UNC Health Talk

Are You Having a Panic Attack?

Have you ever suddenly experienced a rapid heartbeat or shortness of breath alongside a surge of overwhelming anxiety or fear? Did you wonder if you were dying, only to have the feelings go away within minutes or a half-hour?

Chances are, what you experienced was a panic attack.

So what is a panic attack, and how do you know the difference between a panic attack or something more serious, such as a heart attack? We asked UNC Health psychiatrist Rachel Frische, MD, these and other common questions.

What is a panic attack?

A panic attack is a sudden episode of intense fear that triggers a physical reaction. Panic attacks can be triggered by an anticipated anxiety-provoking situation or can be completely unexpected. For example, if you know you have a fear of heights and you walk across a very tall bridge, you may expect a panic attack to occur because you know that’s a trigger.

“Even if it’s somewhat expected, it’s hard to know to what extent, what intensity or what duration it’s going to last,” Dr. Frische says.

But more often than not, a panic attack is unprovoked and unexpected, and can even awaken you from sleep.

“When a panic attack happens, people often remark that they feel like they’re losing control,” Dr. Frische says. “They feel an impending sense of doom like they’re having a heart attack or that they might even be dying.”

What are the signs of a panic attack?

The symptoms of a panic attack vary by person but can include:

  • A rapid heart rate
  • Sweating
  • Shaking
  • Shortness of breath or inability to catch a breath
  • Feeling of being choked or smothered
  • Nausea
  • Dizziness
  • Blurry vision
  • Chills or feeling hot
  • Tingling sensation

“It manifests differently in everybody,” Dr. Frische says. “People can even feel that they are not in their own body or feel confused about who or where they are.”

Panic attacks usually self-resolve in a matter of minutes, and it’s uncommon for a panic attack to last more than 15 to 20 minutes. It’s important to know that panic attacks are not life-threatening, though they often feel that way.

Who gets panic attacks?

Two to 3 percent of Americans have had a panic attack in the past year, and each year, it’s twice as common in women than men, Dr. Frische says.

Recurrent panic attacks can lead to a diagnosis of panic disorder, an anxiety disorder characterized by frequent panic attacks. But it’s common for people to have occasional panic attacks without such a diagnosis.

How can you stop a panic attack?

While it can be hard to predict when you will have a panic attack, there are some things you can do to stop one once it starts or at least reduce its intensity.

1. Take a deep breath.

Start by taking a deep breath in, counting to four, and then blow it out slowly to the count of eight.

“Since shortness of breath can be part of an attack, we don’t want you to hyperventilate, so focus on slow deep breaths,” Dr. Frische says. If possible, “make sure you are in a safe place and comfortable.”

2. Call a friend.

If you have a trusted loved one nearby, tell them how you’re feeling. If you’re alone, call someone. Sharing your feelings can help diffuse them, distract you, and make you feel loved and comforted in a time of need.

“Activate your support system, and this may help you better implement coping skills to resolve your symptoms,” Dr. Frische says.

3. Grab an ice cube.

One way to immediately resolve a panic attack is to activate your diving reflex, which is a physiologic response your body has to temperature change.

If you start to feel the symptoms of a panic attack, drink a glass of very cold water, hold ice cubes in your hand or take a cold shower—whatever option is most accessible to you in that moment.

“When receptors on the skin sense a drastic cold temperature change, our vagus nerve is activated, which reduces our heart rate, blood pressure and stress response while increasing oxygen delivery to our brains,” Dr. Frische says.

Your body naturally slows down because that temperature change triggers your body to relax, much like when a doctor hits your knee with a reflex hammer and causes it to jerk and then relax.

“The same happens with our blood pressure and our heart rate, and that by itself can help very quickly to relieve the panic attack,” Dr. Frische says.

How can you tell the difference between a panic attack and something more serious?

There is no easy answer to this question, and Dr. Frische says it’s very common for people to go to the emergency department during or after a panic attack “because they felt scared for their life.” It’s OK to seek help, even if it’s a “false alarm.”

“There are few differentiating factors between someone’s panic attack and something more serious such as a small stroke or a heart attack,” Dr. Frische says. “If the symptoms resolve very quickly with some therapeutic skills, it is most likely a panic attack, but if it’s for a longer time or the symptoms linger, there are very important things we need to rule out.”

Given this confusion, it’s important to err on the side of seeking help.

This is especially true if you have chronic conditions such as heart disease, diabetes or high blood pressure. If you experience these symptoms and you have any concern it could be something other than a panic attack, call your doctor or go to the nearest emergency department.

If you think you might be experiencing a heart attack, call 911 or go to the nearest emergency department. If you think you may be having a panic attack, call your doctor. Need a doctor? Find one near you.