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If you've ever had a panic attack, you'll know how frightening it is. But no matter how alarming your feelings are, it's important to know that they can't hurt you. They usually fade away after a few minutes.

If you get a panic attack, you suddenly feel terrified for no reason. You may even feel as though the world is going to end or you're going to die. Your heart may pound. And you may feel sweaty or find that it's hard to catch your breath. You may also feel dizzy and start to tremble.

If you worry all the time about having an attack and stop doing things you would normally do, you may have what doctors call panic disorder.

Getting treatment can help you feel better and start to live life normally again.

• Panic attacks are scary but they won't hurt you.
• If you get panic attacks often and worry all the time about when you'll have the next one, you may have panic disorder.
• Panic disorder affects about 1 in 50 Americans. It's very common.
• Women are more likely to get panic disorder than men.
• People usually start having panic disorder in their late teens or early 20s.
• Drug treatments and talking therapies (such as cognitive behavioral therapy) are often used to treat panic disorder.
• Most people with panic disorder get better if they have treatment. But the condition may come and go.¹

It's normal to feel scared and panicky when you're in danger. For example, your heart will start to race if a truck looks like it's about to run you over. But a panic attack happens even when you're not in danger and there's nothing to be scared of. Doctors don't really know why some people get panic attacks when there is nothing for them to be afraid of.

Panic attacks can't hurt you, but they can affect your life. You may have one when you're out shopping or driving your car. You may worry all the time about having another attack and wonder when it will happen. You may stop going out at all just in case you have another panic attack.

Panic and fear are part of your body's built-in protection system. They're actually healthy emotions to have. They can save your life when you're in danger. When you're about to step into the road and see a truck rushing toward you, for example, it's fear that gets you to react quickly to get out of the way. And fear can also give you an extra drive when you're nervous or scared. For example, getting nervous before a test may give you the extra push you need to study harder to get a better grade.

If you're afraid, you may have several symptoms. Your response to fear involves many parts of your body, including your brain, the rest of your nervous system, your heart, your muscles and the network of blood vessels in your body. It can make your heart beat faster, make you sweat and shake, and make you feel queasy. To find out more, see What are the symptoms of panic disorder?

You won't have all of these symptoms every time you get scared. For example, if you're driving and suddenly have to swerve to avoid hitting a dog that has run into the road, your heart may race, you may feel breathless and your arms may feel weak. But your face may not go red and you may not get sweaty.

These reactions are the way your body responds to anxiety. The word anxiety covers a range of feelings from worry to absolute panic. We're not exactly sure how feeling afraid or nervous gives you these symptoms. But there seems to be a part of your brain that senses when you're anxious or scared and triggers these reactions in your body. Your body has these reactions to protect you from danger.²

Here's what happens in your body when you get anxious:³

• Part of your body is put on high alert. This happens automatically. You have no control over it
• Your body gets ready to fight the danger or run away from it. When you're scared your brain tells your adrenal glands to pump out more of certain chemicals into your blood. Your adrenal glands are two small organs that sit in your lower back just above each of your kidneys. One of the chemicals that these glands pump out is epinephrine. Epinephrine is sometimes called the "fight or flight" hormone, because it tells your body to get ready to deal with danger
• Your heart beats faster. This is caused by the extra epinephrine in your blood. When your heart beats faster, more blood is pumped around your body. This gives your muscles the energy they need to help you run away from danger or fight it.
• You may tremble or go pale. The extra epinephrine in your body draws blood away from your skin. This means more blood can go to your muscles in case you need to take action to deal with danger.
• You may feel like you need to go to the bathroom. This is because epinephrine relaxes your bladder and bowels.
• You also get distracted from everything else you're doing. Part of your brain senses that you're anxious and tells other parts of your brain how you are feeling. This makes you stop what you're doing and focus on the thing you're worried about. Two chemicals in your nervous system may be important in triggering this reaction. These chemicals are called epinephrine and serotonin.
• Other chemicals in your brain that may play a part in these responses are norepinephrine and dopamine.

All of these reactions are a normal response to stress or fear. And while they're happening, another part of your brain checks to see whether the thing you were afraid of is actually happening. If it doesn't happen, or if the danger passes, your fear responses will fade away.

If you get panic attacks, you suddenly feel absolutely terrified. The only difference between the feelings you have during a panic attack and a normal response to fear is that you get panic attacks when there's nothing to be afraid of.

You may have panic disorder if you start worrying all the time about when you're going to have another panic attack and if you change your usual routine in order to try to avoid having panic attacks.

• Doctors aren't sure why the normal reaction to fear can be triggered for no reason in some people.
• Panic attacks often start after you've been through a stressful life event, such as a divorce, the death of a loved one or the birth of a child.⁴ It may be that if you are afraid of stressful events, you are more likely to get panic disorder.⁴ Sometimes people shake off panic disorder only for it to return when they go through another stressful event. But not everybody who goes through a stressful time gets panic disorder.
• We're all born with a tendency to be anxious.⁵ People with a relaxed attitude toward life are less likely to get panic attacks. People who are worriers usually get this from one or both of their parents. These are the people who are more likely to get panic disorder.⁵

Some things increase your chances of getting panic disorder. Doctors call these risk factors. Some of the main risk factors for panic disorder are going through a stressful event, such as taking important exams.⁶ Women are more likely than men to get panic disorder. Panic attacks tend to start in the late teens or early 20s, so being this age is another risk factor.

To learn more, see Risk factors for panic disorder.

Panic attacks aren't always caused by panic disorder. Sometimes there's a different cause. Drinking too much coffee or taking certain drugs (both legal and illegal ones) can cause panic attacks. Some medical conditions, such as an overactive thyroid, may also make you panic. If your doctor finds a specific medical cause for your panic attacks, then you don't have panic disorder. Treating the cause usually makes the panic attacks go away.

If you only get panic attacks in certain social situations, such as when you're in a big group of people or traveling on a crowded bus or train, you may have another condition, such as a phobia, obsessive-compulsive disorder or post-traumatic stress disorder.

To find out more about other causes of panic attacks, see What else could it be?

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.