Panic attacks are characterized by feelings of fear, dread, and uncomfortable physical symptoms. These attacks are not classified as a mental health disorder on their own, but typically occur as a part of a mental illness or medical condition. Panic attacks are classified into two types: expected and unexpected. The following describes the symptoms and different types of panic attacks.
The Symptoms of Panic AttacksThe Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (DSM-5) is the handbook used by mental health providers in making accurate diagnoses. According to the diagnostic criteria listed in the DSM-5, panic attacks are experienced as a sudden sense of fear and dread plus 4 or more of the following mental, emotional, and physical symptoms:
- Heart palpitations or accelerated heart rate
- Excessive sweating
- Trembling or shaking
- Shortness of breath or smothering sensations
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal pain
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or hot flashes
- Derealization and/or depersonalization
- Fear of losing control or going crazy
- Fear of dying
- Feelings of numbness or tingling sensations (paresthesias)
The symptoms of panic attacks typically occur rapidly and peak within minutes. Once a panic attack has subsided, the symptoms can taper off completely or the panic sufferer can remain in an anxious state, possibly repeating the panic attack cycle again. Limited symptom panic attacks occur when all criteria are met, but the person experiences less than four of the listed symptoms.
Types of Panic AttacksNot only can panic attacks vary in intensity and duration, but they can also differ according to what prompted the attack. The DSM-5 lists two separate and distinct types of panic attacks:
Expected panic attacks – These panic attacks are anticipated when one is subjected to specific cues or panic triggers. For instance, a person who has a fear of enclosed spaces (claustrophobia) may expect to have panic attacks when in an elevator or other cramped areas. A person who has a fear of flying (aerophobia) may predictably have a panic attack when boarding a plane, at the time of take off, or at some time during the flight.
Unexpected Panic Attacks – These panic attacks occur suddenly without any obvious cause or indication. When an unexpected panic attack occurs, the person can be completely relaxed before symptoms develop. This type of panic attack does not accompany any conscious internal cues, such as having fearful thoughts, feelings of intense dread and anxiety, or uncomfortable physical sensations. Unexpected attacks also do not occur with external cues, such as specific phobias or being exposed to a frightening event or situation.
Having experienced one unanticipated panic attack is usually a sign that the person can expect to have more of them in the future. Persistent and unexpected panic attacks are the hallmark feature of panic disorder. People diagnosed with panic disorder may also be subject to having nocturnal panic attacks, a type of unexpected panic attack that occurs when a person is sound asleep and waking them up with panic symptoms.
A person with panic disorder may experience great limitations due to panic attacks. For example, panic sufferers may spend a significant amount of time worrying about future panic attacks and may even avoid certain places and situations that they believe will contribute to the possibility of having a panic attack. Additionally, many people with panic disorder deal with loneliness and isolation, feeling ashamed of their symptoms and fearing that others would negatively judge them for their panic symptoms.
Panic Attacks and DiagnosisPanic attacks are most often associated with a diagnosis of panic disorder, but can listed as a specifier for other mental health disorders. Panic attacks are often related to mood and anxiety disorders, such as agoraphobia, post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), specific phobias, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), bipolar disorder, major depressive disorder. These attacks can also occur in conjunction with a variety of mental health disorders, including personality disorders, eating disorders, and substance-related disorders.
If you are experiencing panic attacks, you doctor or qualified mental health provider can determine if your panic symptoms are an indication that you have panic disorder or a different condition. Your practitioner can provide you with an accurate diagnosis and proper treatment plan. The earlier you get treated for your panic symptoms, the sooner you can expect to manage your panic attacks.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.