Panic Attacks: Symptoms, Triggers, and Evidence-Based Treatment

Diagnostic Features (DSM-5)

Abrupt surge of intense fear/discomfort peaking within minutes, with ≥4 of:

• Palpitations, tachycardia
• Sweating
• Trembling/shaking
• Shortness of breath/smothering
• Choking sensation
• Chest pain/discomfort
• Nausea/abdominal distress
• Dizziness, lightheadedness, faintness
• Chills/heat sensations
• Paresthesias (numbness/tingling)
• Derealization/depersonalization
• Fear of losing control/"going crazy"
• Fear of dying

Triggers

• Unexpected (uncued)
• Situational (phobic cues)
• Interoceptive (body sensations)
• Substance-induced (caffeine, stimulants, withdrawal)
• Medical (hyperthyroidism, pheochromocytoma, arrhythmia, vestibular dysfunction)

Treatment

1. CBT (gold standard): Cognitive restructuring, interoceptive exposure, in vivo exposure, breathing retraining.
2. Medications: SSRIs/SNRIs first-line; benzodiazepines short-term only (dependence risk).
3. Lifestyle: Regular aerobic exercise, caffeine/alcohol reduction, sleep hygiene.
4. Relaxation: Diaphragmatic breathing, progressive muscle relaxation, mindfulness.

Prognosis

Highly treatable. >80% achieve remission with CBT ± medication. Early intervention prevents agoraphobia and chronicity.