What is a panic attack?

What is a Panic Attack?

A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, during which at least four symptoms of autonomic arousal occur, including palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, fear of dying, and other physical and cognitive symptoms. 1, 2, 3

Core Characteristics

Panic attacks are characterized by:

• Sudden onset: Symptoms develop abruptly and typically reach their peak within 10 minutes 4
• Intense fear: Overwhelming sensation of fear or intense discomfort
• Physical symptoms: Multiple autonomic arousal symptoms occur simultaneously
• Limited duration: Most attacks last between 20-30 minutes, rarely exceeding one hour 5

Diagnostic Criteria

According to medication labeling that follows DSM criteria, a panic attack requires the presence of at least 4 of the following 13 symptoms 1, 2, 3:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or "going crazy"
11. Fear of dying
12. Paresthesias (numbness or tingling sensations)
13. Chills or hot flushes

Temporal Progression of Symptoms

Research suggests panic symptoms often follow a sequence 6:

• Early symptoms: Dyspnea, palpitations, chest discomfort, hot flashes
• Intermediate symptoms: Shaking, choking, derealization, sweating, faintness, dizziness
• Late symptoms: Intense fear and paresthesias

Cultural Variations

Panic attacks may present differently across cultures 4:

• Some cultural groups experience additional symptoms not listed in standard criteria, such as:

  • Tinnitus
  • Neck soreness
  • Headache
  • Uncontrollable screaming or crying

• Cultural syndromes that influence panic attack presentation include:

  • Khyâl attacks in Cambodians
  • Trung gió attacks in Vietnamese
  • Ataque de nervios in Latin Americans

Clinical Implications

• Panic attacks can occur as isolated events or as part of panic disorder when they become recurrent and lead to persistent worry about future attacks 3
• They may arise from either a calm state or an already anxious state 4
• Panic attacks often lead patients to seek emergency medical care due to fear they are experiencing a life-threatening condition (e.g., heart attack) 4
• If left untreated, panic attacks can lead to significant complications including agoraphobia, alcohol abuse, depression, and increased risk of suicide 7

Treatment Options

When panic attacks become recurrent and disabling (panic disorder), treatment options include:

• Pharmacotherapy:

  • SSRIs such as fluoxetine and sertraline 2, 3
  • Benzodiazepines such as clonazepam for acute management 1

• Psychotherapy:

  • Cognitive-behavioral therapy has demonstrated effectiveness in reducing panic symptoms 5

Important Considerations

• Panic attacks are not dangerous but can be extremely distressing and disabling
• Medical causes of symptoms that mimic panic attacks should be ruled out, particularly cardiac conditions 8
• Panic attacks can be a component of various anxiety disorders, not just panic disorder
• Early recognition and treatment can prevent complications like agoraphobia and functional impairment