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Understanding panic attacks: Symptoms and treatment

What are panic attacks?

Panic attacks are symptoms of panic disorder in which a person has an overwhelming feeling of fear, apprehension and anxiety.

Panic attacks can also cause physical symptoms, including sweating, trembling, nausea and heart palpitations.

Panic attacks are common, affecting around 1 in 10 people in the UK at some stage.

Around 1 in 100 people have a panic disorder – recurring panic attacks for no obvious reason.

Panic disorder often develops after the age of 20 and is more common in women than they are in men.

What causes panic attacks?

The underlying cause of panic attacks and panic disorder is not clear. There is evidence of both a genetic and a biochemical basis. There is also an association with phobias, such as school phobia or agoraphobia, as well as with depression, alcohol or cigarette abuse, suicide risk, and seasonal affective disorder - a type of depression that usually occurs during winter months.  

The sudden feeling of terror or doom often brings on hyperventilation - uncontrollable, rapid, shallow breathing. This in itself can cause many of the other physical symptoms by upsetting the balance of oxygen and carbon dioxide in the bloodstream.  

Panic disorder may begin after a serious illness or accident, the death of a close friend, separation from the family, or the birth of a baby. Attacks may also accompany the use of mind-altering drugs. Most often, however, a panic attack comes "out of the blue". It may even begin during sleep.  

Some medical problems and medications can cause panic attacks, including some antidepressants at high dosage. Panic disorder that begins after age 40 suggests depression or another underlying mental health disorder.

What are the symptoms of a panic attack?

If you have four or more of the following symptoms, you may be having a panic attack:

  • Sudden high level of anxiety - with or without a cause
  • Heart palpitations
  • Sweating
  • Shaking
  • A ‘smothering’ sensation
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea
  • Dizziness or faintness
  • A sense of unreality
  • A fear of dying
  • Numbness or tingling
  • Chills or hot flushes

An isolated panic attack, while extremely unpleasant, is not uncommon or life-threatening. Panic disorder and panic attacks are not the same thing. All panic disorders have panic attacks as a symptom but having a panic attack does not mean you have panic disorder. Panic attacks can be a symptom of other anxiety disorders as well.

You may think you're having a heart attack, and it's true that the symptoms can be similar. However, most people having a panic attack have had one before, triggered by a similar event or situation.  

The chest pain of a panic attack usually stays in the mid-chest area (the pain of a heart attack commonly moves toward the left arm). It is often accompanied by rapid breathing, rapid heartbeat, and fear. A panic attack usually lasts only a few minutes, comes suddenly and leaves suddenly, but leaves one exhausted.

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