hour or longer, so duration alone cannot tell you whether symptoms are panic.
- For a familiar attack that has been medically assessed, move to safety, try comfortable breathing or grounding, and follow your agreed care plan.
- After a first attack, get checked for other physical causes, and seek urgent care without waiting for new or severe chest pain or breathing difficulty. Recurring panic attacks can be treated, including with cognitive behavioral therapy.
What is a panic attack and what does it feel like?
A panic attack is a sudden surge of intense fear or discomfort, often with several physical symptoms, even when there is no clear danger. The American Psychiatric Association’s diagnostic criteria (DSM-5) describe an abrupt surge of intense fear or discomfort that reaches a peak within minutes, with at least four symptoms such as those listed by the UK National Health Service (NHS) below. Symptoms alone cannot rule out a medical cause.
- A racing or pounding heart
- Shortness of breath or a choking sensation
- Chest pain or tightness
- Sweating, trembling, chills, or hot flushes
- Dizziness or feeling faint
- Nausea or stomach discomfort
- Tingling or numbness
- Feeling detached from yourself or your surroundings
- Fear of dying or losing control
Panic symptoms: why the pounding heart, breathlessness and dizziness?
The NHS explains that when you feel anxious or scared, your body releases stress hormones such as adrenaline and cortisol, which can cause physical symptoms such as a faster heart rate. NIMH also notes that the physical symptoms of a panic attack can feel like a heart attack.
- Heart — when your heart pounds and races, it is easy to think something is wrong with it. That thought feeds the fear, and the fear makes the heart race again.
- Breathing — gulping air quickly because you feel short of breath can leave you dizzy with tingling hands and feet. Breathing out slowly often feels easier than trying to take in more air.
- Dizziness — feeling light-headed or faint is also on the NHS list of panic symptoms. It can turn into a fear of passing out.
According to NIMH, panic attacks can happen several times a day or only a few times a year. If a symptom is new or feels different from usual, get checked for other physical causes first. If the sense of unreality on the list, as if you were watching yourself from outside, comes often, see depersonalization and derealization.
How long does a panic attack last?
The NHS says most panic attacks last 5–20 minutes. The US National Institute of Mental Health (NIMH) says an attack can last from a few minutes to an hour or sometimes longer. Symptoms are usually most intense within the first few minutes. You may feel tired or unsettled afterward. Do not use a stopwatch to decide whether chest pain or breathing difficulty needs medical help.
A panic attack itself is not considered physically dangerous. But similar symptoms can come from conditions that are dangerous. Reassurance about panic applies after considering other causes—not as a way to diagnose a new episode yourself.
Can a panic attack happen while you sleep?
Yes. NIMH says panic attacks can occur at any time, sometimes even during sleep. A review of waking from sleep in a state of panic (Craske and Tsao, 2005) found that 44–71% of people with panic disorder report at least one such attack. Waking with a racing heart and fast breathing can feel even more frightening than an attack during the day.
The same review describes these episodes as distinct from nightmares, sleep terrors and sleep apnea, so an assessment first looks at other reasons you might be waking up. If it keeps happening, note when you woke, whether you were dreaming or snoring just before, and how long it took to fall back asleep. The review also describes research supporting cognitive behavioral therapy that works on reading body sensations as danger.
What should I do after my first panic attack?
A first panic attack is hard to tell apart from other physical problems on your own. Because symptoms can be intense, some people believe they are having a heart attack and seek emergency care. The American Psychiatric Association describes checking with a doctor for medical conditions that can cause similar symptoms as a common first step. NIMH also explains that a clinician may ask about your history and may do a physical exam to make sure another physical problem is not causing the symptoms.
- Do not wait if symptoms are severe. For new or severe chest pain, significant difficulty breathing, or fainting, follow the urgent help section below.
- If it has passed, book an appointment. Describe the episode to a primary care or mental health clinician and get it checked.
- Note what happened. When and where it started, how long it lasted, and how caffeine, sleep and stress had been beforehand can make the appointment easier.
- Do not draw conclusions from one episode. One panic attack does not mean panic disorder. Plan how to cope once you know what it was.
Coping with a familiar, medically assessed panic attack: five steps
- Get somewhere safe. If you are driving, pull over safely. You do not have to remain in a dangerous or overwhelming setting.
- Use a familiar reminder. If this matches a previously assessed attack, try: “I recognize this feeling. I can follow my plan and ask for help.”
- Breathe comfortably. Let your breathing slow without forcing large breaths or holding your breath. If focusing on breathing feels worse, use grounding instead.
- Notice your surroundings. Feel the support of your chair or the floor, and name a few things you can see. See grounding techniques for step-by-step methods.
- Make a brief note afterward. Record when it happened and what you noticed, if that helps you discuss the episode with your clinician.
You do not have to make the sensations disappear immediately. Focus on staying safe and getting through the next moment. If symptoms feel different from your usual attacks or you are unsure what is happening, seek medical advice.
What causes panic attacks?
The causes of panic attacks are not fully understood. The NHS links panic disorder with very stressful experiences such as bereavement and with having a close family member with the condition. NIMH describes a theory that panic attacks are like “false alarms”, in which the body’s survival responses are active too often, too strongly, or both. Several factors usually combine rather than a single cause.
One influential model, described by Clark in 1986, focuses on how a frightening interpretation of a body sensation can amplify fear. For example: a racing heart → “Something terrible is happening” → more fear → a stronger awareness of the heartbeat. This helps explain some panic experiences, but it is not the only factor involved.
Stress, sleep difficulties, and stimulants can be relevant to some people’s symptoms. Our anxiety coping guide discusses caffeine and other everyday factors. Notice patterns to discuss with a clinician rather than assuming one habit explains every attack.
When should I go to the emergency department?
Panic symptoms can overlap with heart or lung emergencies. Seek urgent help from local emergency services for sudden concerning symptoms such as those below. Do not wait 20 or 30 minutes to see whether severe symptoms pass.
- New or severe chest pain or significant difficulty breathing.
- Chest discomfort that spreads to an arm, jaw, neck, or back, or feels like pressure or squeezing.
- Chest pain with sweating, nausea, marked dizziness, or shortness of breath.
- Fainting, loss of consciousness, or symptoms that are new or different from your usual pattern.
A medical assessment can help identify possible causes and plan appropriate care. A previous normal test does not automatically explain every future episode, especially if symptoms change.
Panic attack aftereffects: what can linger afterward?
For a few hours after an attack you may feel tired, foggy or shaky. What often lasts longer is the worry that it will happen again. NIMH explains that many people with panic disorder worry about having another attack and may make major changes to daily life to avoid one.
- Anticipatory anxiety: worrying in advance about the next attack, even when no attack is happening.
- Sensitivity to body sensations: a slightly faster heartbeat prompts the thought “Is it starting again?”
- Avoidance: starting to avoid the place where an attack happened, trains or elevators, or time alone.
If these changes continue for weeks, consider working on them with a clinician or counselor rather than coping alone. To look at where things stand first, see our panic disorder self-check guide and the seven-question PDSS-SR panic check.
Try a self-assessment without signing inPanic experiences (PDSS-SR)Sudden anxiety and its effect on daily life. Answer the app’s questionnaire and see your result right away.Start the check →Panic attack or panic disorder?
| Panic attack | Panic disorder | |
|---|---|---|
| What it describes | An episode of intense fear or discomfort | A condition involving recurrent unexpected attacks and continuing concern or behavior changes |
| Does one episode establish it? | An attack can occur on its own or with several conditions | One attack alone does not establish the diagnosis |
| Possible impact | Distressing symptoms during an episode | Ongoing fear and restrictions on everyday activities |
| Example | An episode while travelling on a train | Repeated attacks followed by persistent worry and avoiding travel |
Panic disorder can involve repeated unexpected attacks followed by at least a month of worry about further attacks or changes in behavior. Avoidance can maintain difficulties, but it is not the single cause of panic disorder. A professional assessment can help clarify what is happening. Panic disorder is one of several anxiety disorders described in anxiety disorder symptoms and types.
How to overcome panic disorder: what treatment helps?
NIMH describes psychotherapy, medication, or both. CBT can address frightening interpretations of bodily sensations and help people return to activities they have avoided. The choice of treatment depends on your health, needs and preferences. Coping with one attack and treating an ongoing disorder are different tasks.
Discuss exposure exercises and their difficulty with a qualified professional. Do not begin by deliberately making yourself severely breathless or dizzy. Seek medical help for new or severe physical symptoms rather than assuming they are panic.
What can I track beyond the number of attacks?
With your clinician, consider anticipatory worry and activities you can take part in again as well as attacks. You can note a recent episode, changes in avoidance, a planned step you tried, and questions about treatment. A difficult day does not erase earlier progress; there is no single recovery deadline.
- Note when an attack occurred and what felt familiar or different.
- Describe how much time you spend anticipating another attack and its effect on daily life.
- Record activities you tried again according to a plan agreed with your clinician.
- Keep questions about uncomfortable reactions, medication and situations that remain difficult for your next visit.
Attend to sleep, meals and manageable activity, and consider how caffeine or alcohol relates to symptoms. These habits can accompany treatment. There is no fixed number of days by which you must recover.
Prepare a note and continue reflecting between visits
The free appointment preparation note helps you describe when difficulties began, their effect on daily life, and questions to discuss. No sign-up is required and your writing is not sent to CareOps.
An example opening with Maeumi
'My clinician and I have a plan, but I worry before going out. Help me separate what I predict from what has happened, and prepare a question for my next appointment.' Share only what you want to discuss.
CareOps Maeumi offers AI conversations and reflection between visits. Explore how AI counseling works and between-session practice. Discuss changes to your treatment plan with your clinician.
How to support someone during an episode
- Speak calmly and stay nearby if they want you to. “I’m here. What would help right now?”
- Avoid dismissing the experience or ordering them to calm down.
- Offer comfortable breathing or grounding if they want to try it; do not force a technique.
- Ask before touching them, and respect their answer.
- Seek urgent medical help for new, severe, or concerning physical symptoms. Do not assume an episode is panic just because the person looks frightened.
If panic keeps returning and you start avoiding places, the PDSS-SR panic check looks back over the past week. To see whether anxiety is high overall, there is also the GAD-7 anxiety check.
Frequently asked questions
- How many minutes does a panic attack usually last?
- The NHS says most attacks end within 5 to 20 minutes, and NIMH says they can last from a few minutes to an hour or sometimes longer. Symptoms usually peak within the first few minutes.
- I had my first panic attack. Should I see a doctor?
- If it was your first, get checked for other physical causes. Similar symptoms can come from heart, lung or other physical problems. For new or severe chest pain, significant breathing difficulty, or fainting, contact local emergency services without waiting.
- What causes panic attacks?
- The causes are not fully understood. They are linked with very stressful experiences or bereavement and with a family history of the condition, and one theory describes the body’s alarm system switching on too easily. A frightening interpretation of body sensations can also amplify fear.
- How can panic disorder get better?
- Psychotherapy such as CBT and, when appropriate, medication can help address symptoms and daily difficulties. Discuss anticipatory worry and avoidance as well as individual attacks. The best plan and pace vary from person to person.
- Should I try exposure exercises on my own?
- Agree on exercises and their difficulty with a qualified professional who can consider your health. Do not start by deliberately causing severe breathlessness or dizziness.
- Can a panic attack itself be fatal?
- Panic attacks themselves are not generally considered physically dangerous. The important limit is that similar symptoms can have serious medical causes. New or severe chest pain, breathing difficulty, or fainting need urgent assessment, even if you have had panic attacks before.
- Why do I feel drained afterward?
- An intense episode can leave you feeling tired or unsettled. Seek medical advice if symptoms persist or change. If fear of another attack starts limiting daily life, a mental health professional can help.
- Does one panic attack mean I have panic disorder?
- No. Panic disorder involves a broader pattern, including recurrent unexpected attacks and ongoing worry or behavior changes. A clinician considers the full history and other possible causes.
- Can a panic attack wake me up from sleep?
- Yes. NIMH says panic attacks can occur during sleep, and a review found that 44–71% of people with panic disorder have woken in a state of panic at least once. An assessment can tell this apart from other causes of waking, such as nightmares or sleep apnea.
- What if deep breathing makes me dizzy?
- Breathing too rapidly or deeply can contribute to dizziness. Stop forcing the exercise and return to comfortable breathing; grounding may be a better option. New or severe dizziness, fainting, or breathing difficulty should be medically assessed.
Sources
- UK National Health Service (NHS), Panic disorder
- National Institute of Mental Health (NIMH), Panic Disorder: When Fear Overwhelms
- Clark (1986), A cognitive approach to panic, Behaviour Research and Therapy
- UK National Institute for Health and Care Excellence (NICE), Generalized anxiety disorder and panic disorder in adults: management (CG113)
- Ministry of Health and Welfare (2018), the burden of national medical expenses will be reduced from July due to the expansion of health insurance coverage.
- UK National Health Service (NHS), Chest pain
- Katzman et al. (2014), Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders, BMC Psychiatry
- American Psychiatric Association (APA), What are Anxiety Disorders?
- UK National Health Service (NHS), Anxiety, fear and panic
- Craske and Tsao (2005), Assessment and treatment of nocturnal panic attacks, Sleep Medicine Reviews
This guide shares mental wellness information. If you are in immediate danger, contact emergency services where you are. Support and contact information.