Panic attacks: symptoms, coping, and when to seek urgent help

CareOps editorial team · · 7 min read

General information and service guidance published by CareOps. This is not an individual diagnosis or treatment plan.

Translated from our Korean guide. Korean public services, insurance, and helpline numbers refer to South Korea. For urgent help elsewhere, contact local emergency services or a crisis line in your country.

In the subway, during a meeting, or while lying down to sleep. My heart is pounding for no reason and I can't breathe. I think I might die like this. Everyone feels that way when they experience it for the first time. If you know what a panic attack is and what to do in the moment, the fear of the next time will be much less.

At a glance

  • Panic attacks peak within a few minutes and usually last between 5 and 20 minutes. It's very scary, but it doesn't harm you in itself.
  • The key in that moment is to stay present, breathe out slowly, and say, ‘This will pass.’
  • If you experience chest pain or shortness of breath for the first time, seek medical attention to distinguish it from heart or lung problems. If you have recurring panic attacks, cognitive behavioral therapy is effective.

panic attack symptoms

A panic attack is a sudden experience of intense fear and physical symptoms that peak within a few minutes. The symptoms listed by the British National Health Service (NHS) are as follows: According to the diagnostic criteria, when four or more of these symptoms appear at once, it is called a panic attack.

  • Heart racing or pounding
  • Shortness of breath and feeling of tightness in the throat
  • Chest pain or tightness
  • Cold sweat, tremors, chills or hot flushes
  • Feeling dizzy and like you might pass out
  • Nausea, feeling sick
  • Numbness or tingling in hands and feet
  • A feeling of unreality, like I'm separated from my body
  • Fear of dying or going crazy

How long do panic attacks last?

The NHS advises that most panic attacks last between 5 and 20 minutes. There are rare reports of it lasting up to an hour. It's not uncommon to feel dizzy and dazed for several hours afterward.

The same guide clearly states that although panic attacks are scary, they are not dangerous nor cause any harm. No heart stopping or actual suffocation occurs. Just knowing this can make a difference in the size of your next panic attack.

5 steps to deal with a panic attack

  1. Stop and Stay — Stay where you can. If you are driving, park your car in a safe place. If you run away quickly, your body will learn that “that place is dangerous.”
  2. Name it — Say to yourself, “This is a panic attack. It’s scary, but it’s not dangerous, and it will pass.”
  3. Breath slowly — Inhale through your nose and exhale through your mouth longer than you inhaled. If you pant loudly, the dizziness and numbness will get worse, so focus on slow rather than depth.
  4. Turn your senses outward — Feel five things one after another: the feeling of the soles of your feet touching the floor, the coldness of the object in your hand, and the things you see.
  5. Write it down — Write down briefly when, where, and what thoughts or body sensations you had just before. You start to see recurring conditions.

The more you fight to ‘stop’ the panic attack, the longer it lasts. The goal is not to get rid of it, but to stay afloat until the wave passes.

Why do panic attacks occur?

A representative theory explaining panic (Clark, 1986) focuses on the link that interprets bodily sensations as disaster. My heart beats a little faster → ‘Is this a heart attack?’ → Fear → My heart beats faster → ‘It’s definitely a big deal.’ The body's alarm and fearful interpretation feed each other, reaching a peak in a matter of minutes.

Caffeine, lack of sleep, long-term stress, and shallow and fast breathing create a condition in the body that makes it easy for this cycle to begin. In particular, caffeine causes the same physical sensation as anxiety, so it is a good idea to reduce it after experiencing panic.

When to go to the emergency room

The symptoms of a panic attack overlap with those of a heart or lung emergency. If any of the following apply to you, do not assume it is panic, but call 119 or go to the emergency room.

  • First time Severe chest pain or difficulty breathing
  • When the pain spreads to your arms, jaw, or back or feels like a squeezing sensation.
  • When symptoms do not subside after 20 to 30 minutes
  • If you are unconscious or have heart disease

Getting confirmation from a test that there is nothing wrong with your body is helpful in treatment in itself. This is because doubts about whether it may be a heart problem are reduced.

Difference between panic attack and panic disorder

Panic attackPanic disorder
What it describesAn episode of intense fearRecurring attacks followed by ongoing worry or behavior changes
How commonMany people experience one or two in their livesDevelops in some people
Main difficultyIntense fear over several minutesWorry about another attack and resulting avoidance
ExampleAn attack on the subway during a stressful daySubsequently avoiding the subway or going out alone

What causes panic disorder is avoidance rather than the attack itself. The more you avoid the places and situations where you had a panic attack, the fewer places you can go.

panic disorder treatment

The UK National Institute for Health and Care Excellence (NICE) guidelines recommend cognitive behavioral therapy for panic disorder. I re-examine my interpretation of body sensations as disasters, and practice gradually approaching the situations and body sensations I was avoiding. Whether medication is needed and how much to use will be decided with the doctor during treatment. In Korea, cognitive behavioral therapy for panic disorder is covered by health insurance.

When someone close to you is having a panic attack

  • Stay by my side with a calm voice. “I’m here. It’ll pass soon.”
  • I don’t urge you to “calm down” or “it’s no big deal.”
  • Let’s breathe slowly together. It’s okay to count your exhaled breath long and loud.
  • I don't touch my body if I don't want to. Ask what can help.
  • If this is your first time experiencing this or the symptoms do not subside, call 119.

Frequently asked questions

Can you die from a panic attack?
The UK's NHS advises that although panic attacks are scary, they are not dangerous and do not cause harm to the body. However, if you experience severe chest pain or shortness of breath for the first time, it may be due to another cause, so check with your doctor.
Are there any aftereffects after a panic attack?
You may feel tired and dazed for several hours after the attack has passed. What lasts longer is the worry of ‘what if it comes again?’ If you start avoiding places or activities because of this worry, it's time to seek treatment.
If you have a panic attack once, is it panic disorder?
No. A panic attack or two can happen to anyone during times of great stress. If you have repeated unexpected attacks, are worried about the next attack for more than a month, or have a change in behavior because of it, look for panic disorder.
Why do I feel more dizzy when I take deep breaths?
If you breathe too deeply and quickly, carbon dioxide in your body decreases, causing dizziness and numbness in your hands and feet. So, it is important to breathe more slowly than deeply and to exhale longer than inhale.

Sources

  1. UK National Health Service (NHS), Panic disorder
  2. National Institute of Mental Health (NIMH), Panic Disorder: When Fear Overwhelms
  3. Clark (1986), A cognitive approach to panic, Behaviour Research and Therapy
  4. UK National Institute for Health and Care Excellence (NICE), Generalized anxiety disorder and panic disorder in adults: management (CG113)
  5. Ministry of Health and Welfare (2018), the burden of national medical expenses will be reduced from July due to the expansion of health insurance coverage.

This article provides general information, not diagnosis or treatment. For urgent help, contact local emergency services or a crisis line in your country. In South Korea, the suicide prevention helpline is 109 (24 hours), and the mental health crisis line is 1577-0199.

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