What a Panic Attack
Really Is — and What
to Do About It

Dr. Gabriella Farkas, MD PhD

MD/PhD Psychiatrist · Hilton Head Island, SC

Dr. Gabby Farkas reviews these blogs and treats the conditions noted

About Dr. Farkas →

Panic attacks are sudden, intense episodes of fear and physical symptoms that peak within minutes. Per the National Institute of Mental Health, an estimated 2.7% of U.S. adults experience panic disorder in any given year, with 4.7% experiencing it at some point in their lives. Women are affected at more than twice the rate of men.

Panic attacks are intensely uncomfortable but not dangerous — and panic disorder is highly treatable. Understanding the difference between an isolated panic attack (which many people experience without developing a disorder) and panic disorder (recurrent attacks with anticipatory anxiety) matters for treatment.

What a Panic Attack Is

DSM-5-TR defines a panic attack as an abrupt surge of intense fear or discomfort that reaches a peak within minutes, accompanied by four or more of:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling)
• Derealization (feelings of unreality) or depersonalization
• Fear of losing control or “going crazy”
• Fear of dying

Symptoms typically peak within 10 minutes and subside within 30 minutes.

Panic Attack vs Panic Disorder

Panic attacks are common — many people experience one or more in their lifetime, often during periods of high stress, without developing a clinical disorder. Panic disorder requires:

• Recurrent unexpected panic attacks
• At least one attack followed by 1+ months of:
  • Persistent concern about additional attacks or their consequences, AND/OR
  • Significant maladaptive behavioral change related to attacks (avoiding situations, etc.)
• Not attributable to substances or medical condition
• Not better explained by another mental disorder

The Anticipatory Anxiety Cycle

In panic disorder, fear of future attacks (anticipatory anxiety) often becomes more impairing than the attacks themselves. The cycle:

1. Initial panic attack — often unexpected, sometimes during stress
2. Fear of having another attack — particularly in certain situations
3. Avoidance of situations where attacks might happen or escape might be difficult
4. Hypervigilance to physical sensations
5. Misinterpretation of normal sensations as attack onset
6. Heightened physiological state that increases attack likelihood

Without treatment, this cycle often leads to agoraphobia — fear of situations where escape might be difficult — which can substantially restrict daily life.

Common Misconceptions

“I’m having a heart attack”

Many panic attack symptoms overlap with cardiac events. While panic attacks aren’t dangerous, chest pain warrants medical evaluation, especially in first occurrence. After cardiac causes are ruled out, panic attacks can be confidently diagnosed.

“I’m going to faint”

Despite the sensation, fainting during panic attacks is rare. Blood pressure typically rises (not falls) during attacks.

“I’m losing my mind”

Derealization and depersonalization during panic attacks feel disturbing but aren’t signs of serious mental illness. They resolve as the attack subsides.

Evidence-Based Treatment

First-line medication

Per APA practice guidelines:

• SSRIs — sertraline and paroxetine are FDA-approved for panic disorder; escitalopram, fluoxetine, citalopram also commonly used
• SNRIs — venlafaxine extended-release is FDA-approved for panic disorder
• Starting doses are typically lower than for depression — panic patients are often sensitive to activation effects
• Most patients see substantial improvement within 8-12 weeks

CBT

Cognitive Behavioral Therapy for panic disorder has strong evidence. Components include:

• Psychoeducation about panic physiology
• Cognitive restructuring of catastrophic interpretations
• Interoceptive exposure (deliberately experiencing physical sensations of panic in safe context)
• Behavioral exposure to avoided situations
• Breathing and relaxation training

Per Carpenter et al. (2018), CBT produces robust placebo-controlled effects for panic disorder.

Benzodiazepines

While effective acutely, the 2025 Joint Clinical Practice Guideline on Benzodiazepine Tapering recommends limiting use to 2-4 weeks for most patients. Long-term use produces tolerance, dependence, and may interfere with CBT efficacy. Brief courses can be appropriate during SSRI/SNRI initiation.

Combined treatment

SSRI plus CBT typically produces stronger outcomes than either alone, particularly for moderate-to-severe panic disorder.

Common Questions About Panic Disorder

Are panic attacks dangerous?

Panic attacks are intensely uncomfortable but not dangerous in themselves. They don’t cause heart attacks, fainting, or “going crazy.” That said, first occurrence of chest pain or severe symptoms warrants medical evaluation to rule out cardiac causes.

Will I always have panic attacks?

Most patients with panic disorder achieve substantial remission with evidence-based treatment. Many become attack-free. Some have rare recurrences during life stressors but can manage them with skills learned in treatment.

Should I take benzodiazepines for panic?

Brief use during SSRI initiation can be appropriate. Long-term use is generally avoided due to dependence risk and interference with CBT. See our related articles on panic attacks and benzodiazepines.

Can I do CBT without medication?

Yes — many patients with mild-to-moderate panic disorder respond well to CBT alone. For more severe cases, combination treatment typically works better.