Inside a Panic Attack: What It Feels Like and What's Happening Under the Hood

Imagine this: You’re minding your own business, maybe scrolling on your phone, sitting in a meeting, or waiting in line at a coffee shop, when out of nowhere, your body decides you’re in mortal danger. Your heart pounds like a drum solo, your breathing goes haywire, your limbs tingle, and a deep, primal dread floods your system. Your brain has just hit the panic button, except … there’s no actual emergency.  If this sounds familiar, you’re in good company. Panic attacks affect around 2.7 % of adults every year, and for those with panic disorder, these episodes become frequent, unpredictable, and life-disrupting. Unlike general anxiety, which builds gradually, panic attacks strike like a lightning bolt: sudden, intense, and seemingly out of nowhere. One moment you’re fine, and the next, your body is convinced you're about to die, lose control, or go completely insane [1,2].

But here’s the thing: Panic attacks feel catastrophic, but they’re actually a mechanical process, your body running an outdated survival script at the wrong time. Once you understand what’s happening under the hood, it may be easier to start rewriting that script. So, let’s break it down: What exactly happens during a panic attack, and why does your body react like you’ve just been dropped into a horror movie? Spoiler: It’s not random, and your neurohormonal system is (mostly) just trying to help, it’s just really bad at knowing when to stop.

Drowning on Dry Land: The Sensations of a Panic Attack

The first panic attack typically occurs between the ages of 20 and 24, though it can happen at any age. It involves sudden intense fear or severe discomfort, accompanied by physical symptoms such as pounding or racing heart, rapid and shallow breathing, sweating, shaking or trembling, choking sensations, chest pain, nausea, abdominal discomfort, dizziness, fainting, chills, flushing, and numbness or tingling. You may also experience derealization (feeling disconnected from your surroundings, as though the world isn’t real) or depersonalization (feeling detached from yourself, as if you’re observing your body or actions from outside). These symptoms can be accompanied by an overwhelming fear of losing control, going crazy, or even dying.  About one-third of individuals with panic disorder experience nocturnal attacks, where you awaken from sleep feeling panicked.  The frequency and intensity of panic attacks varies a lot among individuals [5,6,7]. And if you experience panic attacks (or even didn't until now), reading that list might’ve just given you some new ideas. But I’ve pointed it out, so the spell is broken. Everything wil be okay.

Even if you’ve experienced panic attacks many times and know exactly what they are, an acute episode can still leave you feeling overwhelmed by fear and uncertainty, which only intensifies the symptoms. If you’re prone to panic attacks, you’re likely to be excessively anxious and often expect the worst outcomes. Panic attacks often fuel concerns about your physical health; it’s hard to believe that such intense symptoms could be purely psychological. After a panic episode, a persistent fear of recurrence often develops, leading to the avoidance of situations perceived as potential triggers. But panic attacks can strike in a variety of stressful circumstances, some of which may not even be obvious. Something as mundane as stale air or a lack of oxygen can be enough to trigger an episode. Over time, you may find yourself avoiding ... well, just everything.  The avoidance can immensely impair your quality of life, gradually isolating you from activities, places, and even people. The constant worry that often accompanies panic disorder doesn’t just weigh on your mind; it increases your susceptibility to further panic attacks. The unrelenting state of anxiety can also lead to unhealthy coping mechanisms, like the use of addictive substances and activities. Brutal.

The Bilogy of Freaking Out: What’s Happening in Your Brain and Body

Panic attacks may look and feel like pure chaos, but mechanically, your body is following a well-worn biological script. The initial slamming of the panic button starts with the amygdala, a part of the brain located in the temporal lobes. Often called the brain’s “fear center,” the amygdala is like an overzealous security guard, constantly scanning for threats and sometimes going overboard—interpreting harmless situations, like a crowded elevator, as if they’re a five-alarm fire. Once the amygdala raises the alarm, it immediately dispatches the message to two key departments: the nervous system and the hormonal system. In the nervous system, the alarm reaches the locus coeruleus, a.k.a. “adrenaline headquarters.” This manager of alertness and arousal takes its job very seriously, ensuring every corner of the body is prepped for action. Once the locus coeruleus is on board, it activates the sympathetic nervous system, sending out an urgent memo to the heart, blood vessels, sweat glands, and eyes. The result? Your heart races, blood flows to the muscles, and your pupils dilate: all part of your body’s emergency preparedness plan [6].

At this point, all hell breaks loose in your body’s office, and the team shifts into full survival mode. The heart, a loyal overachiever in emergencies, starts working overtime, pumping faster and harder to ensure every muscle has the fuel it needs. Blood pressure surges, and the pupils, ever the eager assistants, switch to "zoom mode," sharpening your vision to spot distant threats, no matter how far-fetched they might be. Meanwhile, the blood vessels in your muscles throw open the gates, readying you for action, while the digestive team gets a memo to stand by. With digestion effectively put on pause, energy is conserved for the real stars of the show: fight or flight. Over at the adrenal department, the glands get a direct order from the sympathetic system to release adrenaline and noradrenaline into the bloodstream. These hormones act like turbo boosters, delivering an extra jolt of energy to help you either fight the proverbial bear or sprint away at record speed. Heart rate, blood pressure, and breathing rate hit peak performance—all part of the body’s epic overreaction, whether the danger is real or just a figment of the amygdala’s imagination [6].

On the hormonal side, the amygdala calls in reinforcements by activating the hypothalamus, the brain’s dependable operations manager. Often called the body’s thermostat, the hypothalamus oversees essential processes like temperature, hunger, and stress. In this scenario, it grabs the stress-response whistle and blows it loud, releasing CRF (corticotropin-releasing factor). Think of CRF as the urgent memo that kicks off the next step in the chain reaction: rallying the pituitary gland. The pituitary, sometimes dubbed the "master gland", acts like the head of HR at the brain’s headquarters. Sitting at the base of the brain, it coordinates hormone production for a wide variety of bodily functions. When it gets the CRF memo, it immediately dispatches ACTH (adrenocorticotropic hormone), a courier tasked with delivering stress-related instructions to the adrenal cortex. The adrenal cortex, the outer layer of the adrenal glands perched like little hats on top of your kidneys, is the long-term crisis manager in this operation. Its main job is to produce cortisol, the body’s go-to stress hormone. Cortisol works overtime to keep you energized by increasing blood glucose levels, while also temporarily suspending less critical tasks like digestion and immunity. This stress-response chain, known as the HPA axis, operates like a well-oiled relay team, passing signals down the line to ensure your body is ready for action—whether the danger is a rampaging lion or just the overenthusiastic imagination of your amygdala [6].

Hyperventilation during a panic attack throws yet another wrench into the machinery. Instead of deep, steady breaths that fuel your body efficiently, shallow, rapid breathing from the upper chest takes over—like an overworked employee rushing through tasks and making mistakes. This frantic exhalation expels too much CO2, causing respiratory alkalosis, a condition where your blood’s pH rises, disrupting the delicate balance of oxygen and carbon dioxide. The result? It’s like your body’s engine starts sputtering on a bad fuel mix. Reduced blood flow to key areas leads to dizziness, tingling in your hands and feet, headaches, and even fainting—symptoms that make the whole ordeal even scarier [8]. Luckily, there’s a quick fix: breathing into a paper bag. Think of it as recycling your CO2, gently rebalancing your system and coaxing your body back to its steady rhythm. With restored balance, those alarming symptoms start to subside, and the chaos gradually gives way to calm.

From Panic to Power

Panic disorder might have gotten a head start, but it doesn’t have to be the boss of you. Sure, your brain’s ancient survival system is trying a little too hard to keep you safe, but with the right tools and a bit of practice, you can teach it to chill. After all, you should be in charge, not some overzealous alarm system that can’t tell the difference between a cyclist and a crowded elevator.  The journey from panic to power isn’t about erasing your alarm system, but about turning the volume down and learning to work with it. Think of it as upgrading your operating system: you’re keeping the parts that help you and letting go of the parts that hold you back. Panic might be part of your story, but it doesn’t get to write the ending. That’s up to you.

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