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About anxiety and panic attacks

Explains anxiety and panic attacks, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

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Anxiety is something we all experience from time to time. Most people can relate to feeling tense, uncertain and, perhaps, fearful at the thought of sitting an exam, going into hospital, attending an interview or starting a new job. You may worry about feeling uncomfortable, appearing foolish or how successful you will be. In turn, these worries can affect your sleep, appetite and ability to concentrate. If everything goes well, the anxiety will go away.

This type of short-term anxiety can be useful. Feeling nervous before  an exam can make you feel more alert, and enhance your performance. However, if the feelings of anxiety overwhelm you, your ability to concentrate and do well may suffer.

The 'fight or flight' reflex

Anxiety and fear can protect you from danger. When you feel under threat, anxiety and fear trigger the release of hormones, such as adrenalin. Adrenalin causes your heart to beat faster to carry blood where it's most needed. You breathe faster to provide the extra oxygen required for energy. You sweat to prevent overheating. Your mouth may feel dry, as your digestive system slows down to allow more blood to be sent to your muscles. Your senses become heightened and your brain becomes more alert.

These changes make your body able to take action and protect you in a  dangerous situation either by running away or fighting. It is known as the 'fight or flight' reflex. Once the danger has passed, other hormones are released, which may cause you to shake as your muscles start to relax.

This response is useful for protecting you against physical dangers; for example, it can help you run away from wild animals, attackers, fires etc. very quickly. The response is not so useful if you want to run away from exams, public speaking, a driving test, or having an injection. This is because, if there is no physical threat, and you have no need to physically run away or fight, the effects of adrenaline subside more slowly, and you may go on feeling agitated for a long time.

Severe anxiety

If the anxiety stays at a high level for a long time, you may feel that it is difficult to deal with everyday life. The anxiety may become severe; you may feel powerless, out of control, as if you are about to die or go mad. Sometimes, if the feelings of fear overwhelm you, you may experience a panic attack.

What is a panic attack?

A panic attack is an exaggeration of the body’s normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations, such as a pounding heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly. If you experience this, you may fear that you are going mad, blacking out, or having a heart attack. You may be convinced you are going to die in the course of the attack – making this a terrifying experience.

Panic attacks come on very quickly, symptoms usually peaking within 10 minutes. Most panic attacks last for between 5 and 20 minutes. Some people report attacks lasting for up to an hour, but they are likely to be experiencing one attack after another, or a high level of anxiety after the initial attack. You may have one or two panic attacks and never  experience another. Or you may have attacks once a month or several  times each week. For some people they seem to come without warning and strike at random.

I’m walking to the village shop, then the earth shifts to one side, my heart’s hammering as if it will explode, my vision is blurred  and my hands are sticky with sweat. And I’ve no idea why.

Panic attacks can also come in the night and wake you up. These nighttime attacks occur if your brain is on 'high alert' (due to anxiety) and can detect small changes in your body which it then interprets as a sign of danger. Night-time attacks may be particularly frightening, as you may feel confused and are helpless to do anything to spot them coming.

Why do some people feel more anxious than others?

If you worry more than others, it could be because of your personality, current circumstances or your past or childhood experience; it could be a mixture of these.

Past experiences

If something distressing happened to you in the past, and you were unable to deal with your emotions at the time, you may become anxious about facing similar situations again in case they stir up the same feelings of distress.

Feeling anxious could also be something you learned early on in life; for example, your family may have tended to see the world as hostile and dangerous and you’ve learned to respond in the same way.

Some theories suggest that you may inherit a tendency to be more anxious, and so it is a part of your personality.

Everyday life and habits

On a day-to-day basis, caffeine, excess sugar, poor diet, drug misuse, exhaustion, stress and the side effects of certain medication can also mimic and trigger symptoms of anxiety.

Fear of losing control

You may worry about the future. Sometimes, if you feel you are not in control of many aspects of your life, you can start to feel anxious about events beyond your control, such as the threat of global warming, of being attacked, of developing cancer, or of losing a job. 

After a while, you can start to fear the symptoms of anxiety, especially feeling out of control. This sets up a vicious circle. You may feel anxious because you dread feeling the symptoms of anxiety, and then you experience those symptoms because you are having anxious thoughts.

What are the effects of anxiety?

Anxiety can have an effect on both your body and your mind.

Physical effects

Short-term effects:

  • Increased muscular tension can cause discomfort and headaches
  • Rapid breathing may make you feel light-headed and shaky, and give you pins and needles
  • Rising blood pressure can make you more aware of a pounding heart. 
  • Changes in the blood supply to your digestive system may cause nausea and sickness
  • You may feel an urgent need to visit the toilet, and get 'butterflies' in your stomach.                   

Long-term effects:

  • Fear combined with tension and lack of sleep can weaken your immune system, lowering your resistance to infection
  • You may experience digestive difficulties
  • You may also feel depressed. (See Depression)

Psychological effects

Anxiety can make you more fearful, alert, on edge, irritable, and unable to relax or concentrate. You may feel an overwhelming desire to seek the reassurance of others, to be weepy and dependent. 

The way you think can be affected: if you fear that the worst is going to happen, you may start to see everything negatively and become very pessimistic. For example, if a friend is late, you may imagine and worry that he or she has had an accident or doesn’t want to see you; even though your friend may simply be late because their train was delayed.

To cope with these feelings and sensations, you may feel tempted to start smoking or drinking too much, or misusing drugs. You may hold on to relationships that either encourage your anxious outlook or help you avoid situations you find distressing – and so stop you dealing with what’s worrying you.

Impact on work, leisure and relationships

If your anxiety is severe, you may find it difficult to hold down a job, develop or maintain good relationships, or simply to enjoy leisure time. Sleep problems may make your anxious feelings even worse and reduce your ability to cope. (See How to cope with sleep problems).

For some people, anxiety becomes so overwhelming that it takes over their lives. They may experience severe or very frequent panic attacks for no apparent reason, or have a persistent 'free-floating' sense of anxiety. Some people may develop a phobia about going out, or may withdraw from contact with people – even their family and friends. Others have obsessive thoughts or compulsive behaviour, such as endlessly washing their hands.

Anxiety podcast

Mindcast's Matt Wilkinson talks to Gus Marshall about his experience of anxiety and panic attacks.

Read a transcript of the Mindcast.

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