The Physical and Emotional Signs of Panic Attacks: A Psychologist’s Guide
TL; DR
Panic attacks are the body's fight-or-flight response firing when there's no real danger. It’s like a faulty alarm system that triggers intense physical symptoms like a racing heart, sweating, trembling, and shortness of breath. Catastrophic thoughts like "I'm dying" or "I'm having a heart attack” can also occur. To officially qualify as a panic attack rather than general anxiety, the episode must include specific symptoms from a clinical list of 13, peak within minutes, and typically resolve within 15 to 30 minutes. However, the emotional exhaustion can linger for days. Recognizing the signs is an important first step, but understanding them doesn't make them less disruptive on their own. Therapy for panic disorder, particularly CBT and exposure-based approaches, is the most effective way to retrain that oversensitive alarm system and stop letting panic dictate how you live.
What's Really Happening When Panic Feels Like Danger, But Isn't?
Panic disorder is like a faulty alarm system. Alarms are supposed to let you know when something is wrong, so you can fix it and stay safe. But if an alarm system is too sensitive, it could mistake a bunny in your yard for an intruder. It gets tripped too easily, putting you on edge and disrupting your life. You feel that you have to respond to the alarm every time, just in case this time it’s a real problem.
Responding to the alarm is exhausting, and you spend a lot of energy dealing with it. You might even change how you go about your daily life to try to avoid setting it off. Your life might even be completely structured around the alarm. But in the end, even though it feels like there is a danger, it is just an alarm. It’s a signal, and the signal can be wrong. When folks have panic disorder, panic attacks are the alarm, and the system is way too sensitive. It leaves folks feeling like alarms are going off all the time, and danger is around every corner. Remember, though, that there is hope! Treatment for panic disorder is available, and it tends to be very effective.
What Are Signs of a Panic Attack?
Physical Symptoms of Panic Attacks
Panic attacks involve multiple physical symptoms of fear. There are a certain number of specific symptoms required to diagnose a panic attack (see next section), but there are many physical symptoms that might be going on.
Panic attacks are our body going into full alarm mode. And our body’s main alarm system is the fight or flight response. This nervous system response results in a whole bunch of physical symptoms due to changes going on in the body. Physical signs of a panic attack can include:
Gastrointestinal (GI) symptoms: nausea, stomach ache, diarrhea, or feeling the need to pee
Pupils dilating to let in more light and more visual information (some people find their eyes hurt or are sensitive)
Heart rate increases, or heart pumps harder
Airways relax, breathing can get faster to get more oxygen intake
Muscles tense or might start shaking or trembling
Sweating, to prepare the body to cool it down when it exerts itself.
These are not the only physical symptoms, but they are all aspects of the fight or flight response. They all have the purpose of getting the body ready for fighting danger or running away from it to get to safety. It’s also very difficult not to notice, and thus is a very effective alarm system.
Emotional Symptoms of Panic Attacks
Emotional signs of panic attacks are important to recognize. Sometimes, the fight or flight system is activated, but the main emotions are actually excitement, and it is someone who enjoys feeling that adrenaline. A lot of these symptoms are also present in sexual arousal (for example, pupils dilating and heart rate increasing), but the emotion going on there may be pleasant as well.
When someone is experiencing a panic attack, the primary emotion is fear. As a panic disorder therapist, I recognize that it is not pleasant in any way. The panic attack feels dangerous, and the symptoms of the panic attack themselves seem dangerous.
Cognitive Symptoms of Panic Attacks
There are a few cognitions (thoughts) that are often running through the mind of someone in a panic attack. Some are listed in the next section as well. Some examples are:
“I am dying” - There is a distinct fear and belief that they are dying or going to die because of the panic attack.
“I’m having a heart attack” - The person might think they are having a heart attack, which can lead to death.
“I’m going to faint” - They might think they are going to faint and be seriously harmed.
“I’ll short-circuit and die” - There is sometimes a fear their body won’t be able to handle it anymore, and they’ll just collapse.
“I’m going crazy” - Some may fear they are having a psychotic break or that they will not be able to control their actions. These thoughts often come from how out of control they feel of their own bodies in the moment.
These are all examples of catastrophic interpretations of their physical symptoms, which is a hallmark of panic disorder.
Other cognitive signs of a panic attack have to do with feeling safe again. Often, this looks like focusing on escaping the situation or physical place they are in. Other times, their minds are set on getting help, so they may be thinking about how to get to an emergency room, focusing on calling a safe, trusted loved one, or even on calling 911.
Finally, they are often very focused on the physical symptoms they’re having. Folks often closely monitor their heart rate or other symptoms that are scaring them to see if they change. It’s like monitoring the progress of a venomous snake, hoping it doesn’t finally strike and kill you.
The 13 Signs of A Panic Attack
The above are common experiences of people with panic disorder during a panic attack. Next, I will describe the symptoms required to diagnose someone with a panic attack. This can be helpful to know if it is an anxiety attack or a true panic attack (both of which are highly distressing, in different ways). The 13 signs are:
Pounding heart or increased heart rate
Sweating
Trembling or shaking
Shortness of breath
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, lightheaded, or faint
Chills or hot flashes
Numbness or tingling sensations
Feeling detached from reality or detached from your own body
Fear of losing control or “going crazy”
Fear of dying
Panic Attacks Are Sudden and Short
One feature of panic attacks that often best distinguishes a panic attack from an anxiety attack is how quickly it comes on and how long it lasts. Panic attacks go from 0 to 100 in seconds, or at most a few minutes. And by a few, I mean a few. It shouldn’t take more than about 3 to 5 minutes from when the fear starts rising before it reaches its peak. It really is like a sudden fire alarm going off. Panic attacks then usually only peak once, but there are instances where people have experienced multiple panic attacks in a row.
Panic attacks usually only last from about 10 to 30 minutes (30 minutes being on the long side). In the moment, it feels like it is going on forever and it’s never going to end. In reality, though, they don’t last very long. That being said, the emotional consequences and feeling of exhaustion afterwards can last for a few days for some. On the other hand, anxiety attacks can last pretty much all day. Since the body isn’t going at 100 like it is with panic, the body can keep up feelings of anxiety for much longer.
What is the Most Effective Treatment For Panic?
If you think you’ve been experiencing panic attacks, help is out there. You don’t have to go through it all alone. There is a very effective treatment for panic disorder, and Leap Counseling and Consultation can help. Even if you don’t go with Dr. Wood at Leap, be sure to reach out to a therapist who knows how to use exposure therapy and other cognitive-behavioral treatment (CBT) strategies for panic disorder. CBT for panic, especially the exposure therapy components, is shown to be consistently effective. It is the gold standard treatment for panic disorder. It’s hard work, but support is provided all along the way. It might be time to stop letting that faulty alarm system run your life.
Ready to Stop Letting the Alarm Run Your Life? Panic Disorder Treatment in Wauwatosa, WI, Can Help
Recognizing the signs of a panic attack is a powerful first step, but understanding what's happening in your body doesn't make the panic stop on its own. Panic disorder treatment can help you go further, retraining that oversensitive alarm system so that fear stops feeling like an emergency and starts feeling manageable.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including panic disorder. Dr. Wood offers personalized, evidence-based CBT treatment that targets both the physical and cognitive symptoms of panic. She helps clients challenge catastrophic thinking, build tolerance for uncomfortable sensations, and gradually stop structuring their lives around the next alarm. Taking that first step is more straightforward than panic makes it seem:
Reach out to schedule a free 15-minute consultation to talk through what you've been experiencing
Work one-on-one with an experienced panic disorder therapist in Wauwatosa
Begin learning to recognize panic for what it is and stop letting it call the shots
Other Ways Leap Counseling Helps Clients in Wauwatosa, Wisconsin, and All PSYPACT States
Once you understand what's happening in your body during a panic attack, the next step is learning to respond to those signals differently. That's exactly what panic disorder treatment is designed to help with. With consistent support, many people find that the symptoms that once felt unbearable and dangerous become far more tolerable, and that their lives gradually stop being organized around avoiding the next attack.
Panic disorder is one of several conditions I work with at my Wisconsin-based online therapy practice, and panic rarely travels alone. If other anxiety-related concerns have been part of your experience alongside panic attacks, whether that's OCD, phobias, or something else, those deserve attention too. I offer therapy for a wide range of conditions, including OCD, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I provide specialized anxiety care online to clients across many locations.
However long that faulty alarm system has been disrupting your life, it doesn't have to stay that way. Browse my mental health blog for more on panic attacks, panic disorder, and anxiety treatment. When you're ready to get started, I encourage you to reach out.
About the Author
Dr. Johanna Wood knows what it's like when your own body feels like the threat. Having personally experienced the intrusive thoughts and anxiety spiral of relationship OCD, she understands the physical and emotional intensity of an anxiety system in overdrive. The racing thoughts, the desperate search for safety, and the exhausting cycle of fear and avoidance that can take over a person's life. That lived experience gives her a uniquely grounded perspective when working with clients whose bodies are sending false alarms, whether through panic disorder or another anxiety condition. Her own ERP treatment taught her that moving toward fear rather than away from it is where real relief begins.
That personal insight is backed by extensive clinical training. Dr. Wood is a Wisconsin-based clinical psychologist who earned her PhD in Clinical Psychology from Northern Illinois University and completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program, one of the most specialized anxiety treatment environments in the country. She later supervised clinical staff in that same setting, deepening her expertise across the full spectrum of anxiety disorder severity and presentation. Dr. Wood is licensed in Wisconsin, holds PSYPACT authorization, and is an active member of the International OCD Foundation, contributing to national education efforts on scrupulosity OCD. Her online practice brings that depth of training and personal understanding to clients across Wisconsin and all PSYPACT states.
