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What Causes Panic Attacks

What Causes Panic Attacks?

Beyond other anxiety disorders, fear, and worry there are physical and mental processes responsible for panic attacks and anxiety.

The sympathetic nervous system, the amygdala, catastrophic thinking, psychological issues, and risk factors are some of the main causes of panic attacks.

A panic attack is a very brief episode of intense fear and discomfort.

The symptoms of a panic attack include:

  • Shortness of breath

  • Feelings of choking

  • Chest pain

  • Nausea

  • Feeling dizzy

  • Faintness

  • Feelings of unreality (Derealization) or feeling detached from your body (Depersonalization)

  • Fear of losing control or going crazy

  • Fear of dying

  • Numbness or tingling

  • Chills or hot flashes

  • Pounding heart

  • Sweating

  • Trembling

Sympathetic Nervous System

The sympathetic nervous system is responsible for the “Stress Response” also called the “Fight or Flight or Freeze Response” in order to provide us with the internal resources to deal with a real threat or danger.​

Just remember that the sympathetic nervous system "Sympathizes" with you in times of danger.

It is fast, automatic, and is activated mostly without your conscious control. It is responsible for the physical sensations of panic or the fight, flight, and freeze stress response.


During times of stress or danger, your senses send messages to your amygdala in the brain.

The small almond shaped amygdala is your emotional center and is responsible for causing the emotional feeling of fear. ​

When your amygdala gets the message that there is danger, it sounds the alarm for your sympathetic nervous system to release adrenaline to help you react to the danger.

This causes the symptoms you feel during a panic attack.

The thinking part of your brain also gets this message so that you can determine if the danger is real or not.

If you have the thought or belief that the danger is real, then your amygdala will get that message from your thoughts and it will continue to sound the alarm which will cause your hypothalamus to dump more hormones into your blood stream, further fueling a panic attack.

Catastrophic Thinking

Catastrophic thinking causes the amygdala to turn on the body's fight or flight or freeze stress response and triggers the vicious cycle of panic.

The Vicious Cycle of Panic

  • The Trigger can be a thought or a situation.

  • You then Perceive Danger. The thought or situation can be of an internal (Physical) or external (Phobic) threat. An example of an unhelpful thought for an internal threat is “My heart feels like it is beating fast. I must be having a heart attack.” An example of an unhelpful thought for an external threat is, “This plane that I’m on could crash.”

  • This sends a message to your amygdala to sound the alarm and causes more Fear and apprehension of the perceived danger.

  • The sympathetic nervous system automatically kicks in and increases physical Body Sensations (pounding heart, sweating, shaking).

  • You Label the Sensations as Catastrophic, you have a panic attack, and this confirms the danger.

Your Perceived Danger increases and the cycle continues. This becomes a vicious cycle of panic. Avoiding the situation or running away also falsely confirms that the danger is real and gives more power to future panic attacks.

Psychological Issues

With Panic Attacks, the main issue is worry and fear of having future panic attacks after experiencing your first panic attack.

The reason your panic attacks started in the first place, however, is usually related to something other than fear of a panic attack.

A current death of a loved one or some other kind of loss could trigger the belief that the world is a dangerous place and that you are vulnerable and helpless.

Depression and anxiety disorders can manifest from these beliefs and lead to a number of emotional, physical, and behavioral symptoms such as panic attacks.

Risk Factors for Panic Attacks

Family history of anxiety: Some research indicates that first-degree relatives of patients with panic disorder have higher rates of panic disorder than relatives of patients with major depression and relatives of healthy controls (Goldstein et al 1994).

Respiratory illnesses: Conditions such as asthma can cause breathing issues that lead to shortness of breath and feeling dizzy. This could cause the fear of internal physical danger, triggering a panic attack.

Environment: Physical and psychological abuse, traumatic events, the death of a loved one, divorce, abandonment, and maladaptive behaviors learned from parents pose a greater risk for the development of an anxiety disorder such as panic disorder.

Those with an anxiety disorder may have inherited anxiety from their families as a result of stressful family and life circumstances.

Other anxieties: Other anxieties such as PTSD, social anxiety, and phobias all have the potential risk to trigger panic attacks.


Attacking Panic System

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I want to help you. Please feel free to contact me confidentially by email below with any questions or if you need some advice about the content posted on The Fear Blog.

Dr Hunter's Qualifications


My name is Dr. Russell A Hunter, PsyD and I am a Licensed Clinical Psychologist recognized by the National Register of Health Service Psychologists as meeting the National Register’s stringent requirements for education and experience as a healthcare professional.


I specialize in the field of Clinical Psychology and I am an expert in the treatment of Panic Disorder, Anxiety Disorders,  ADHD, and Neurocognitive Disorders. I provide CBT and psychological testing at Northern Virginia Psychiatric Associates within the Prince William Medical Center.

I published a book titled, "Attacking Panic: The Power to Be Calm" and it is available on Amazon and Barnes & Noble. 

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