What are the Symptoms of a Panic Attack?

Learning Objectives

  • Understand the structure and functions of the nervous system, including the amygdala and hypothalamus.
  • Learn about the fight or flight response and its implications on body functions.
  • Understand how a panic attack mirrors the flight or fight response and how it affects the body.

A panic attack is a surge of intense, overwhelming anxiety. The symptoms of a panic attack come on suddenly and usually peak within ten minutes, then begin to subside. The triggers may be either external, like being in a meeting or a strange place, or internal, as with shaking, sweating, and heart rate. Unfortunately, the triggers may also be completely unknown. Panic attacks indicate that the fight-or-flight system has been triggered. This system prepares the body for immediate emergency action.

Fight or Flight: Symptoms of a Panic Attack

Flight or fight is a whole organism response, a massive activation of your sympathetic nervous system. Below is a list of symptoms. Even if you’re having panic attacks, you probably don’t have all of these symptoms, but you will have many of them. There are physical, emotional, behavioral, and cognitive symptoms. Panic affects what you feel from your body, the emotions you experience, what you do in response, as well as the thoughts that go through your mind. Every mental disorder has a defined set of symptoms in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is published by the American Psychiatric Association. Symptoms that appear in DSM-5 are marked as such. They are paraphrased from DSM-5 to avoid copyright issues. Consult the DSM-5 for actual wording. Other symptoms are derived from popular sources.

Physical Symptoms of a Panic Attack

  • (DSM-5) Increased heart rate (tachycardia), heart palpitations, pounding heart.
  • (DSM-5) Faster or slower breathing, subjective feeling of suffocation
  • (DSM-5) Chest pain or pressure.
  • (DSM-5) Tightness in throat, frequent swallowing, choking sensations.
  • (DSM-5) Feeling dizzy, light-headed, unbalanced.
  • (DSM-5) Sweating, hot flashes, chills
  • (DSM-5) Nausea, stomach upset, vomiting.
  • (DSM-5) Trembling and shaking.
  • (DSM-5) Tingling, electrical sensations, numbness
  • Feeling weak or unsteady
  • Muscle tension
  • Dry mouth

Emotional Symptoms of a Panic Attack

  • Feeling nervous, tense, keyed up, on edge
  • Feeling afraid, threatened, terrified, doomed
  • Feeling impatient, frustrated

    Behavioral Symptoms of a Panic Attack

  • Attempts to escape or flee
  • Avoidance of the feared object or situation
  • Avoidance of reminders or cues of the feared object or situation
  • Restlessness or agitation
  • Difficulty speaking coherently

Cognitive Symptoms of a Panic Attack

  • (DSM-5) Fear of losing control, becoming overwhelmed, not being able to cope, going crazy
  • (DSM-5) Derealization or depersonalization (feeling detached or altered with regard to one’s surroundings and one’s own self, respectively)
  • (DSM-5) Fear of injury or death
  • Fear of being judged by others
  • Threatening predictions about the future, what-if catastrophic thoughts
  • Problems concentrating and problem solving, confusion, loss of perspective
  • Hypervigilence for threats
  • Memory issues
  • Three Intense Symptoms of a Panic Attack

    Three symptoms of panic attacks seem more severe than the others (they are not, however, separated out as extreme symptoms in DSM-5).

    Fear of Going Crazy

    First, there’s a fear of going crazy. This represents the extreme terror that saturates awareness during a panic attack. You may experience frantic efforts to escape or manage the anxiety, like running away or hiding or calling someone you know for assistance. Unfortunately, since the symptoms are internally generated, escape is impossible. There’s riding out the attack and not much more.

    Fear of Dying

    The second extreme symptom is fear of dying. Fear of dying especially seems to accompany cardiac symptoms. Chest pain, shortness of breath, and tachycardia sometimes send clients to the emergency room. They ask “How long can my heart beat so fast without having a heart attack?” The medical answer to this question is apparently days, but no one knows the answer when they start experiencing panic attacks.

    Depersonalization and Derealization

    The third extreme symptom combines depersonalization and derealization. Depersonalization is the feeling of detachment from your body. Perhaps you’re observing yourself from a distance or experiencing yourself as you might observe someone else. You may experience yourself as being robot-like, an automaton responding to events in a stimulus-response fashion. You may have thoughts of losing touch with reality, which amplify fears of going crazy. Physical symptoms like numbness and tingling are common.

    Derealization also involves a feeling of detachment, but detachment from your surroundings. Familiar situations may seem strange. Family members may seem like strangers. You may feel spaced out, and there may be perceptual alterations. With macropsia objects appear closer or larger than you know they should be. With micropsia, objects appear smaller or further away than you know they should be. Events and objects may seem animated or cartoonish and therefore, unreal. You might feel trapped, or fear becoming trapped, in some parallel dimension, “a stranger in a strange land.”

    How Panic Causes Anxiety to Generalize

    Since panic attacks involve absolute terror, they are extremely aversive. Anyone who experiences panic attacks really, really wants to understand the signals or triggers for the attack. They may be confused about the exact triggers, saying things like “Twice it happened, and then it didn’t happen, and I have no idea why.” Not knowing the exact reasons that panic attacks occur makes them seem ominous and random and powerful. The person begins to pay attention to any possible signal or trigger, looking for anything that could provide some warning that a panic attack is coming. At this point the possible triggers have acquired real power to cause anxiety on their own, just because they sometimes SEEM to predict a panic attack. The anxiety has now expanded.

    Heart rate is a classic panic symptom and trigger of panic attacks. In the beginning, as the disorder is getting started, the client notices their racing, pounding heart. They then begin monitoring and fearing their heart rate, which begins to act as a powerful predictor of the attacks, whereas previously it was just a symptom. The client’s internal narrative might run something like this: “Gosh…my heart is a little fast, my god, I hope this isn’t a panic attack…I know I shouldn’t be checking, but I have to know…what is my heart doing now? Oh God, it is beating faster, I wonder if I’m having a heart attack, oh God, I hope not, I hope not…oh God I hope not…oh God, here we go, I’m having a panic attack!” Continued checking elevates anxiety, which increases heart rate, which causes more checking, and so on, until the person literally talks themselves into a panic attack.

    As the number of signals that predict panic increases, so does avoidance. Triggers may seem to be everywhere. The person may end up staying indoors, as everything in the real world becomes too provocative to be endured without causing an attack.

    Reading Comprehension Questions

    1. What parts of the nervous system are involved in the fight or flight response?

    • A. The amygdala and the parasympathetic system
    • B. The sympathetic system and the hypothalamus
    • C. The amygdala and the hypothalamus
    • D. The frontal lobes and the autonomic system

    2. What is the function of the sympathetic nervous system in the fight or flight response?

    • A. It slows down the body’s responses
    • B. It intensifies the functioning of organs and muscles that respond to threat
    • C. It triggers the feeling of anxiety
    • D. It modulates the level of arousal in the body’s various organ systems

    3. What role does the hypothalamus play in the fight or flight response?

    • A. It detects the threat and triggers the response
    • B. It secretes hormones that slow down the body’s responses
    • C. It secretes hormones such as epinephrine into the circulatory system
    • D. It takes over control from the amygdala

    4. How does a panic attack relate to the fight or flight response?

    • A. A panic attack occurs when the fight or flight response is inhibited
    • B. A panic attack is essentially the fight or flight response occurring in an inappropriate context
    • C. A panic attack suppresses the fight or flight response
    • D. A panic attack only triggers the fight or flight response in severe cases

    5. What is one example of an extreme symptom during a panic attack?

    • A. Increased heart rate
    • B. Fear of going crazy
    • C. Muscle tension
    • D. Dry mouth


    1. C. The amygdala and the hypothalamus

    2. B. It intensifies the functioning of organs and muscles that respond to threat

    3. C. It secretes hormones such as epinephrine into the circulatory system

    4. B. A panic attack is essentially the fight or flight response occurring in an inappropriate context

    5. B. Fear of going crazy