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A panic attack is a sudden feeling of intense fear. Some people say they feel like they are going to die. Others become terrified that they are having a heart attack or a seizure.

One of the main symptoms of panic disorder is having panic attacks again and again.¹

Panic attacks can happen out of the blue, or when you feel generally anxious about a situation (although you may not get a panic attack every time you face a similar situation). They may happen every time you face a particular challenge, say speaking in public.

You'll usually have several symptoms during a panic attack. You may not get all of these with every attack. And your symptoms may change from one attack to another. The symptoms of a panic attack are similar to those that you would feel in a scary situation. For some people, symptoms may be triggered by a kind of deep and heavy breathing called hyperventilation.²

Panic attacks usually come on quickly. And your symptoms are usually at their worst in about 10 minutes. The attacks tend to last just a few minutes. But it may feel like they go on for much longer.

Many people who have panic attacks go to the emergency room because they think they're having a heart attack, an asthma attack or some other serious illness. Many people who have panic disorder that isn't diagnosed, end up going back again and again.

To figure out whether you are having a panic attack, your doctor will try to find out if you have at least 4 out of the 13 symptoms of an attack.

Doctors can often diagnose panic disorder without doing any tests. But sometimes your doctor may do some blood tests or do a test on your heart known as an electrocardiogram (or EKG). You may have these tests if the doctor thinks that something else may be causing your symptoms. Your doctor will also ask you if you worry about having panic attacks because this is one of the main symptoms of panic disorder.

You may have panic disorder if your doctor can't find anything else that is causing your attacks and you've started worrying all the time about when you might have another attack or you've changed your daily routine to try to keep from having another attack.¹

If you don't get treatment for panic disorder, your condition may get worse. You may find it harder to do everyday things like shopping. And you may get agoraphobia (a condition in which you become afraid of many situations and have a hard time leaving your house).² To find out about agoraphobia, see More about agoraphobia.

In a full panic attack you will have at least 4 of the 13 symptoms. If you have fewer than four, then you may have what's called a limited symptom attack. Generally, people with limited attacks have a milder illness than those who get full panic attacks.³ However, people who have limited attacks can go on to get full panic attacks.⁴

Here are some of the symptoms you might get if you have a panic attack.²

Because your brain thinks you are in a scary situation, your heart beats faster and more strongly to send more blood to your muscles. This gets them ready to take any action that's needed, such as running away or fighting.

You start breathing more quickly to get more oxygen into your blood. This oxygen fuels your muscles so that you can run away or fight the threat that you feel is coming. You may feel as though you are having trouble breathing or you're gasping for breath.²

When you breathe deeply and quickly (or hyperventilate), the muscles in your chest can get tired and tense. This makes your chest feel tight or painful.

Your body slows down your digestion so that your muscles can have more energy. When your digestion slows down you make less saliva than usual (saliva plays a part in digestion). So your mouth may feel dry or you may feel as though you're choking or have a lump in your throat.

Your body sweats to cool down. This is another way it gets ready for a burst of physical activity, such as fighting or running away.

You may feel dizzy because some of the blood that usually goes to your brain is being sent to your muscles to get them ready for action.

Your body saves energy by slowing down your digestion. This means that more energy can go to your muscles to get them ready to take action. Because your digestion is slowed down, food stays in your stomach longer and may make you feel queasy.

As your body gets ready for action (running away or fighting), blood is sent to your muscles, especially those in your legs. This means that less blood flows to other parts of your body, especially your feet and hands. And this can make them feel tingly or numb.

Depending on the situation, you may feel hot or cold, or first one way and then the other. As more blood goes to your muscles, less gets to the surface of your skin. This can make you feel cold. Or blood vessels may open up more and move blood toward the surface of the skin to cool the body down. This can make you feel hot.

Trembling or shaking is your body's way of warming up. These things happen because less blood is reaching some parts of your body, such as your hands, feet and skin. And this makes them cold.

You may feel like things are not real or like you're watching yourself from far away. This happens because less blood is getting to your brain as more blood is sent to your muscles.

If you have several panic attacks, you may begin to avoid places or situations where the attacks happened. You may also avoid places where it would be embarrassing to have an attack. You might stop going to the supermarket or other places where you know there will be a lot of people. If this happens you may have a condition called agoraphobia. People have agoraphobia when they can't leave familiar, safe and comfortable surroundings (usually their home). To read more, see More about agoraphobia.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.