Why Do People Get Unexpected Panic Attacks?

Panic attacks are sudden and spontaneous debilitating attacks of intense distress often accompanied by physical symptoms such as shortness of breath, sweating, and heart palpitations. Although they can be extremely frightening and distressing, panic attacks themselves are not physically dangerous.

Everyone experiences feelings of anxiety and panic at times as they are natural responses to stressful or dangerous situations. However, for someone struggling with panic disorder, feelings of anxiety and stress occur regularly, and as such the cause of great distress and unmanageability. 

Panic Attack Signs and Symptoms

The signs and symptoms of a panic attack can vary from person to person. The symptoms of a panic attack are not dangerous but can be very frightening and last from a few minutes to an hour. 

Those who have experienced a panic attack often report:

  • a fear of dying or that they are having a heart attack

  • flashing vision or other visual disturbances

  • faintness or nausea

  • numbness throughout the body

  • Rapid pounding heart

  • Sweating

  • Trembling or shaking

  • Nausea or abdominal cramping 

  • shortness of breath and hyperventilation, or loss of body control

  • Dizziness, lightheadedness, or faintness

  • tunnel vision

Panic attacks are distinguished from other forms of anxiety by their intensity and episodic nature. They are often experienced in conjunction with anxiety disorders and other psychological conditions but aren’t necessarily an indicator that someone has a mental disorder.

What Does a Panic Attack Feel Like?

A panic attack is a feeling of sudden and intense anxiety that can be incredibly frightening. They are often accompanied by a feeling of leaving one’s body, a sense of dying, and/or a strong urge to escape the place where the attack began. The physical symptoms of a panic attack can be so severe that some believe that they are experiencing a heart attack or a nervous breakdown. 

The feelings experienced during a panic attack are caused by the fight-or-flight or the fight-flight-or-freeze response (also called hyperarousal or the acute stress response), a physiological reaction to perceived harmful events, attacks, or threats to survival. The feelings of a panic attack are triggered by the release of hormones that prepare the body to either stay and deal with a threat or to run away to safety.

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Can a Panic Attack Be Caused by Nothing?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes panic attacks as expected or unexpected. Expected panic attacks occur when facing a situation that has caused problems in the past, triggered by a phobia or by a commonly stressful event. Unexpected attacks occur when the cause is unidentified.

Unexpected panic attacks occur suddenly and without any obvious cause. Someone might feel completely at ease before symptoms develop. Unexpected panic attacks won’t seem to be triggered by internal cues such as fearful thoughts, anxiety, or a sense of dread, or external cues such as phobias or threatening situations. 

It is not yet known what causes panic attacks but genetics, mental health disorders, PTSD and complex PTSD, stress or having a predisposition to anxiety can all contribute. 

Complications of Panic Disorder

Panic disorder is a common mental disorder that affects up to 5% of the population at some point in life. Those suffering from panic disorder experience recurring and regular panic attacks, often for no apparent reason, which can be very disabling and are associated with poor functioning and reduced quality of life. 

Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as phobias, addictions, physical illnesses, depression, and suicidal ideation, to name just a few.  

Agoraphobia and Other Phobias

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn’t be available if things go wrong. Agoraphobia is a common condition to develop alongside panic disorder due to the fear of a panic attack occurring in a public place. Some may worry that a panic attack in a public place will be embarrassing, or that they’ll have difficulty getting help if they need it. They may also worry about public places that they would have difficulty leaving, such as public transport if they were to have a panic attack.

Someone with panic disorder may also develop other phobias which can often seem irrational. For example, they may start to worry about a particular object or action that triggers attacks and develop an aversion in response. 

Drug and Alcohol Misuse

Mental health disorders that cause intense anxiety, such as panic disorder, can increase the risk of alcohol and/or drug misuse as in the short term, substances can ease the symptoms of a panic disorder. However, this isn’t a long-lasting solution and the side effects or withdrawal symptoms of both prescribed medication, illegal drugs, and alcohol can increase the symptoms of anxiety.

Depression and Suicidal Ideation

Living with panic disorder and its associated mental health conditions can lead to a sense of hopelessness as it can make everyday life very difficult, particularly if those with the condition perceive others as coping well. It can create a belief that they are unable to cope with life which can lead to depression and even suicidal ideation. 


Panic attacks can be particularly debilitating for children and young people, and panic disorder may affect their brain development and learning. The fear of a panic attack may stop children from going to school, having a social life, and concentrating on schoolwork. Panic attacks in younger children can look like screaming and crying which can lead to hyperventilation. 

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When to Get Help?

Panic attacks can affect people differently. Whilst some overcome a panic attack on their own, others may require more intensive help.

If you feel you are struggling with panic disorder or panic attacks, it is important to seek professional help so you can access treatment. Struggling with panic can lead to all kinds of complications that can be avoided if help is received early. 

There are various ways of managing the panic disorder and panic attacks from therapeutic techniques to medical interventions such as medication. 

Support Groups

Support groups for those struggling with panic attacks are usually comprised of a small number of people who come together to share their experiences in a safe and supportive environment. Group members often form strong bonds with each other, based on the shared experiences of living with panic attacks. The group settings allow people to learn from each other, feel a sense of hope, and become inspired by each other’s journeys. 

Cognitive Behavioral Therapy (CBT)

CBT is a form of psychotherapy used in the treatment of mental health conditions and is based on the notion that a person’s thoughts, feelings, and perceptions influence their actions and behaviors. In general, people with panic disorder are often more susceptible to negative thoughts and self-defeating beliefs which can result in lowered self-esteem and increased anxiety. CBT can assist people with panic disorder in developing ways to manage their symptoms and reduce fear around having panic attacks. 


Neurotransmitters are chemicals in the brain and when imbalanced can cause mood and anxiety disorders. Antidepressants work by affecting these neurotransmitters in a way that helps reduce anxiety and decrease the frequency and intensity of panic attacks. Different classes of antidepressants influence various types of neurotransmitters. 

Medication for Panic Attacks and Panic Disorder

The most frequently prescribed groups of antidepressants for panic disorder include the following.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are a common type of antidepressant that can be used to treat panic disorder and panic attacks. SSRIs balance serotonin, a neurotransmitter that’s associated with the regulation of bodily functions such as mood and sleep. By preventing your brain cells from absorbing serotonin, SSRIs can help to enhance mood and reduce feelings of panic and anxiety. 

Tricyclic Antidepressants (TCAs)

TCAs are used to successfully treat anxiety and mood disorders. Similar to SSRIs, TCAs work to balance serotonin levels but also norepinephrine, a neurotransmitter linked to the fight-or-flight stress response.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are one of the earliest types of antidepressants but are still considered to be effective in treating conditions related to mood and anxiety. Like TCAs, MAOIs influence the availability of serotonin and norepinephrine and additionally stabilize dopamine, a neurotransmitter that’s linked to energy levels, physical movements, and feelings of motivation.

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Self-Help Tips for Panic Attacks

A panic attack can be very frightening, whether you are experiencing one for the first time or have had many before. Here are some suggestions to help manage panic attacks when they arise. 

Stay Where You Are

When you start having a panic attack, for safety reasons, it is important to stay where you are. This might mean you need to stop driving. Panic attacks can last up to one hour and keeping yourself safe and stable whilst you see it through can prevent unnecessary harm. Your brain might be telling you that the attack is going to last forever, as it feels in danger and the panic attack is the brain’s way of inspiring action to ensure safety. But it will end.


Intentionally slowing your breath lets your body know that everything is okay as it can activate the parasympathetic nervous system which helps move you from fight-flight-freeze to a state of ‘rest and digestion. A breathing exercise that can be helpful to start with is box breathing. Also known as four-square breathing, box breathing involves exhaling for four counts, holding the breath out for four counts, inhaling for four counts, and holding the breath in for four counts before exhaling and beginning the pattern again.

Challenging Fear-Based Thinking

Understanding that during a panic attack your brain will be generating negative thoughts about your safety can help you start challenging them. It is important to remember that these thoughts aren’t facts and are based on a perceived threat. Recognizing the patterns of negative thoughts during a panic attack can help you see them as false which can ease the intensity of panic attack symptoms and your fear of them returning. 

Change Your Focus

Focusing on the negative thoughts and images that are running through your mind during a panic attack can compound the already frightening experience. It can be helpful to actively shift your focus. Some find it helpful to count things that they can see, move their attention to what they can hear, feel their feet on the ground, or speak to someone they trust. 


When you are feeling anxious or are having a panic attack, to counteract the negative thinking, affirmations that feel true can prove helpful in managing the symptoms of a panic attack. Affirmations that might help to self-soothe are: 

  • This panic attack is just a physiological response to fear-based thinking

  • This panic attack will soon pass as they have done before 

  • I can manage this panic attack knowing it is going to pass

  • I have never had a heart attack due to a panic attack 

  • I have never lost my mind due to a panic attack  

  • My brain is telling me I am unsafe, but I am very much safe

  • I am not losing control


Many of the symptoms of panic attacks are attributed to the ‘fight or flight response during which adrenaline and cortisol are released, tricking your body into thinking that you are in danger. Meditation techniques such as breathing, mindfulness, and visualization, can have the opposite effect and trigger the relaxation response, which tells the body it is safe in the here and now. 

Meditation is a powerful tool to help manage panic attacks as they are happening. If meditation is built into your daily routine, it can help decrease the amount of stress in your life making panic attacks less likely to happen. 

Treatment for Panic Attacks and Panic Disorder

Panic attacks are distressing and difficult to live with but with effective treatment, they can be managed. If you think that you might be struggling with a panic disorder, you are not alone.

Treatment for panic attacks and panic disorder aims to reduce the number of panic attacks and ease symptoms through talking therapies, usually cognitive behavioral therapy, and perhaps medication. The treatment suggested will depend on the severity of symptoms someone might be experiencing, how long they have been suffering, any co-occurring disorders they may have or their quality of life. 

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Treatment for Panic Attacks and Panic Disorder at Castle Craig Hospital

At Castle Craig Hospital, we offer bespoke treatment for panic attacks on an inpatient, outpatient, and online basis. To identify the best treatment for you, we can organize a consultation with a trained clinician who will listen to your story and review your medical history to determine the most appropriate level of care to help you recover. 

Inpatient Treatment

Inpatient rehabs are secure, peaceful, safe, and substance-free environments where you might stay for between one and three months. The duration of treatment can vary depending on several factors including the severity and duration of your condition, the type of treatment best suited to you, and any special care you may require.

Outpatient Treatment 

Outpatient rehab is a treatment structure for mental and behavioral health concerns without the need for a residential setting. The programmes offered are often similar to inpatient programmes which are characterized by individual therapy, group work, and 12-step meetings, but without the need to leave your home for weeks at a time. Outpatient treatment can be longer than inpatient treatment as the therapeutic sessions are spread over more days.

Online Rehab 

Online Rehab is an effective way to benefit from our treatment programme without needing to leave your home. Our flexible, confidential, and research-informed online therapy offering is a great option if you think you might be struggling but aren’t able to commit to a traditional inpatient stay.

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