As described in the first example above, the symptoms of a panic attack appear suddenly, without any apparent cause. They may include

• racing or pounding heartbeat (palpitations)
• chest pains
• stomach upset
• dizziness, lightheadedness, nausea
• difficulty breathing, a sense of feeling smothered
• tingling or numbness in the hands
• hot flashes or chills
• trembling and shaking
• dreamlike sensations or perceptual distortions
• terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
• a need to escape
• nervousness about the possibility of losing control and doing something embarrassing
• fear of dying

Although the duration of a panic attack can vary greatly, it typically lasts for more than 10 minutes, is one of the most distressing conditions that a person can experience, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause, or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include posttraumatic stress disorder (PTSD), schizophrenia, and intoxication or withdrawal from certain drugs of abuse.

Certain medical conditions, like thyroid abnormalities and anemia, as well as certain medications, can produce intense anxiety. Examples of such medications include stimulants like methylphenidate (Ritalin), diabetes medications like metformin and insulin, antimalarial medications like quinine, as well as corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron). As individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP), this possibility should be investigated by a doctor since MVP may dictate the need for special precautions to be taken when the individual is being treated for any dental problem. While the development of panic attacks have been attributed to the use of food additives like aspartame, alone or in combination with food dyes, more research is needed to better understand the role such substances may have on this disorder.

Anxiety attacks that take place while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic symptoms while sleeping tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and other psychiatric disorders compared to people who do not have panic attacks at night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.

While panic disorder in adolescents tends to have similar symptoms as in adults, symptoms of panic disorder in younger children are less likely to include the thought-based or so-called cognitive aspects. Specifically, teenagers are more likely to feel unreal or as if they are functioning in a dream-like state (derealization) or be frightened of going crazy or of dying.

Symptoms of panic attacks in women tend to include more avoidance of anxiety provoking situations, show more frequent recurrence, and more often result in the use of medical care compared to panic attack symptoms in men. The frequency of panic attacks may increase, decrease, or remain unchanged during pregnancy.

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The upcoming DSM-V has some new criteria for Panic Attacks,

(Note: A Panic Attack is not a codable disorder. List Panic Attack as a specifier (categorical or dimensional) for all DSM disorders to which it may apply (e.g., panic disorder).)

A Panic Attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur. The abrupt surge can occur from a calm state or an anxious state:

1. Palpitations, pounding heart, or accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or smothering

5. Feeling of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, lightheaded, or faint

9. Chills or heat sensations

10. Paresthesias (numbness or tingling sensations)

11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)

12. Fear of losing control or going crazy

13. Fear of dying

NOTE: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, and uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

To be diagnosed with Panic Disorder, a person must have:

A. Recurrent unexpected panic attacks

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, going crazy).

2. Significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

C. The Panic Attacks are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

D. The Panic Attacks are not restricted to the symptoms of another mental disorder, such as social phobia (e.g., in response to feared social situations), Specific Phobia (e.g., in response to a circumscribed phobic object or situation), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

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Difficulty breathing, often accompanied by a feeling of tightness or heaviness in chest often causing more anxiety as a person fears they may be having a heart attack.  Also a panic attack manifests itself causing one to be more easily agitated or frustrated with simple things that would not normally bother them.  The person typically appears unable to sit still, displays fear of something as they do not understand what is taking place and why they feel this sudden overwhelming rush of nervousness in them.  Tapping fingers, pacing floors, chewing nails, appearing overly aggressive when irritated by "little things", swinging of feet or shaking of legs and feet.  The feeling could be easily compared to that adrenaline rush in the "fight or flight" response used as a means of keeping one safe under certain situations and conditions.

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I HAVE A PHOBIA OF BRIDGES AND BEING STUCK AT RED LIGHTS.  MY HEART STARTS TO RACE IF I AM NEARING ONE OR BOTH OF THE ABOVE.  THEN I FEEL AS IF I CAN'T BREATHE AND START TO FEEL TINGLY BECAUSE NOW I AM HYPERVENTILATING.  I FEEL AS IF I AM GOING TO DIE.  ONCE I LEARNED WHAT WAS GOING ON WITH ME, I NOW KEEP A PAPER BAG IN ALL VEHICLES.  I WENT THROUGH MANY TESTS TO FIND OUT MY CURE WAS A FIVE-CENT PAPER BAG.  YES, I DO TAKE XANAX NOW TO EDGE THE COMING OF ONE TO BACK OFF.  THERE ARE TIMES THOUGH ONE OF THESE ATTACKS WILL START BY ME ONLY WATCHING A MOVIE OR STAYING ON THE COMPUTER TOO LONG.  I RECENTLY HAD TO HELP A FRIEND WHO HAD HER FIRST PANIC ATTACK.  I GOT MY TRUSTY PAPER BAG AND SOOTHINGLY TALKED HER DOWN.  IT TOOK ABOUT 20 MINUTES OR SO.  WHEN SHE FINALLY CALMED DOWN SHE SAID I FELT AS IF I WERE GOING TO DIE.  I TOLD HER KEEP BAGS AROUND THAT IT IS ONLY YOU STRESSING OUT OVER SOMETHING AND YOU MAY FEEL AS IF YOU ARE GOING TO DIE BUT YOU WONT.

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User-generated content areas are not reviewed by a WebMD physician. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice. Please see the bottom of the page for more information or visit our Terms and Conditions.