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Beach And Ocean

Understanding Panic Attacks and Panic Disorder

What They Are, Why They Happen, and How to Make Sense of Them

Written by Gio Arcuri, OT, MSc

Mental Health Occupational Therapist

Course Lecturer, McGill University

Founder of Clinique Vivago

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February 22, 2026

Important Medical & Clinical Disclaimer

The information provided on this page is for educational and informational purposes only. It does not constitute medical, psychological, psychiatric, or therapeutic advice.

 

This content is not intended to:

 

  • Diagnose any mental health condition

  • Replace individualized clinical assessment

  • Recommend specific medications or treatment plans

  • Substitute for consultation with a licensed healthcare professional

 

Treatment decisions — including whether to start, stop, or adjust medication — must always be made in consultation with a qualified physician, psychiatrist, nurse practitioner, or other authorized prescriber.

Panic attacks can feel terrifying.

 

Your heart races.

Your chest tightens.

You feel dizzy or disconnected.

You may think you are dying, losing control, or “going crazy.”

 

If you’ve ever searched:

 

  • “Am I having a panic attack?”

  • “Why does this keep happening?”

  • “Are panic attacks dangerous?”

  • “What’s the difference between anxiety and panic?”

 

You are not alone.

 

This guide provides a clear, evidence-based explanation of panic attacks and panic disorder — grounded in current psychiatric and psychological research.

 

If you are looking specifically for how to treat panic disorder, visit:

→ Treatment Options for Panic Attacks and Panic Disorder (/panic-anxiety-treatment-options)

What Is a Panic Attack?

 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric Association, 2022), a panic attack is:

 

A sudden surge of intense fear or discomfort that reaches a peak within minutes.

 

Symptoms must include four or more of the following:

 

  • Heart palpitations or rapid heart rate

  • Sweating

  • Trembling or shaking

  • Shortness of breath

  • Chest pain or discomfort

  • Nausea

  • Dizziness or faintness

  • Chills or heat sensations

  • Numbness or tingling

  • Derealization or depersonalization

  • Fear of losing control

  • Fear of dying

 

Panic attacks are time-limited. They typically peak within 5–20 minutes and resolve within about 30 minutes.

 

They are intensely uncomfortable — but not dangerous in themselves.

 

 

What Is Panic Disorder?

 

Panic Disorder is diagnosed when:

 

  • There are recurrent, unexpected panic attacks

  • At least one attack is followed by one month or more of persistent concern about additional attacks

  • There are significant behavior changes (avoidance)

 

(APA, 2022)

 

Not everyone who experiences panic attacks develops panic disorder.

 

The key difference is persistent fear and avoidance.

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The Neurobiology of Panic

 

Panic involves rapid activation of:

 

  • The amygdala (threat detection)

  • The sympathetic nervous system

  • The locus coeruleus (noradrenergic activation)

  • The HPA axis (stress hormone regulation)

 

Some individuals show heightened sensitivity to carbon dioxide levels (Klein, 1993) and increased reactivity to internal sensations.

 

This helps explain why shortness of breath or dizziness can trigger a cascade of fear.

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The Cognitive Model of Panic (Clark, 1986)

 

One of the most influential models proposes:

 

  1. A bodily sensation occurs (e.g., increased heart rate).

  2. It is misinterpreted as catastrophic.

  3. Anxiety increases.

  4. Physical symptoms intensify.

  5. A panic attack develops.

 

Example:

 

Heart racing → “I’m having a heart attack” → Fear → More adrenaline → Faster heart → Full panic.

 

This feedback loop can occur within seconds.

Panic vs Anxiety Attacks

 

“Anxiety attack” is not a formal diagnosis.

 

Panic attacks:

 

  • Sudden

  • Intense

  • Physical

  • Peak quickly

 

Generalized anxiety:

 

  • Gradual

  • Persistent worry

  • Diffuse

  • Long-lasting

 

If chronic stress feels more relevant to your experience, read our article on Understanding Burnout.

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Anxiety Sensitivity

 

Anxiety sensitivity refers to fear of anxiety-related sensations (Taylor, 1999).

 

People high in anxiety sensitivity may interpret:

 

  • Dizziness as fainting

  • Rapid heartbeat as heart failure

  • Brain fog as “losing control”

 

This amplifies vulnerability to panic disorder.

 

 

Are Panic Attacks Dangerous?

 

Panic attacks:

 

  • Do not cause heart attacks in healthy individuals

  • Do not cause brain damage

  • Do not cause psychosis

 

However, first-time symptoms should always be medically evaluated to rule out:

 

  • Hyperthyroidism

  • Cardiac arrhythmias

  • Asthma

  • Hypoglycemia

  • Substance withdrawal

 

 

Panic and Functional Impairment

 

Panic disorder becomes impairing when avoidance develops.

 

Common impacts:

 

Work:

 

  • Avoiding meetings

  • Avoiding commuting

  • Reduced concentration

 

Daily living:

 

  • Avoiding driving

  • Avoiding exercise

  • Avoiding being alone

 

Social:

 

  • Avoiding crowds

  • Avoiding restaurants

  • Avoiding travel

 

This is how agoraphobia develops.

 

 

Panic, Trauma, and the Nervous System

 

Trauma can increase baseline nervous system activation and hypervigilance.

 

In some individuals, panic is linked to trauma-related physiological activation.

 

For a deeper understanding on trauma and the nervous system, visit our page on Understanding Trauma and our page on Nervous System Sensitivities.

 

 

Panic and ADHD

 

Emotional dysregulation, impulsivity, and interoceptive sensitivity associated with ADHD may complicate panic symptoms.

 

If attention regulation is also a concern read more on Understanding Adult ADHD.

 

 

Clinical Vignettes

 

 

The Executive Who Stopped Driving

 

After one highway panic attack, avoidance expanded until driving ceased entirely. Medical tests were normal. Avoidance maintained the cycle.

 

 

The Student With “Heart Problems”

 

Emergency visits ruled out cardiac causes. Anxiety sensitivity amplified normal physiological changes.

 

 

Trauma-Linked Panic

 

Chronic hyperarousal made panic episodes more likely in specific environments.

 

 

Do Panic Attacks Go Away?

 

Sometimes.

 

But when avoidance expands or panic becomes recurrent, evidence-based treatment significantly improves outcomes.

 

For a detailed treatment breakdown:

→ Treatment Options for Panic Attacks and Panic Disorder (/panic-anxiety-treatment-options)

References 

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American Psychiatric Association. (2022). DSM-5-TR.

Clark, D. M. (1986). Behaviour Research and Therapy.

Craske, M. G., & Barlow, D. H. (2007). Mastery of Your Anxiety and Panic.

Klein, D. F. (1993). False suffocation alarms.

Taylor, S. (1999). Anxiety Sensitivity.

Panic Attack

FAQ 

 

Can panic attacks happen during sleep?

Yes. Nocturnal panic attacks can wake someone from sleep with intense fear, palpitations, sweating, or shortness of breath.

 

Can you die from a panic attack?

No. Panic attacks are extremely distressing but not life-threatening on their own in otherwise healthy individuals.

 

Why do I feel like I’m “going crazy” during a panic attack?

Derealization and depersonalization can occur during intense autonomic activation. They feel frightening but are common panic symptoms.

 

Can caffeine trigger a panic attack?

Yes. Caffeine can increase physiological arousal and can trigger panic in sensitive individuals.

 

What’s the difference between an anxiety attack and a panic attack?

“Anxiety attack” isn’t a formal diagnosis. Panic attacks follow a defined symptom pattern with a sudden peak.

 

Is panic disorder genetic?

There is moderate heritability, but environment and chronic stress also play major roles.

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