What Happens During A Panic Attack: Mental And Physical Responses

Panic attacks may cause intense personal pain and fear. However, the biology behind panic attacks is often the same, regardless of the individual they are happening to. 

Whether you have had a panic attack before or know someone who has, it can be helpful to learn what happens during panic attacks and what you can do to make them more manageable in case they occur. 

This article will explore the biological and psychological factors associated with panic disorder and related psychiatric illnesses. 

The psychological causes of and biology behind panic attacks

Panic attacks are characterized by panic-like symptoms and distress signals that occur suddenly and unexpectedly. They create a physiological response that may include a sense of impending doom and bodily sensations associated with the fight-or-flight response, such as an increased breathing rate. But what causes panic attacks? 

Individuals often associate panic attacks with anxiety. However, while people with anxiety disorders and panic disorder (PD) can experience panic attacks, panic attacks can happen to anybody at any time. 

The origin of most panic attacks likely lies in the central nervous system, which can be activated by common fears or sudden stress, among other things.

According to a study published in 2023 examining biological theories regarding panic attacks, “A neurochemical imbalance of neurotransmitters in the brain, such as serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid (GABA), is thought to cause PD symptoms. This biological theory is evidenced by the symptom reduction effects of antidepressant or anxiolytic medication in many PD suffers.”

In other words, an imbalance in the serotonin system and other neurotransmitters that impact cognitive functioning may cause panic disorder. Effective treatments often include antidepressants and anti-anxiety medications, which lends further credibility to this theory. 

Other research suggests a multifaceted set of causes involving both genetic and environmental factors. For example, individuals who have first-degree relatives diagnosed with panic disorder may have a higher risk of developing the condition themselves. Likewise, neurobiological studies implicate various brain regions, including the prefrontal cortex and brain stem, as well as dysregulation in neural pathways associated with fear responses. 

In some cases, panic attacks do not have a significant cause. However, there are a few mental illnesses, physical conditions, and factors that can lead to or coincide with panic attacks, including but not limited to the following. 

Generalized anxiety disorder

Anxiety and anxiety disorders can cause panic attacks. While not everyone who has an anxiety disorder experiences panic attacks, the distress associated with anxiety disorders can lead to this symptom. Experiencing panic attacks may lead to more panic attacks, and some people with severe fear of having panic attacks may be diagnosed with panic disorder. 

Autism spectrum disorder

Autism spectrum disorder is not a mental illness but a neurodevelopmental condition and form of neurodivergence. Autistic individuals may experience panic attacks and can be at a higher risk of developing mental health conditions like social anxiety disorder. In addition, some autistic people have difficulty with sensory input, such as specific tactile sensations, loud noises, or smells. Evidence suggests that approximately 40% of individuals living with ASD or another form of neurodivergence are also living with an anxiety disorder.

Phobias

Phobias are intense, irrational fears of a specific situation or idea. Although there is no one cause of phobias, researchers believe a traumatic event may sometimes cause phobias. However, some people with phobias may not have had a traumatic encounter–or any encounters–with the object or theme of their fear. Regardless, people with phobias may have panic attacks in response to exposure to–or even at the thought of exposure to–their specific fear. 

For example, an individual with social phobia may find themselves in a vicious cycle because they fear entering social situations. This fear can elicit behavioral responses and cognitive symptoms associated with autonomic arousal, leading to panic attacks. This experience then tells their brain that the fear of going into social situations is valid, potentially increasing the phobia and related panic attacks in the future. This is known as fear conditioning. 

Stress

While people with the above mental health conditions are at an increased risk for panic attacks, anyone can have a panic attack if they experience significant stress. Some situations may be highly stressful for many people, including being the survivor of or witness of a violent crime or traffic collision. Panic attacks can also occur in response to workplace stress, burnout, sensory overload, and other challenges. 

The tendency to assume that panic attacks only happen to people with mental illnesses may be part of the reason some people without diagnosed mental health conditions mistake panic attacks for heart attacks and other challenges. For this reason, it can be helpful to educate yourself about common panic attack symptoms to know when they may be occurring to you or another person. Because panic attack symptoms are often primarily physical, they may not feel the same as anxiety.

Psychological symptoms of panic attacks

During a panic attack, it can be challenging to remember that you are not in danger and the attack will pass. However, reminding yourself and focusing on grounding can help you control your body so you can focus on the moment and prevent worsening symptoms.

The physical responses to panic attacks

The psychological causes of panic attacks, whether specific events or feelings, can differ for each individual. However, the common theme is that some stimulus convinces the mind that the body is in danger. When this response occurs, the body incites the “stress response.” Commonly called the “fight-flight-freeze” response, the stress response is a physiological process that prepares the body to run, fight, or freeze in a traumatic or stressful situation. 

The stress response is an evolutionary carryover. In human ancestors, stressors such as animals or large storms were significantly dangerous. The response helped early humans survive threats. However, modern stressors are often more likely to be social or material rather than traumatic. People may not need to fight off their taxes or outrun their workplace. However, the body can still cause emotional responses that make it seem necessary. Below are some physical reactions to this process that may occur during a panic attack. 

Heart rate and blood pressure changes

When you exert yourself, your muscles often require more oxygen through the blood. While your heart constantly pumps, your body can use a couple of processes to direct blood toward your muscles.

Your body can increase the rate at which your heart beats and the strength of each beat, both of which increase blood flow. While this feeling is natural and expected during exercise, it can be alarming if you are standing still. For this reason, some people mistake panic attacks for heart attacks.

Another way for the body to send blood to your muscles is to direct it away from your internal organs. This process can lead to flushed skin, feeling warm, queasiness, and lightheadedness, all symptoms of panic attacks. 

Breath rate and depth changes

In another attempt to get you more oxygen, your brain may signal your lungs to take faster, deeper breaths. Hyperventilating can be uncomfortable and can change the balance of gases in your blood, which may lead to lightheadedness. In severe cases, it can lead to passing out. While you can’t necessarily control your heart rate, you may have more control over your breath than you realize. Controlling breath is often one of the most effective ways to control a panic attack. 

How to cope with a panic attack

There are elements of panic attacks that you may struggle to control. However, when you realize that you are having a panic attack, you can take steps to make it shorter and more manageable. Working with a therapist may help you identify ways to help manage panic attacks, as well as try the following coping mechanisms. 

Recognize the situation

While panic attacks can be frightening and uncomfortable, they aren’t dangerous. Recognizing that you are experiencing a panic attack is often the first step in managing your symptoms. Try to avoid asking for reassurance or looking up your symptoms online, as this process may increase your anxiety. 

Tell someone

Panic attacks and the mental health conditions that can cause them may be seen as taboo. However, if you realize that you’re having a panic attack, it can be helpful to tell someone. If you experience a panic attack and others don’t know that it is occurring, they may mistake it as a heart attack or allergic reaction. By letting others know you are experiencing a panic attack, you can prevent them from unnecessarily calling medical personnel.

Telling someone that you have a panic attack may also allow them to comfort you, try to help you manage the situation, or stay with you until your attack passes. If you have frequent panic attacks, you may have an idea of what helps you best during them. Tell people close to you how they can best support you before the panic attack occurs, as you may struggle to communicate clearly during one. 

If you’re not with someone else when you have a panic attack, you might consider calling someone and talking to them. It may be comforting to have someone on the end of the line until your panic attack passes, even if they can’t stop it for you. 

Breathe deeply 

While it may seem that your breathing is out of control during a panic attack, you can control your breath. All bodily functions fall into two categories: autonomic and somatic. Somatic functions are those that you need to think about doing, like throwing a baseball. Autonomic functions are those you don’t need to consider like your heart pumping.

When you have a panic attack, your autonomic system controls your breathing. You can overpower this process by taking long, slow, deep breaths. Your nervous system communicates with breathing both ways, so taking slow, deep breaths sends signals to your brain that you are safe. If you struggle to breathe deeply when panicking, consider downloading a breathing app to guide you through each deep breath alongside calming songs or sounds. 

What happens after a panic attack?

Often, panic attacks only have symptoms while they’re occurring. The individual gradually recovers with no serious, lasting consequences. However, although panic attacks haven’t been linked to the likelihood of more severe conditions like heart health complications, chronic stress has been. If your panic attack was the result of stress, you may consider talking to a mental health professional. 

If the thought of speaking with a therapist in person leaves you with anxiety or stress, you might consider alternative options, such as online therapy through a platform like BetterHelp. Meeting with a licensed therapist online can allow you to receive support conveniently at a time that works for you. In addition, you can choose between phone, video, or live chat sessions. 

A 2012 study showed that online, therapist-guided treatment could help those experiencing recurrent panic attacks. Symptoms in participants improved immediately after treatment and 12 months later.

Individuals may wish to seek a diagnosis from a psychologist or psychiatrist to have their panic disorder symptoms evaluated based on clinical practice guidelines. This can offer definitive answers regarding any symptoms you’re experiencing.