Panic Attacks
A panic attack is a sudden episode of intense, overwhelming fear or physical discomfort that reaches its peak within minutes and then subsides — typically within 20 to 30 minutes, though it can feel far longer. During an attack, the physical sensations are so powerful that many people believe they are having a heart attack or are about to die. This fear of dying or "going mad" is itself one of the diagnostic features of a panic attack and contributes significantly to the distress it causes.
What happens during a panic attack
The body's alarm system — the fight-or-flight response — fires inappropriately, flooding the body with adrenaline. This triggers a cascade of physical symptoms including a pounding or racing heart, shortness of breath or a sense of suffocation, chest tightness or pain, dizziness or light-headedness, trembling or shaking, sweating, nausea, numbness or tingling in the hands and face, chills or hot flushes, and a feeling of unreality or detachment from the self (derealisation or depersonalisation).
Causes and triggers
Panic attacks can occur completely out of the blue, without any obvious trigger — a phenomenon particularly associated with panic disorder. They can also be triggered by specific situations (such as crowded spaces, social situations, or feared objects), by stress or significant life changes, by physical illness, certain medications or substances (including caffeine, alcohol withdrawal, and cannabis), or as part of other anxiety disorders. Not everyone who has a panic attack goes on to develop panic disorder — a single episode is relatively common.
Panic disorder
Panic disorder is diagnosed when a person experiences recurrent, unexpected panic attacks and develops persistent concern about future attacks, worry about their implications, or significant changes in behaviour to avoid them. Avoidance is a key maintaining factor — the more situations a person avoids for fear of triggering a panic attack, the larger anxiety's territory grows.
Treatment
Cognitive behavioural therapy (CBT) is the most effective psychological treatment for panic disorder, with a strong evidence base. It teaches patients to understand the physiological basis of panic, challenge catastrophic interpretations of bodily sensations, and gradually confront avoided situations. Breathing techniques and graded exposure are central components. Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication for panic disorder. The combination of CBT and medication is often more effective than either alone.
Choosing where to be treated
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