Panic Attacks: What They Are and What They Aren't

“I can’t breathe. Something is wrong. I think I’m dying.”

These were the first thoughts that crossed Andrei’s mind, a 28-year-old man, as he was driving to work. His heart was pounding, his hands were trembling, and the feeling of suffocation was becoming more and more intense. Convinced that he was having a heart attack, he pulled his car over and called an ambulance.

A few hours later, after thorough medical examinations, he received an unexpected diagnosis: a panic attack.

For those who have never experienced one, it may be difficult to understand just how real and terrifying it feels. For those who have gone through it, however, the experience is often impossible to forget.

In this article, we will explore what a panic attack is, why it occurs, and some of the most common myths that surround it.

What Is a Panic Attack?

A panic attack is a sudden onset of intense fear or severe discomfort, accompanied by physical and emotional symptoms that reach their peak intensity within a few minutes. Often, the person cannot identify a real danger or an obvious cause at the moment the symptoms appear.

During a panic attack, the following may occur:

• Palpitations or the feeling that the heart is beating very hard

• Difficulty breathing or a sensation of choking

• Dizziness or unsteadiness

• Sweating

• Trembling or shaking

• Feelings of heat or chills

• Nausea or abdominal discomfort

• Tingling sensations in the hands or feet

• A sense of unreality or detachment from one's own body

• Fear of losing control

• Fear of dying

Although the symptoms are very intense, they tend to decrease gradually after a few minutes, even though the person may remain tired or frightened for a longer period.

What a Panic Attack Is NOT

1. It Is Not a Heart Attack

Many symptoms resemble those of a heart attack: chest pain, palpitations, sweating, and difficulty breathing. For this reason, people often believe they are in danger of dying.

However, a panic attack and a heart attack are different conditions. If there is any uncertainty about the cause of the symptoms, medical evaluation is important, especially during the first episode.

2. It Does Not Mean You Are “Going Crazy”

During a panic attack, you may feel as though you are losing control or going insane. This experience is common, but it does not indicate the onset of a psychotic disorder or a loss of contact with reality.

3. It Is Not a Sign of Weakness

Panic attacks can occur in people of all ages and levels of functioning. They are not the result of a lack of willpower or a “weak” personality. Rather, they are a complex reaction involving both biological and psychological mechanisms.

4. It Does Not Automatically Mean You Have Panic Disorder

A person may experience one or more panic attacks without developing panic disorder. A diagnosis of panic disorder requires recurrent panic attacks and persistent concern about having additional attacks, or significant behavioral changes driven by that fear.

Why Does a Panic Attack Occur?

From a cognitive-behavioral therapy (CBT) perspective, catastrophic interpretations of bodily sensations play an important role.

For example:

• “My heart is beating fast—I must be having a heart attack.”

• “I can't get enough air—I’m suffocating.”

• “I feel dizzy—I’m going to faint.”

These interpretations increase fear, which intensifies the physical symptoms and maintains the vicious cycle of panic.

When Should You Seek Help?

It is useful to consult a mental health professional when:

• The attacks recur

• You begin avoiding certain places or situations for fear of another episode

• Anxiety affects your personal or professional life

• You constantly live with the fear that another attack will occur

The good news is that panic attacks can be treated effectively. Cognitive-behavioral therapy is one of the interventions with the strongest scientific evidence for reducing symptoms and preventing recurrence.

What Happens in the Body During a Panic Attack?

One of the most frightening aspects of a panic attack is how real the physical symptoms feel. Many people become convinced that they are having a heart attack, suffocating, or losing control of their body.

In reality, the symptoms are produced by the body's normal alarm system, often called the "fight-or-flight" response. This system evolved to help us respond quickly to danger. During a panic attack, however, the alarm is activated even though there is no immediate physical threat.

The Role of Breathing

When we perceive a real threat, our body's alarm system prepares us to respond quickly. One of the changes is an increase in breathing rate. This response is adaptive because the muscles need more oxygen and produce more carbon dioxide (CO₂) as they prepare for action.

During a panic attack, however, the same alarm system is activated even though there is no physical danger requiring intense muscular activity. As a result, breathing may become faster than the body's actual needs—a pattern known as hyperventilation.

Hyperventilation does not usually lead to dangerously low oxygen levels. Instead, it causes excessive amounts of carbon dioxide (CO₂) to be exhaled. This reduction in CO₂ can contribute to many of the uncomfortable sensations experienced during a panic attack, including dizziness, tingling, chest tightness, and feelings of unreality.

These sensations are uncomfortable but not dangerous. Unfortunately, they are often interpreted as signs of a serious medical emergency, which increases fear and further intensifies the body's alarm response.