Panic Attack Types and Symptoms

Key Takeaways

• There are two types of panic attacks: expected and unexpected.
• Panic attacks might happen suddenly without any obvious cause.
• Common symptoms include chest pain, chills, rapid breathing, and rapid heart rate.

Panic attacks are characterized by feelings of fear, dread, and uncomfortable physical symptoms. Attacks are not classified as a mental health disorder in and of themselves; rather, they are classified as a set of symptoms that occur in the context of other mental disorders. Panic attacks are classified into two types: expected and unexpected. Here’s what you need to know about each one.

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is the handbook used by mental health providers for accurate diagnoses.

According to the diagnostic criteria listed in the DSM-5, panic attacks involve a sudden sense of fear and dread, along with at least four other mental, emotional, and physical symptoms.

These symptoms may include:

• Chest pain or discomfort
• Chills or hot flashes
• Derealization or depersonalization
• Excessive sweating
• Fear of dying
• Fear of losing control or going crazy
• Feeling of choking
• Dizziness, feeling unsteady, lightheadedness, or faintness
• Numbness or tingling sensations (paresthesias)
• Heart palpitations or a rapid heart rate
• Nausea or abdominal pain
• Shortness of breath or feelings of smothering
• Trembling or shaking

Panic attack symptoms usually appear suddenly and peak within minutes. After a panic attack, symptoms may either fade away completely or the person might remain anxious, potentially experiencing another panic cycle.

Limited-symptom panic attacks occur when the person experiences less than four of the listed symptoms.

Types of Panic Attacks

Panic attacks can vary in intensity and duration, and they may be triggered by different factors.

The DSM-5 lists two separate and distinct types of panic attacks: expected panic attacks and unexpected panic attacks.

Expected Panic Attacks

Expected attacks occur when specific cues or triggers are present. For example, someone with claustrophobia may anticipate a panic attack in an elevator or other enclosed spaces.

A person who has a fear of flying (aerophobia) might have a panic attack when boarding a plane, during takeoff, or at some point during the flight.

Unexpected Panic Attacks

Unexpected panic attacks occur suddenly without an obvious cause. A person may be completely relaxed before symptoms start.

This type of panic attack doesn’t accompany any conscious internal cues, such as having fearful thoughts, feelings of intense dread and anxiety, or uncomfortable physical sensations. Unexpected attacks also don’t occur with external cues, such as specific phobias or being exposed to a frightening event or situation.

Diagnosis

Panic attacks are most often associated with a diagnosis of panic disorder but can be associated with other mental health disorders. Panic attacks are often related to mood and anxiety disorders, such as:

These attacks can also occur in conjunction with a variety of mental health disorders, including personality disorders, eating disorders, and substance-related disorders.

If you’re experiencing panic attacks, your doctor or qualified mental health provider can determine if your panic symptoms are an indication that you have panic disorder or a different condition.

Your practitioner can provide you with an accurate diagnosis and a proper treatment plan. The earlier you get treated for your panic symptoms, the sooner you can expect to manage your panic attacks.

Panic Attacks in Panic Disorder

Panic disorder is a complex mental health condition that involves feelings of anxiety and apprehension. As outlined in the DSM-5, panic disorder is classified as an anxiety disorder with its own distinct set of diagnostic criteria.

Having experienced one unanticipated panic attack is usually a sign that a person can expect to have more of them in the future. Recurrent and unexpected panic attacks are a hallmark feature of a panic disorder. There is also persistent concern about having additional attacks or significant changes in behavior related to the panic attacks.

People diagnosed with panic disorder may also be subject to having nocturnal panic attacks, a type of unexpected panic attack that occurs when a person is sound asleep and wakes them up with panic symptoms.

Panic disorder typically develops in late adolescence or early adulthood, but can occasionally begin in childhood or late adulthood. It is also almost twice as prevalent in women as men. Because of this, experts recommend that women and girls over the age of 13 be screened for anxiety disorders during routine preventative care exams.

The causes of panic disorder aren’t currently known, but research has found strong familial links, suggesting that having a close biological family member with panic disorder puts someone at greater risk for developing this condition.

Different theories examine the influence of environmental, biological, and psychological influences. Most experts agree that panic disorder is the result of a combination of these factors.

Treatment for Panic Disorder

A person with panic disorder may experience great limitations due to panic attacks. For example, they may spend a significant amount of time worrying about future panic attacks and may even avoid certain places and situations that they believe will contribute to the possibility of having a panic attack.

Additionally, many people with panic disorder deal with loneliness and isolation, feeling ashamed of their symptoms and fearing that others would negatively judge them for their panic symptoms.

Even though there isn’t a cure for a panic disorder, there are numerous treatment options available to help people manage their symptoms. The most common options include prescribed medication and/or psychotherapy. Most people with panic disorder will try both of these options along with practicing self-help techniques.

Medications for panic disorder, such as antidepressants and benzodiazepines, can reduce the intensity of panic attacks and other anxiety-related symptoms. Psychotherapy can assist in helping you deal with difficult emotions and develop healthy coping techniques.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. 2013.

2. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women’s Preventive Services Initiative. Ann Intern Med. 2020. doi:10.7326/M20-0580

3. Na HR, Kang EH, Lee JH, Yu BH. The genetic basis of panic disorder. J Korean Med Sci. 2011;26(6):701-710. doi:10.3346/jkms.2011.26.6.701

By Katharina Star, PhD

Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. 

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