In many cases, panic attacks strike out of the blue, without any warning. Often, there is no clear reason for the attack. They may even occur when you’re relaxed or asleep.

A panic attack may be a one-time experience, but many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as flying in an airplane or speaking in public – especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to flee.

You may experience one or more panic attacks, yet be otherwise perfectly normal and relaxed. Or your panic attacks may occur as part of another disorder, such as panic disorder, agoraphobia, or the blues. Regardless of the cause, panic attacks are curable. There are many effective treatments and coping strategies you can use to deal with the symptoms.

Signs and symptoms of a panic attack

Panic attacks often strike when you’re away from home, but they can happen anywhere and at any time. You may have one while you’re in a store shopping, jogging down the street, driving in your car, or sitting on a chair at home.

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour.

A full-blown panic attack includes a combination of the following signs and symptoms:

• Shortness of breath or hyperventilation

• Heart palpitations or a rapid heart beat

• Pain in the chest or (uneasiness~discomfort}

• Trembling or shaking

• Choking feeling

• Feeling unreal or detached from your surroundings

• Sweating

• Nausea or upset stomach

• Feeling dizzy, lightheaded, or faint

• Numbness or tingling sensations

• Hot or cold flashes

• Fear of dying, losing control, or going crazy

Signs and symptoms of panic disorder

Many people experience panic attacks without further episodes or complications. There is little reason to worry if you’ve had just a couple panic attacks. However, some people who’ve experienced panic attacks go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.

Signs and symptoms of panic disorder

You may be suffering from panic disorder if you:

• Experience (more than once~frequent}, unexpected panic attacks that aren’t tied to a specific situation.

• Worry a lot about having repeating panic attack.

• Are responding differently because of the panic attacks, such as avoiding places where you’ve previously panicked.

While a single panic attack may only last a few moments, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense emotion and horror that you feel during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:

• Anticipatory anxiety – Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This "fear of fear" is present most of the time, and can be extremely disabling.

• Phobic avoidance – You begin to avoid certain social situations or environments. This fear may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks. With agoraphobia, you’re afraid of having a panic attack in a situation where fleeing would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help.

Because of these fears, you stay away from more and more situations. For example, you might begin to avoid crowded places such as shopping malls or sports arenas. You might also avoid cars, ferries, trains, and other forms of travel. In more severe cases, you might only feel safe at home.

Situations or activities you may avoid if you have agoraphobia:

• Being far away from home

• Going somewhere without the company of a "safe" person

• Physical activity (because of the belief that it could trigger a panic attack)

• Going to }locations~places} where escape is not readily available (e.g. shopping, movie houses, stores, buses)

• Driving

• Places where it would be embarrassing to have a panic attack, such as a social gathering

• Eating or drinking anything that could possibly provoke panic (such as alcohol, caffeine, or certain foods or medications)

Although agoraphobia can develop at any time, it usually appears within a year of your first recurrent panic attacks.

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unsure, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job layoff can also trigger a panic attack.

Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilties:

• Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly.

• Hyperthyroidism

• Hypoglycemia

• Stimulant use (amphetamines, cocaine, caffeine)

• Medication withdrawal