Emotions Is a Sense of Impending Doom a Real Symptom? By Lynne Eldridge, MD Lynne Eldridge, MD Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Updated on November 05, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Background Symptom vs. Saying History Causes Other Symptoms Physiological Mechanisms Research Studies Call Your Doctor You may have heard people speak of a "sense of impending doom" in a number of ways, but the truth is that this feeling can be a real medical symptom. What medical conditions may cause this symptom, and what mechanisms might explain why it occurs? Should you pay attention to this feeling if you experience it yourself? Verywell / Cindy Chung What Is a Sense of Impending Doom? Before going into the possible medical or psychological causes of a sense of impending doom, it's important to briefly define and describe this symptom. A sense of impending doom is a feeling of knowing that something life-threatening or tragic is about to occur. Certainly being in the midst of a life-threatening crisis may lead people to feel they may die , but this symptom may actually precede other obviously critical symptoms. For example, for some people who have had serious allergic reactions (anaphylaxis), or who have developed Irukandji syndrome, (collection of symptoms that appear in response to a sting from Carukia barnesi, a type of jellyfish sting) the feeling of impending doom may occur before other serious symptoms which would make a person believe death is imminent. There are several words and phrases people may use in addition to a sense of doom that describes this symptom. These include: A sense of urgencyBeing unable to "settle down"Desire to seek immediate medical care even though other symptoms don't warrant itFeeling anxious, discouraged, restless, or uncertain (to an extreme)Feeling that something bad or unusual is happeningSensing a premonition 1:31 Click Play to Learn More About Senses of Impending Doom This video has been medically reviewed by Akeem Marsh, MD. Symptom vs. Saying One of the difficulties in looking at the sense of impending doom is that this phrase is used in many different ways. It may be used literally to describe a feeling that something very bad is about to happen to you personally. In this way, the phrase would be considered a "symptom." It may also be used to describe your opinion about what is happening in the world in some way. In this case, the phrase might be used as a "prediction." At other times the phrase may simply be used as a figure of speech. For example, a man may remark that he thought he was going to die when his boss stood to discuss company dress code having forgotten to zip his fly. When the man, as an employee, remarks on the irony of this to his boss, he may have a metaphorical sense of impending doom about the future of his employment. History of Medical Significance While most emergency medicine physicians, critical care physicians, and paramedics will tell you that a feeling of impending doom should be taken very seriously, the understanding that a sense of impending doom is a legitimate medical symptom came about long before scientific Western medicine took hold of the developed world. This symptom has been reported as having had medical significance all the way back in ancient Greek and Roman literature. A sense of impending doom was feared in the 1400s and 1500s as a symptom which foreshadowed other symptoms related to the deadly plague (at that time referred to as sweating sickness). Today, in the 21st century, the complaint of a sense of impending doom can be met with the same concern in the eyes of the person experiencing the symptom as well as those of the healthcare professionals faced with the confession of the feeling by their patients. Medical and Psychological Causes There are surprisingly few direct medical studies looking at a sense of impending doom as a symptom, given the frequency with which this symptom appears in the lists of "differential diagnoses" in medical textbooks or on hospital rounds. Some conditions in which a sense of impending doom is listed as a symptom include: Anaphylaxis: A severe allergic reaction can bring a sense of impending doom. Anxiety disorders: Panic disorder (during panic attacks), generalized anxiety disorder, and post-traumatic stress disorder may lead to this symptom. Blood transfusion reactions: Transfusions may trigger allergic reactions (anaphylaxis) with hemolysis (breakdown) of the transfused red blood cells. Symptoms of anxiety and impending doom occur before other symptoms like shortness of breath, palpitations, and blood pressure drop. Exposure to toxins and poisonings: This includes, in particular, the jellyfish stings noted earlier and cyanide poisoning, in which a sense of impending doom is often the first symptom. Intraoperative awareness: Sometimes people "wake up" during surgery, which is also called anesthesia awareness, or unintended awareness. Pheochromocytoma: This type of adrenal gland tumor is often caused by a massive release of catecholamines such as adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine. In turn, these chemicals can cause a sudden increase in blood pressure, a rapid heart rate, sweating, and possibly a sense of impending doom. Pulmonary emboli: Pulmonary emboli are clots that travel to the lungs after breaking off in the legs (deep venous thrombosis). Other symptoms often include the sudden onset of sharp chest pain which increases with a deep breath and may rapidly progress to lightheadedness and unconsciousness. Seizures: Both an epileptic aura and non-epileptic psychogenic seizures can cause a sense of impending doom. Various conditions: Heart attacks, bipolar disorder, and depression all list a sense of impending doom as a possible symptom. In many cases, the sense of impending doom occurs before the symptoms that would indicate a true medical emergency is present. Other Symptoms That Can Occur A sense of impending doom may occur alone (as it did prior to other symptoms with the plague in the middle ages) or along with other symptoms. Some of these symptoms (depending on the underlying cause) may include: Depersonalization (a sense of being detached from yourself) Heart palpitations (heart arrhythmias) Hot flashes Shortness of breath Sweating Tremors and shaking Physiological Mechanisms There are a number of physiological explanations that may help to explain the sense of impending doom and how this feeling arises. A release of catecholamines may occur as a primary factor (such as in pheochromocytoma) , in response to the body recognizing a medical emergency (such as with a heart attack or pulmonary embolism), or in response to psychological stress (panic) as part of the fight or flight response to stress. A nervous system component could very well underlie this symptom in some cases. A sense of impending doom has been noted in many people with temporal lobe epilepsy and may also occur as part of an epileptic aura (focal aware seizures). Certainly, the symptoms of a heart attack or another life-threatening condition may cause a sense of impending doom in a conscious rather than unconscious manner , as you recognize symptoms (such as a sudden severe drop in blood pressure and major chest pain) that are often associated with death. It is not so surprising that people may have a sense of impending doom when faced with a life-threatening medical condition, even without conscious thought. We know that our bodies respond in many ways to stress without conscious deliberation. There are changes that precede seizures that dogs can sometimes recognize before people (and are the reason behind seizure alert service dogs). Another concept somewhat akin to the sense of impending doom that is similarly not well understood is near death awareness. In near-death awareness, a person who appears unchanged to you may suddenly remark that they are going to die—and then die. Research Studies About Sensing Impending Doom Surprisingly, there are few studies directly looking at the importance of a sense of impending doom as a symptom of various medical conditions, despite the fact that this symptom is mentioned fairly often in the lists of symptoms in the medical literature. A 2012 study looking at people who developed cardiac tamponade, a life-threatening condition in which blood accumulates between the membranes lining the heart (restricting the ability of the heart to contract), found that almost 90 percent of people experienced a "dysphoric mood." Many of them stated that they knew that "a bad thing was happening." Most studies have looked at this symptom only indirectly. For example, a Chinese study found that emergency physicians were more likely to determine that a patient required emergency care for a cardiac condition if the patient complained of a sense of impending doom. In fact, this symptom carried more weight than other symptoms in making that decision. While studies such as this tell us that physicians are heeding and acting on this symptom, they don't really tell us the significance of the symptom. When to Call Your Doctor Unless you commonly have the feeling of impending doom as part of an anxiety disorder, it may be best to call 911 if you have an overwhelming sense of impending doom. Many people have stayed alive due to trusting their instinct and intuition. If you are uncertain, ask yourself, "what is the worst thing that could happen?" If your symptom means nothing, you may waste your day and the cost of an emergency room visit. Unlike modern video games, our bodies don't have a "restart" button if you choose to ignore a symptom that is signaling a life-threatening condition. A Word From Verywell While we don't really understand the significance of a sense of impending doom, we do recognize this feeling as being important medically at times. The mechanisms which could underly this symptom also support that impending doom is a legitimate medical symptom. Finally, the intuition of physicians spanning the years from ancient Greece to the 21st century tells us that a sense of impending doom deserves to be heeded, at least until we know more. 18 Sources 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. Willis MA, Haines DE. The Limbic System in Haines DE, Mihailoff GA Eds. Fundamental Neuroscience for Basic and Clinical Applications (Fifth Edition). Elsevier. 2018. doi:10.1016/B978-0-323-39632-5.00031-1 Gershwin LA. Jellyfish: A Natural History. University of Chicago Press. 2016. Symptom. Merriam-Webster Dictionary. Figure of speech. Merriam-Webster Dictionary. Huppert, D., Oldelehr, H., Krammling, B., Benson, J., and T. Brandt. What the Ancient Greeks and Romans Knew (And Did Not Know) About Seasickness. Neurology. 2016;86(6):560-5. doi:10.1212/WNL.0000000000002355 Anaphylaxis: An overwhelming allergic reaction. Harvard Health Publishing. Harvard Medical School. 2009. Anxiety disorders. Mayo Clinic. Yu H, Wu D. Effects of different methods of general anesthesia on intraoperative awareness in surgical patients. Medicine (Baltimore). 2017;96(42):e6428. doi:10.1097/MD.0000000000006428 Pheochromocytoma. Mayo Clinic. 2018. Epilepsy. Stanford Health Care. Heart Attack (Myocardial Infarction). Cedars-Sinai. Graeff FG. New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray. Braz J Med Biol Res. 2012;45(4):366-75. doi:10.1590/S0100-879X2012007500036 Panic Attacks and Panic Disorder. Mayo Clinic. 2018. Lalitha R, Opio CK. A missed diagnosis or a masquerading disease: back to the basics. Pan Afr Med J. 2013;15:29. doi:10.11604/pamj.2013.15.29.2039 Gilchrist PT, Ditto B. Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms. Biol Psychol. 2015;104:28-34. doi:10.1016/j.biopsycho.2014.11.006 Ikematsu Y, Kloos JA. Patients' descriptions of dysphoria associated with cardiac tamponade. Heart Lung. 2012;41(3):264-70. doi:10.1016/j.hrtlng.2011.08.005 Song L, Yan HB, Hu DY, Yang JG, Sun YH. Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing. Chin Med J. 2010;123(6):664-9. Anaphylaxis. American Academy of Allergy Asthma & Immunology. Additional Reading Greyson, B., Fountain, N., Derr, L., and D. Broshek. Out-of-Body Experiences Associated with Seizures. Frontiers in Human Neuroscience. 2014. 8:65. Huppert, D., Oldelehr, H., Krammling, B., Benson, J., and T. Brandt. What the Ancient Greeks and Romans Knew (And Did Not Know) About Seasickness. Neurology. 86(6):560-5. Ikematsu, Y., and J. Kloos. Patient’s Descriptions of Dysphoria Associated With Cardiac Tamponade. Heart and Lung. 2012. 41(3):264-70. Iles-Smith, H., Deaton, C., Campbell, M., Mercer, C., and L. McGowan. The Experiences of Myocardial Infarction Patients Readmitted Within Six Months of Primary Percutaneous Coronary Intervention. Journal of Clinical Nursing. 2017 Jan 2. (Epub ahead of print). Song, L., Yan, H., Hu, D., Yang, J., and Y. Sun. Pre-Hospital Care-Seeking in Patients with Acute Myocardial Infarction and Subsequent Quality of Care in Bejing. Chinese Medical Journal. 2010. 123(6):664-9. By Lynne Eldridge, MD Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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