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Anxiety Disorders
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Panic Attacks: A Classic Symptom of Several Anxiety Disorders

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

Panic attacks are a specific, common symptom of many anxiety disorders. Panic attacks can also occur in the context of other psychiatric and medical disorders. Since panic attacks are such an important symptom of many anxiety disorders, we will describe this symptom in detail. We will also discuss the three types of panic attacks that aid diagnostic discrimination.

panic buttonPanic attacks are sudden, extreme feelings of fear and/or discomfort lasting for a distinct period of time. This sudden surge peaks in intensity within a few minutes, at which point it begins subside. There is often a sense of doom and gloom and a powerful desire to escape. To meet the definition of a panic attack, a person must have 4 of a possible 13 symptoms: These are:

  • Palpitations and/or pounding heart;
  • Sweating;
  • Trembling or shaking;
  • Shortness of breath or a sense of being smothered;
  • Feelings of choking;
  • Chest pain or discomfort;
  • Nausea;
  • Feeling dizzy, unsteady, lightheaded, or faint;
  • Hot flashes or chills;
  • Numbness or tingling sensation;
  • Derealization (feelings of unreality) or depersonalization (feeling detached from oneself);
  • Fear of losing control or "going crazy"
  • Fear of dying.

When someone experiences less than four symptoms, this is known as a limited-symptom panic attack. The most common symptom of limited-symptom panic attacks is shortness of breath, due to hyperventilation.

Panic attacks are different from other anxiety symptoms because they tend to have a sudden onset. They are accompanied by intense fear or terror, and a powerful desire to escape. In addition, panic is perceived as danger occurring in the present moment, while anxiety and worry are future oriented.

As previously discussed, a panic attack is different from a fear reaction. While both involve the fight-or-flight system, a fear reaction is in response to a very real, clear and present danger, and results in a true alarm. In other words, if a bear is chasing someone there is a very good reason to be alarmed! On the other hand, a panic attack occurs without any clear and present danger. It results in a false alarm. However, even though it is a false alarm, the body will respond the same way it does when there is a true alarm. Thus, during a false alarm a person experiences the same sensations, cognitions, and emotions of a true alarm. More information about panic attacks and false alarms is found in the section on the Development and Maintenance of Anxiety Disorders.

Because panic attacks occur in the context of many different anxiety disorders, it is important for the clinician to distinguish between two different types of panic attacks in order to make the most accurate diagnostic determination: 1) expected (cued), 2) unexpected (un-cued).

Unexpected (uncued) panic attacks seem to come from "out of the blue." They do not have an identifiable source that sets them off. It is believed these uncued panic attacks are in response to some kind of life stress. However, this stress is often outside the immediate awareness of the person experiencing it. For example, suppose a woman who recently lost her job, is out shopping for groceries. Suddenly, she feels short of breath and dizzy. She senses her heart is racing. Naturally, she becomes alarmed by these sensations that just "came out of the blue" for no apparent reason. This would be considered an un-cued panic attack. It is quite likely the attack was brought about by the necessity of having to shop for food, even though she has lost her job. Unexpected panic attacks are a diagnostic requirement for Panic Disorder.

Expected (cued) panic attacks are attacks with an obvious cue or trigger. They invariably occur when a person is exposed to certain situations or objects where panic attacks have previously occurred. The onset is sudden and occurs immediately upon exposure. This type of panic attack is most often associated with Social Anxiety Disorder, Specific Phobia, and Agoraphobia.