In this article I will review the most complete list of the symptoms of panic attacks and panic disorder. Apart from that I will explain the reasons of these symptoms, how dangerous they are and where they can lead to. In addition, in the end of the article I will tell you whether it is possible to get rid of it and how difficult the situation may be.
The purpose of this article is not to just list the symptoms but also to give complete and proper understanding of the phenomena of panic attacks (PA) and panic disorder. This comprehension is needed not only for those who suffer from panic disorder but also for their family members and friends. In the article I will explain the difference between panic attack and generalized anxiety disorder (GAD), agoraphobia, obsessive–compulsive disorder etc. (are they different at all and how they relate to each other).
When a person begins to have panic attacks on a regular basis, usually there are more than that: apart from sudden panic attacks and fear, that can be easily ascribed to a panic attack, a person may begin to feel uncomfortable anxiety between attacks, derealization (brain fog), suffer from insomnia, have fear of death and going insane, obsessive thoughts, stress in the body, nausea; depression and agoraphobia (fear of open spaces) or any other phobia may develop.
And this fact causes even greater concern for people who already are in a difficult situation. They don’t understand what the cause of these symptoms is, whether they refer to panic attacks or it is a kind of serious illness.
I’m often asked the questions like: “I’m suddenly waking up during the night as if current passes through my body. Are these panic attacks?” or “I began to have panic attacks and recently had a feeling of unreality, some fog – what is it?”
Although this article doesn’t pretend to be an accurate diagnosis (a diagnosis can be made only by a specialist after personal observation), it will help everyone to understand what are the symptoms a person with panic attacks can observe (and there can be many symptoms) and what they relate to.
Since I had personally suffered from panic attacks and got rid of them and now I help people to forget about the fear forever, I know the symptoms from first-hand experience. Many of them I personally had.
Then, in those hard times, I felt like I was exposed to some kind of an incurable serious illness, but now I know that certain reactions of the body are only a consequence of panic disorder. In this article I will talk about these reactions.
Going through doctors, I realized that many of them can do nothing except prescribing pills. There is some confusion concerning the matter of panic attacks. So I hope this article will make things more clear for you.
Panic attacks, anxiety – what is the difference?
Speaking of different diagnoses, I will start out from the International Classification ICD-10. What you should know before reading further.
- I will use such terms as “anxiety disorder”, “obsessive–compulsive disorder” and it should not disorient you. I don’t think these concepts are not connected to each other. I can’t say that, for example, “anxiety disorder” and “agoraphobia” are two entirely different ailments (I don’t use the word “illness” on principle in this article), that require cardinally different approaches as, for instance, common cold and broken arm. These things are closely connected, can be part of one another or, more likely, part of one phenomenon.
I’m convinced that there is some kind of (let’s call it) overall anxiety (I am not talking about General Anxiety Disorder in this case) in that for one person may be expressed as panic attacks, for another – as obsessive thoughts, for others – both things together and, moreover, may be accompanied by depression. And from my point of view, you should work not with panic attacks as such, but with general anxiety with its consequences as PA and phobias.
In short, effective method of getting rid of restless thoughts and constant anxiety will not differ crucially from the methods of working with panic attacks. You should be aware that there is no an individual solution, for example, for agoraphobia. There is range of measures, aimed at working with overall anxiety, getting rid of which you will get rid of all its consequences whatever they are – phobias, panic attacks or obsessive thoughts.
- I will divide the symptoms into three groups. The first one: “The symptoms of panic attack”. This group will include only such symptoms that a person can feel right in the middle of an attack. The second one: “The symptoms of panic disorder”. Panic attack – is a single onset. Panic disorder is a repetition of attacks on a regular basis along with concerns over the emergence of new attacks. I will gather here everything that you can feel either during attacks or between attacks in accordance with the classification of the ICD-10. And the third group: “Concomitant symptoms”. These are such symptoms that cannot refer to either PA or panic disorder as it is but anyway they disturb people faced PA very often, being both the reason and the consequence of whiplashes of fear as well. This separation was done for the sake of convenience. Again, don’t get attached to it: all these symptoms are interconnected and the boundaries of these groups are actually somewhat arbitrary and vague.
The symptoms of panic attack
Panic attack – is a sudden fear or acute anxiety that is accompanied by fast heartbeat, dizziness, shallow breathing and other symptoms as well. Panic attack may last from a few minutes to a few hours.
Sudden, intense fear!
Let’s start with the most important thing: what panic attack is usually associated with. It is an abrupt onset of fear that can appear in the absence of any danger.
What is happening in our body at this moment? Everything starts from the amygdala – a part of our brain located in the temporal lobe. As an alerting device it starts ringing the alarm: “Danger, danger, fight or run!” The amygdala sends a signal to other areas of the brain, stimulating the ejection of such hormones and neurotrasmitters as adrenaline, noradrenaline, and cortisol. Such chemical bouquet creates intense fear, desire to leave “danger zone” as soon as possible.
This reaction is called “fight or flight”. It is absolutely natural and most probably used to save people’s lives a lot of times from the danger of death. You should understand that every emotion is formed for a reason and serves to the principles of survival. Therefore, fear is created by nature not for torturing you, but so that you will be able to run as fast as you can go from the threat at critical moments without thinking of anything.
But the point is that during a panic attack there is no danger. Why ever does our amygdala work as a broken alarm device, switching “a false alarm” on? That is another story, but I will consider it briefly towards the end of this article, so stay with me!
Now it is important to understand that during the attack you are in no danger. A natural biological mechanism comes into an action with the only difference that there is no threat in the external reality. Adrenaline rush hasn’t killed anyone yet, instead such reaction has saved many lives. It is the adrenaline rush that is connected with the feeling of sudden fear (there is a wrong hypothesis that adventure-seekers enjoy the thrill of adrenaline. It’s not like that. It is the endorphins – endogenous morphine serving to prevent possible death from pain shock as a result of injury that makes them feel “high” during a parachute jump. And adrenaline makes us fear, panic and mobilizes our protective resources of the body. Incidentally, adrenaline rush increases our immunity, disease resistance).
During a panic attack the heart rate may increase. And it scares a lot of people. People start thinking that they have a heart attack. But what really happens in such moments in your body? Again adrenaline rush provokes a fast heartbeat. But why is it happening (we remember that many reactions in our body have a reason)? It is happening because our brain “thinks” that our live is under threat.
And since there is a danger, the body must be ready to flee or to fight. And that’s why the heart starts to work at a rapid pace for faster blood flow to muscles and tissues. The body is mobilized for the increased activity so to speak. It is a normal body reaction for a danger (let’s omit that there is no danger) and it doesn’t lead to the cardiac arrest or death. This mechanism, as well as the attack of fear, is created for self-preservation, not for the suicide of the body.
Breathing during an attack may become rapid and shallow. And again, feeling panic and fear people are beginning to fear they are suffocating. But if we remember that a panic attack – is the reaction of “fight or flight”, everything falls into place. Our body is mobilized to protect itself and attack, so we often breathe so that oxygen may enter the lungs and blood faster as during exercising. Again, it is not dangerous, as well as rapid breathing while running is not. It does not lead either to the risk of suffocation or fainting. The latter is discussed below.
Dizziness, high blood pressure, fear of fainting
Many people feel dizzy during the attack. Blood pressure can dramatically increase. These symptoms can cause the feeling as if you are fainting. What, in its turn, causes the fear of falling. I would like to sooth you: fainting during the attack is highly unlikely. Why?
Because fainting is preceded by a sudden decrease of pressure, but during the panic attacks it, on the contrary, increases! Don’t worry, if people fainted at the sight of danger (it is possible only in the films, but in the real world it is an extremely rare thing), then, I’m afraid, humanity wouldn’t have lived until today because in this case they would have become wild animals’ dinner. People would have spread on the ground instead of escaping. Nature has provided everything. Dizziness can be caused by hyperventilation, because you breath very fast using chest muscles. Diaphragmatic breathing can be a help.
Gastrointestinal reactions (nausea, stomach pain)
Some people feel nausea during the panic attacks. It is connected with several factors. Sudden adrenaline rush may influence the work of stomach and intestines. In some cases the process of digestion may slow down significantly or even stop. Digesting food is not the most important and urgent thing at a dangerous time. In this case, our body again redistributes resources in favor of what will help us to avoid the threat (we remember that there is no threat during panic attack, our body “thinks” so due to mistake and creates the corresponding response). Although some people do feel nausea during a panic attack, vomiting is extremely unlikely.
There are also other symptoms that I will just list, not delving into their deep meaning. Excessive sweating, tremor, tunnel-vision perception, uncontrolled eye movement may occur during panic attack.
The symptoms of panic disorder
I am reminding that panic disorder is a repetition of panic attacks on a regular basis that is accompanied by all the discomfort for a life of a person subjected to the constant fear of new attacks. There are people for whom panic attack is a single onset in their lives. For example, one man told me that an attack had happened to him a long time ago when he had been taking a bus. But it had never happened again. That’s why we can’t say that this person suffers from panic disorder; nevertheless, he had the panic attack.
Such people have occasional panic attacks, so they would unlikely visit specialist or read articles on the Internet. Therefore, with great certainty it can be argued that patients of psychiatrists and psychotherapists, readers of this article have faced panic disorder (which may be accompanied by the symptoms of anxiety, depression, obsessive thoughts, etc.), because this is what causes problems in their life, and, one might even say, is characterized by the presence of these problems.
Although, of course, we used to call it “panic attacks”, as it is the most noticeable symptom of this disease. But such definition should not be misleading. It should be clear that a person confronted with panic disorder may have not only the symptoms of panic attacks as they are.
Next, I will consider those symptoms which are characterized primarily by the fact of the repetition of PA and can appear during an actual attack as well as between attacks.
Derealization and depersonalization (feeling of haziness, unreality)
These clever words are meant to denote a feeling that I can describe as “a feeling as if you are looking at the world through a haze, a dense veil”. It seems that the signals from the outside world as if are bogged down in the “haze”, pass through it behind the time. I am very familiar with this feeling; it had been accompanying me throughout the whole period when I had been suffering from the panic attacks.
It made me pretty nervous, suggesting that it is the most direct symptom of schizophrenia. Providing a support for people who suffer from panic attacks and panic disorder, I was convinced that derealization (feeling of unreality) and depersonalization (feeling of unreality of oneself) disturb many people who faced the constant fear and anxiety.
The mechanism of appearing of these symptoms has not been fully understood. One of the theories states that because of the stressful situation there is a short delay in the transmission of signals in our brain, because of which, in fact, the feeling of “haze” is formed. But whatever these symptoms relate to, you need to know that they are derived from anxiety and panic attacks. This is not a sign of insanity, not the symptoms of schizophrenia, but simply the consequence of panic disorder.
Despite the fact that there are techniques to get rid of derealization (I as well as western psychotherapists insist on applying techniques of awareness in order to release this problem), this symptom is based on our anxiety. That is, once you get rid of anxiety, derealization is gone. That is what happened to me. This symptom has not bothered me anymore since I got rid of panic attacks.
In more detail about this issue you can read my article “How to get rid of derealization and depersonalization | Mindfulness approach”
Fear of new attacks
Despite the fact that the panic attacks are safe (although it is difficult for people to agree with this idea in time of intense attack), they are rather unpleasant and leave behind a bad aftertaste as fatigue and nervous tension. It is rather reasonable that a person, who had several attacks, begins to fear their return. This fear creates tension, a state of constant suspense of attacks that could be even more unpleasant than the attack itself. The objective of this article does not include analysis of the causes and development of panic disorder. Therefore, I would like to say that the fear of attacks is the main driving mechanism of new attacks, and I will not take the point further.
Fear of insanity, losing control. Fear of death.
Despite the fact that during a panic disorder a variety of fears may appear, so to speak, suit any taste, it is the fear of madness or losing control over behavior that is most observed. According to my personal observations, for most people this fear appears with panic disorder. I had such fear as well.
A lot of my readers, worrying about their mental health, write me that they constantly fear to go mad, lose control, do some horrible things to themselves or their family. They think that only they have this fear, that it is their personal “thing”, and it precipitates them into an even greater anxiety. But I quickly reassure them offering to read the comments of other readers, where they describe the same symptom.
Everybody (or almost everybody) who suffers from panic attacks has this fear. Let’s conduct a little research together. Please leave in the comments, whether you have such fear or not.
Could this fear become real? That is, whether you can go mad because of panic attacks? I have to reassure you, I haven’t heard of such cases, although I learned a lot of information on the subject and talked to so many people with this problem.
Panic attacks don’t relate to schizophrenia or other mental disorders. The main difference of schizophrenia from the panic disorder is that a schizophrenic would not worry about the fact that he is going crazy, not being aware of the changes that are happening to him. The man with the PA, on the other hand, is constantly worried about his condition, is constantly noticing all the slightest changes.
If you have a fear of something, it does not mean that the object of your fear will be realized. You won’t go crazy and lose control, do not worry.
Fear of losing control is probably connected to the fact that the situation of sudden panic attack is a bit beyond the ordinary experience. Roughly speaking, you are lying in bed in complete safety and suddenly you are grasped by acute panic (that’s how my first attack happened). Why would it happen? If you faced the attack of fear meeting a bear in the forest, it would not surprise you at all. It is the commonness of the situation where extraordinary sensations happen that creates dissonance, the result of which is the fear of losing control over the body. In addition, usually you can not control your emotions during the attack. And it begins to seem that your body will come out of control as well now.
I remind you that you have nothing to fear. This won’t happen to you. No one has lost control or gone crazy because of the panic attack. It’s just a reaction to the danger, adrenaline rush. The aim of this mechanism is to save you (although there is nothing to be saved from in this case), not to kill you.
There is no opportunity to die during an attack, so don’t worry. We remember that the attacks are safe: they do not lead either to heart attacks or to respiratory failure.
Tension in the body
Many people feel tension in different parts of the body: neck, head. In most of the cases it is discomfort in the chest area.
Also many people fear that it is related to a heart disease. However, pain during heart disease is concentrated closer to the left hand, while the tension of panic attacks is localized in the center of the chest. Again there is no danger, and it disappears with panic attacks.
The group of “Concomitant symptoms” will include the symptoms of anxiety, depression. Before considering them, I want to remind you that if you find apart from panic disorder symptoms, let’s say, the symptoms of anxiety disorder, it does not mean that you have several different ailments. Also, it does not mean that you need to “treat” both ailments separately, taking “pills for panic attacks” and “anxiety pills.”
There are no such medicines. In fact, all these symptoms are interrelated, cross each other, are the causes, consequences and varieties of each other. Just as cough and runny nose are considered different common cold symptoms, depression, insomnia, panic attacks in certain cases are different symptoms of the same ailment. No need to treat cough, you need to treat a cold. The same principle one can apply to all the symptoms associated with anxiety, rather than work with only one of them.
The symptoms of anxiety disorder (GAD – generalized anxiety disorder)
People suffering from panic attacks often have the symptoms that I describe below. I had all of them. But don’t worry, if you get rid of the overall anxiety (as reason of all that case including PA), these unpleasant effects will disappear.
Many of the symptoms of anxiety and panic disorder overlap (rapid breathing, rapid heartbeat, nausea, derealization, etc.) so I will not list them. I will enumerate only those that can not be considered only as part of the PA and panic disorder symptomatology.
Right after the first panic attack had finished, I realized that I was alive and apparently sane. But there was no relief because panic was replaced by sluggish, trailing anxiety. This feeling is hard to describe. Perhaps we can say this: the feeling when it seems that something is wrong, but you can not say what exactly. Some people write me that panic attacks last for days or weeks. This can not be true: bouts of acute fear can not last more than a few hours. Most probably, when people say that they mean this unpleasant anxiety. A person can wake up with it, and then fall asleep.
Sometimes it happens like this: panic attacks are gone, but the feeling of constant anxiety remains. Therefore, it is important to work not with particular manifestation of anxiety such as panic attacks, but with the cause of general symptomatology, which is behind all these unpleasant effects. When this cause is eliminated, anxiety is gone. Don’t worry, you can get rid of all that things, it is confirmed by my experience and the experience of many people who already live without fear and panic.
Nervous tension, jerks during wakefulness
Sometimes panic disorder is accompanied by such effects as irritability, constant change of mood, increased anxiety, stress, problems with concentration. Also, there may be cases when a person shudders at every sharp sound.
I had it all, and now it’s all gone along with the other symptoms of anxiety disorder.
People suffering from panic disorder have insomnia that may relate to several factors. Firstly, it can be the result of general nervous tension, constant anxiety. Secondly, the cause of it may be the attacks of fear, anxiety and panic that some people have at night. Finally, along with the sleep problems people may be worried that they can’t fall asleep, thereby producing further insomnia (and people who suffer from PA are usually restless, prone to worry). I described this mechanism in the article on How to Fall Asleep Easily – Reducing the Anxiety of not Being Able to Sleep.
Again, if insomnia is a consequence of anxiety, agitation, then once these factors are eliminated, sleep will become normal. No need to “heal” insomnia itself, you need to get rid of the anxiety that caused it.
There are few more factors of insomnia that I will discuss below.
Another effect that may seem unpleasant and even frightening, but is absolutely harmless. It’s like a man “is thrown out of sleep”: he shudders, have a feeling of falling, loss of balance and wakes up.
When I was suffering from PA, it could happen five times a night mainly in the initial phase of sleep.
There is nothing to fear. This symptom occurs even among “healthy” people (I use quotation marks because I don’t want to say that you are sick when you suffer from PA. It is not a disease). There is an explanation of it in terms of evolution: in ancient times people were sleeping in the trees. Nature has equipped them with such an internal alarm clock that used to awake a person so that he could make sure that his body is in a stable position, and to change the position, if his body is under the threat of falling down. .
The snag is that people with symptoms of panic and anxiety disorder have this effect more frequently than all others for some reason.
But again, there is nothing to fear.
Auditory and visual hallucinations while falling asleep
People with symptoms of anxiety disorder may have auditory and visual hallucinations, especially while falling asleep. It may be images with closed eyes, a sudden squeak (as if you are listening to a recorded speech). Sometimes a strong squeak you heard falling asleep may be accompanied by a jerk while sleeping, which I mentioned above.
Again, there is nothing terrible. If you have other symptoms of panic and anxiety disorder and realize that these hallucinations are something unreal and extraordinary (as we remember, truly crazy people do not doubt the reality of their manias), it is quite possible that you have nothing to fear. These effects are likely to go away with panic and anxiety. However, I will repeat again that only doctor can make a diagnosis properly.
We have discussed some phobias earlier. It is the fear of going mad, fear of death. But sometimes it’s not all. Any fear may appear and evolve to a state of phobia, obsessive fear.
Phobias can be very different:
- Agoraphobia (fear of open spaces. Occurs quite often among people with panic attacks)
- Hypochondria (not quite related to phobias, but I’ll write it here. It is over-concern about own health. It also appears very often with panic disorder)
- Fear of using an elevator
- Fear of flying by an airplane, travelling by means of transport
- Fear of swallowing food
- Fear of suffocation
- Fear of driving
- Fear that the food was poisoned, or psychoactive substance was added to it
Phobias “suit any taste”. Please, understand my irony in a right way. I say “suit any taste” because I want to emphasize that the object of a phobia of a person suffering from PA doesn’t really matter. Anxiety and worrying that became the cause of the phobia matter. If you try to “strangle” single phobia, then another phobia will take place: you had had a fear of using elevators, and then began to fear of flying by plane. Therefore, we must work with what underlies phobias.
Obsessive thoughts almost always occur during panic attacks. It’s such negative ideas which are very difficult not to think of during panic attacks or between them. “What if I die!”, “I’m losing my mind,” “Something’s wrong with me“. Despite all attempts to dismiss it, to convince yourself that you are safe, intrusive images of death, violence, madness would not leave your mind. No matter how long you would convince yourself that the attack is safe, it is hard to get rid of the feeling of danger and all thoughts related to this feeling.
Also, such thoughts may occur between attacks as obsessive thoughts of death, indecent, shocking behavior. They may relate to blasphemy, sacrilege and violence. A person begins fear these thoughts and thereby contributes to their appearing. Again, don’t rush to call yourself a “Psycho”. As I like to mention, real psychos don’t get scared of such thoughts and think of them as nothing abnormal. The fact that you react to them just shows that you’re all right.
These thoughts are one of the main engines of panic attack and panic disorder. Therefore, if you want to get rid of fear, you will have to learn how to work with your mind and cut off these thoughts.
Read my article “How to Stop Obsessive Thoughts and Fears”
No wonder that because of constant fear, concern over own life and sanity, failed attempts to improve the situation somehow, because of futile visits to the psychologists, a person will have a strong despair that can transform into depression. Again, don’t raise the alarm if you face the symptoms of a constant depression, sadness, apathy and lack of motivation. There is a chance that your depression is entirely based on the presence of panic disorder and its negative reflection on your life. Perhaps there is no need to be in a hurry to “treat” depression as a separate ailment. You need to work with your anxiety. If you get rid of it, depression will be gone as well.
How good is the prognosis for a person with these symptoms?
People often write me, “I have been suffering from the anxiety for many years, is my case hopeless?” I dare assure you that there are no hopeless cases. Each person can get rid of panic attacks and concomitant symptoms forever. How is this possible?
As we found out, a panic attack is something like a “false alarm”, the result of wrong assessment of the danger by our brain. This mechanism is put in motion and transform into panic and anxiety disorder under the influence of certain factors. These factors include our response to fear, our apprehensive attitude towards new attacks, the fact of avoiding situations when panic attacks may occur, anxious and restless mind (many people with PA have been anxious since childhood).
If we conclude, we can say that we provoke new attacks by our own reaction. When we respond to the attack by fear and anxiety, when we begin to fear repetition of the attack, when we interpret the situation as dangerous by means of our mind (“I die, I’ll go crazy”), we just don’t give our mind the possibility to “understand” that its assessment of the situation as threatening to us (on a basis of which an attack may occur) is incorrect.
We even somewhat encourage our attacks, saying to our brain, “Yes, there is a danger, please, continue to emit alarm signals.” In other words, we do stop ourselves from getting rid of panic attacks because we are used to respond to them in a certain way.
And if we generally summarize, the principle of getting rid of panic attacks can be formulated as follows: “To get out of the pit you just need to stop digging.” We need to let our wise body understand that there is no danger, and just stop doing everything that prevents it from understanding.
But people having PA for many years have been digging, digging and digging their pit deeper without even realizing it. They just need to stop and look up to see the light and the way out of this hole. And everyone can do it. Each of you can change your mental reaction, so that you could turn the false alarm off forever. It’s even more accurate to say that everyone can make it turn off!
But you must understand that there are no “magic anti-panic pills.” However there is a range of measures are sure to help each of you. And what is most important – these measures should be done.
I’m sure many of you felt a relief after reading this article. I said that panic disorder may be accompanied by a variety of different symptoms. And they are basically safe and don’t show any signs of any serious illness, in addition, they are gone with the PA. Nevertheless, I do not think you can get rid of panic just having read the article. It is not enough just to “know” something, it is necessary to change your habitual response to panic completely to turn the false alarm off, give your body the opportunity to find out its mistakes and correct them.
Everybody can do this. Read the article on how to get rid of panic attacks without medication.
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