Panic attack: symptoms, causes, and what actually happens in the body

The first panic attack often feels like a heart attack. An ambulance, a cardiologist, tests — and “there’s nothing wrong with you.” But something is wrong. Something strong enough that your body believed it was dying. If you’re here because you’ve lived through that — or because you’re afraid it will happen again — you are not crazy. You are not dying. And you are not alone.

In Bulgaria, anxiety disorders are the most common mental health condition — about 8.4% of people. A panic attack is one of the most intense ways anxiety shows up. This article explains what happens, why it feels like mortal danger, and what actually helps.

What is a panic attack

A panic attack is a sudden wave of intense fear or discomfort. It usually peaks within about ten minutes and then eases on its own — even when it feels like “this will never end.”

The key thing many people learn late: a panic attack is safe, even though it feels like dying. Your body is not falling apart. The alarm system is on full blast — without a real external threat.

It can happen once. It can happen again. It can come during the day — or at night, when you wake with a racing heart and the sense that something is terribly wrong. Night-time panic attacks are not a “more dangerous kind.” Same mechanism, just at a moment when there’s nothing to distract you.

Symptoms — what the body feels and what the mind says

People search for “panic attack symptoms” because they want a name for what happened. Here are the most common:

In the body:

• racing heart / palpitations
• tightness in the chest or a lump in the throat
• shortness of breath or the feeling that air isn’t enough
• numbness in limbs, lips, face
• dizziness, unsteadiness
• sweating, shaking
• nausea
• hot or cold waves

In the mind:

• “I’m having a heart attack.”
• “I’m going to faint.”
• “I’m going crazy.”
• “I’m losing control.”
• a sense of unreality (derealization) — the world feels distant, “like a film”
• fear of death

If you recognise several of these at once — especially with sharp fear and the urge to flee or seek help — you have likely had a panic attack.

What actually happens in the body

This is often where fear starts to ease: when the symptoms make sense.

The brain’s alarm system — the amygdala — fires as if there is real danger. Adrenaline is released. The body enters “fight or flight.” That is an ancient, useful programme. The problem is that it switches on without a lion in front of you.

Every symptom has a logic in this mode:

• Heart rate rises to send blood to the muscles — ready to run.
• Breathing speeds up for more oxygen.
• Blood moves to the large muscles — which is why hands and face can go numb.
• Vision narrows toward the “threat” — which is why dizziness or unreality appear.

The body is doing exactly what it was built to do. Just at the wrong moment. The symptoms are a side effect of protection, not of disease.

When you understand this, the attack does not become pleasant — but it becomes less mysterious. And mystery is what feeds the next wave of fear.

“But are you sure it isn’t my heart?”

A reasonable question. And the answer is not “don’t see a doctor.”

A one-time check with a cardiologist is sensible — especially after a first attack. No one should self-diagnose via Google at 2 a.m. If you have chest pain, severe breathlessness, or suspect an emergency — call your local emergency number.

But: when tests are clear and the episodes repeat in a similar pattern — the same sensations, the same peak, the same fading — endless specialist visits often don’t bring calm. They feed the fear. Health anxiety grows with every new test “just in case.”

Brief orientation points (not a diagnosis):

• panic usually peaks and eases within minutes
• it comes with strong fear of going crazy, losing control, or dying
• it often appears at rest, under stress, or without a clear external cause
• cardiac emergencies have a different pattern — and deserve medical assessment when there is doubt

Once medicine has ruled out the acute — the next useful step is usually not another test. It is understanding the anxiety.

Why it feels like it comes “from nowhere”

“From nowhere” is how it feels. Rarely how it works.

A panic attack often follows build-up: months of overload, suppressed emotions, conflicts you “don’t have time” to feel, care for everyone except yourself, a body that has long been whispering “enough.”

Panic is an alarm that has been screaming quietly for a long time before you heard it. It is not weakness. It is not drama. The body says what you have not allowed yourself to say — fatigue, fear, anger, grief, a need for a boundary.

That is why in-the-moment techniques help you ride the wave. Therapy helps you understand why the alarm was set so sensitive.

What to do during an attack (step by step)

There is no magic formula that “stops” every attack in seconds. There are things that lower intensity and teach the nervous system that you are safe.

1. Don’t flee the place. If you escape every time, the brain records: “This place is dangerous.” Next time the fear is stronger. Stay if you can — even when it’s hard.
2. Lengthen the exhale. Inhale for 4 seconds. Exhale for 6–8. The exhale calms the nervous system faster than “breathe deeply” with no direction.
3. Grounding 5-4-3-2-1. Name: 5 things you see; 4 you can touch; 3 you hear; 2 you smell; 1 you taste. It brings attention into the present — where there is no catastrophe.
4. Name it. Quietly or out loud: “This is a panic attack. It will peak and pass in minutes. It is safe.” Naming reduces the sense that “something unknown is killing me.”

After the attack the body can stay “wired” for hours. That is normal. It is not a new attack. It is the aftershock of adrenaline.

What does NOT help (though it looks logical)

• Constantly checking pulse and blood pressure. The device becomes a mirror of fear. Every blip intensifies it.
• Avoiding places and situations. It shrinks life. That is how agoraphobia grows — life inside an ever smaller circle of “safe” places.
• Alcohol “to calm down”. It may dull the evening. It often returns anxiety doubled the next day.
• “Pull yourself together.” Your own voice or someone else’s. Panic does not obey willpower. It eases with understanding and safety — not with shame.

When it’s time for a psychotherapist

If the attacks repeat. If between them you live in fear of the next one — “fear of fear.” If you start avoiding driving, the metro, shops, travel, meetings. If night-time awakenings have become part of the week.

Techniques help in the moment. Therapy works with the cause — what the alarm has been accumulating and why it rings. In my work with adults around anxiety and panic attacks, we don’t only ask “how do I stop the symptom.” We ask what the body is saying when it can no longer whisper.

The good news that is rarely said loudly enough: panic disorder and recurring panic attacks respond very well to psychotherapy. Not because you “have to be strong.” Because the nervous system learns — when there is space, relationship, and time.

Book a session

I work with adults around anxiety, panic attacks, stress, and emotional difficulties — in Sofia or online.

Book a session via the website · Book via Superdoc

This article is for information only and does not replace consultation with a doctor or psychotherapist. If you have chest pain or suspect an emergency, call your local emergency number.