Biology of a panic attack: What happens to your body and mind under conditions of extreme stress?

A panic attack is a quick period of anxiety accompanied by a heightened physiological reaction to a threat or danger, real or imagined.

Certain physical and psychological symptoms result from this rapid wave of extreme dread or worry. They frequently reach their maximal intensity in a few minutes.

The signs of a panic attack might be a direct reaction to something frightful or upsetting, but they can also occur for no apparent cause. It’s understandable that they could feel overpowered and afraid due to the abruptness and lack of control.

“Panic attacks may only happen once for many people. Some could experience it frequently. This typically takes place in the setting of a mental health problem like panic disorder, according to Dr Christine Marie Tomcheck, a psychiatrist who practises in Gardens, Cape Town. Yet, she continues, “panic episodes can always be controlled.

Understanding the signs and symptoms of a panic attack, whether they occur sometimes or frequently, is the first step in controlling them.

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Panic attack signs and symptoms

You may simultaneously feel physical, emotional, and cognitive symptoms during a panic attack.

A formal diagnosis of a panic attack is made if you experience four or more of the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR): heart palpitations, sweating, trembling or shaking, shortness of breath or feeling choked, chest pain, nausea or abdominal discomfort, dizziness or light-headedness, de-realisation or depersonalisation, fears of losing control.

Heart palpitations

Your heart rate rising quickly is a typical sign of panic episodes. You could detect a pulse point throbbing especially loudly, feel or hear your heart beating quicker or harder, or both, adds Dr Tomcheck.

Once the panic attack and its symptoms pass, your heart rate will usually decrease.

You can start sweating as a result of your anxious reaction. This sensation often only lasts for a few minutes and is quite natural, but it might feel awkward or even humiliating if you’re in public.

Shaking or trembling

According to Dr Tomcheck, severe and uncontrollable trembling or shaking in your hands and legs might be one of the earliest indicators of a panic attack.

Even hours after the other symptoms of your panic attack have subsided, you can continue shaking, albeit less severely. When you regain your composure and relax, the shaking should gradually lessen.

Although unpleasant, this panic attack symptom often doesn’t point to any health issues.

Breathing difficulties

Many people hyperventilate or experience suffocation during a panic episode. You could cough, gag, or even throw up as a result of this. Dr Tomcheck adds that these sensations are a normal reaction to the adrenaline surge you are feeling, despite how strong and painful they may be.

By taking slow, deep breaths in and out, try to concentrate on keeping your breathing constant. Between five to thirty minutes, your breathing should resume at its normal pace, she says.

Chest discomfort

You could also have anxiety and chest discomfort in addition to hyperventilating and palpitations. Although you can think it’s your heart and not realise it’s a worry, the first time this happens is frequently terrifying.

Although chest pain is a typical sign of panic attacks, it’s crucial to get help if you’ve never had it before. Dr Tomcheck advises that doing this might help you rule out any underlying heart issues. She continues, “A doctor would often order tests and ask questions to determine whether it’s anxiety- or heart-related”.

Abdominal distress

The effects of all that adrenaline might sometimes cause nausea or stomach ache. Throughout the first 10 minutes of the panic attack, these symptoms may get worse.

“You could occasionally continue to feel queasy hours after the assault has ended”. Generalised anxiety can upset the stomach, according to Dr Tomcheck.

Feeling weak, jittery, unstable, or dizzy

You may have light-headedness or dizziness as a result of the combination of panic attack symptoms, including racing heart, hyperventilation, and fear of losing control. According to Dr Tomcheck, this is a typical reaction to panic. If the other symptoms go away, you should start to feel more stable.

De-realisation or depersonalization

Dr Tomcheck claims that when the symptoms of a panic attack worsen, you may start to feel as though you’re in a movie or start to see your environment differently. “We refer to this as de-realisation. Another possibility is to experience a sense of disconnection from your body and from yourself. Depersonalisation is the term used for this.

Numbness or tingling sensations

Anxiety and adrenaline may be the cause of the pins-and-needles sensation you start to experience all over your body. Another possibility is feeling numb or briefly frozen. Usually, these feelings disappear within a short period of time.

Cold or hot flashes

You may also have chills or hot flashes, which are typically accompanied by heavy perspiration. Your body is attempting to adjust to the rush of adrenaline and stress.

Other symptoms, including sobbing, headaches, or vomiting, are also possible. But, you still need to experience at least four of the specific symptoms listed above in order to be diagnosed with a panic attack.

The extreme physical symptoms you experience during a panic attack, such as chest discomfort or heart palpitations, can be so distressing that some individuals mistake them for a heart attack.

Also, the mental and emotional effects can be debilitating. You can get the impression that something terrible is about to happen or that you need to get out of your current predicament because you’re in danger.

There isn’t always a connection between these sensations and sentiments and a particular cause. You may have panic attack symptoms unexpectedly, even while you are relaxing or sleeping. “The most unsettling aspect of panic attacks is frequently how suddenly they occur”, notes Dr Tomcheck.

While some people only experience panic attack symptoms once, others may suffer them repeatedly or chronically throughout their lives.

Those who have symptoms of panic disorder or whose anxiety is affecting their daily lives should consult a healthcare provider to talk about treatment or coping mechanisms.