Anxiety & Panic Attack Symptoms

A panic attack can feel like a heart attack, a stroke or the start of losing your mind. Many people who have one go straight to the emergency room, only to be told that nothing is wrong. Something is wrong, but it is treatable. Panic attacks and anxiety disorders are among the most common conditions psychiatrists see. The National Institute of Mental Health estimates that about 2.7% of U.S. adults have panic disorder in a given year.

Dr. Granoff has specialized in anxiety and panic for four decades, and he knows these symptoms first-hand: he had two full-blown panic attacks himself as a young psychiatrist. (Read his story.) The lists below describe what patients most often experience.

Panic attack symptoms

Panic attacks may include all or some of the following symptoms:

• Shortness of breath or feelings of smothering
• Dizziness, unsteady feelings, faintness or light-headedness
• Choking sensations, difficulty swallowing, feeling your throat is closing or feeling something is caught in your throat
• Palpitations: feeling your heart is beating so hard that it is going to jump out of your chest
• Increased heart rate
• Trembling or shaking
• Abdominal distress including cramping, nausea, vomiting or diarrhea
• Numbness or tingling sensations, especially of the hands and feet but also of the head or face
• Hot flashes or chills
• Severe chest pains with the feeling that you are having a heart attack and are going to die
• Fear that you are dying
• Fear that you are going crazy or are going to lose control of yourself and go berserk, make a fool of yourself or embarrass yourself
• Blurred vision
• Headache
• Derealization: feelings of unreality. Things around you don't feel real; they might look or feel different, time slows down and everything appears to be in slow motion. Sounds might get louder or softer even though you know the intensity is not changing, and objects might appear brighter or duller, or larger or smaller, even though you know the object is not changing.
• Depersonalization: feeling that you are outside your body looking back at it, or feeling like your arms or legs are detached from your body, as if they belong to someone else.

An attack usually builds to a peak within minutes. Many people then feel drained, shaky or frightened for hours afterward, and begin to worry about when the next one will strike.

Panic disorder, agoraphobia and phobias

A single panic attack does not always mean panic disorder. Panic disorder is diagnosed when attacks keep returning and you spend a great deal of time worrying about them or changing your life to avoid them. That avoidance is how phobias develop. After an attack on a bridge, in an elevator, in a grocery line or while driving, a person may start avoiding that place, then similar places, until their world becomes smaller and smaller. In its most severe form, agoraphobia, some people become unable to leave home at all.

Social phobia, an intense fear of being watched, judged or embarrassed, often begins in the teenage years. Dr. Granoff's patient Rita had her first attack while giving a report in front of her high school class. You can read her story and four others in Panic Attack Stories: Five Lives Changed.

Generalized anxiety disorder symptoms

Generalized anxiety disorder (GAD) is different from panic. Rather than sudden attacks, it is a steady, hard-to-control worry and tension that lasts for months. Symptoms may include:

• Usually starts in childhood
• Trembling, twitching, feeling shaky
• Headache
• Muscle tension, soreness or aching, especially of the head, neck and back
• Feeling restless or hyped up
• Tiring easily
• Difficulty getting to sleep or staying asleep
• Difficulty focusing attention or concentrating
• Forgetfulness
• Irritability
• Waking from sleep not feeling rested

When anxiety may be something else

Some medical problems can cause or mimic anxiety, including thyroid disease, heart rhythm problems, some medications, caffeine and withdrawal from alcohol or other substances. Anxiety that appears for the first time later in life, without an obvious physical, psychological or environmental stressor, deserves a careful look for another cause. This is one reason a medical evaluation by a psychiatrist matters. If you have chest pain and are not sure what is causing it, call 911 or go to the emergency room first. Panic can be diagnosed only after a heart problem has been ruled out.

Getting an accurate diagnosis

Panic attacks and anxiety disorders are too often misdiagnosed and inadequately treated. Diagnosis is the key to treatment. At your first appointment, Dr. Granoff takes a complete history of your symptoms, medical problems and family history, and does a mental status examination to find out exactly what you are dealing with. Learn what an evaluation includes.

How anxiety and panic are treated

Anxiety disorders run in families and involve brain chemistry, so medication is often an important part of treatment, together with therapy and education about the illness. Dr. Granoff's approach to medication, including his long experience with benzodiazepines, is described in detail in his article Anxiety and Panic Treatment: Benzodiazepines as a First-Line Treatment and in his letter on benzodiazepines and Alzheimer's disease. Every medication has benefits and risks, and the right choice depends on your diagnosis, health and history, which is exactly what your evaluation is for.

For a deeper, plain-language guide, see Dr. Granoff's book Help! I Think I'm Dying! Panic Attacks and Phobias.

Common Questions

Can a panic attack feel like a heart attack?

Yes. Chest pain, a pounding heart, shortness of breath, numbness and a feeling of dying are common in panic attacks. Because the symptoms overlap, anyone with unexplained chest pain should get emergency medical care first. Panic is diagnosed after heart problems are ruled out.

What is the difference between a panic attack and generalized anxiety?

A panic attack is a sudden surge of intense fear with strong physical symptoms that peaks within minutes. Generalized anxiety disorder is a steady, hard-to-control worry and tension that lasts for months, often with muscle aches, poor sleep, fatigue and irritability.

Can panic attacks and phobias be treated?

Yes. With an accurate diagnosis and proper treatment, most people with panic attacks and phobias can return to a full, functioning life. Treatment may include medication, therapy and education about the illness.

Ready to take the next step? Call 757-461-7571 to schedule a consultation with Dr. Granoff. The office is at 1604 Hilltop West Executive Center, Suite 309, Virginia Beach, VA 23451.

If you are in crisis: call or text 988 to reach the 988 Suicide & Crisis Lifeline (available 24/7), call 911, or go to the nearest hospital emergency room.