Panic Disorder Symptoms An Overview of Panic Attack Types and Symptoms What you need to know about the two main types By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn 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. Learn about our editorial process Updated on September 17, 2020 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 PeopleImages.com / Getty Images Table of Contents View All Table of Contents Symptoms Types Diagnosis Panic Disorder Treatment 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 in making accurate diagnoses. According to the diagnostic criteria listed in the DSM-5, panic attacks are experienced as a sudden sense of fear and dread. These symptoms are accompanied by at least four other mental, emotional, and physical symptoms. The four or more other symptoms may include: Chest pain or discomfort Chills or hot flashes Derealization and/or depersonalization Excessive sweating Fear of dying Fear of losing control or going crazy Feeling of choking Feeling dizzy, unsteady, lightheaded, or faint Feelings of numbness or tingling sensations (paresthesias) Heart palpitations or accelerated heart rate Nausea or abdominal pain Shortness of breath or smothering sensations Trembling or shaking The symptoms of panic attacks typically come on rapidly and peak within minutes. Once a panic attack has subsided, the symptoms can taper off completely or the person can remain in an anxious state, possibly repeating the panic cycle again. Limited-symptom panic attacks occur when the person experiences less than four of the listed symptoms. How to Recognize and Cope With Panic Attack Symptoms Types of Panic Attacks Not only can panic attacks vary in intensity and duration, but they can also differ according to what prompted the attack. The DSM-5 lists two separate and distinct types of panic attacks: expected panic attacks and unexpected panic attacks. Expected Panic Attacks Expected attacks are anticipated when a person is subjected to specific cues or panic triggers. For instance, someone who has a fear of enclosed spaces (claustrophobia) may expect to have panic attacks when in an elevator or other cramped areas. A person who has a fear of flying (aerophobia) may predictably have a panic attack when boarding a plane, at the time of take-off, or at some time during the flight. Unexpected Panic Attacks Unexpected panic attacks occur suddenly without any obvious cause or indication. When an unexpected panic attack occurs, a person can be completely relaxed before symptoms develop. 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. Panic Attack Symptoms, Causes, and Treatments 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: Agoraphobia Bipolar disorder Generalized anxiety disorder (GAD) Major depressive disorder Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Social anxiety disorder (SAD) Specific phobias 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. How Panic Disorder Is Diagnosed 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. Panic Disorder Risk 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. A Word From Verywell Regardless of the options someone chooses, it's important to get help for panic and anxiety. The sooner a diagnosis has been made and treatment begins, the quicker a person can expect to cope with symptoms and manage life with panic disorder. If you or a loved one are struggling with panic attacks or other anxiety symptoms, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. The Best Online Anxiety Support Groups 3 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. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. 2013. 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 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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