• Shortness of breath or hyperventilation
• Sweating
• Heart palpitations or a racing heart
• Trembling or shaking
• Choking feeling
• Feeling unreal or detached from your surroundings
• Nausea or upset stomach
• Feeling dizzy, light-headed, or faint
• Numbness or tingling sensations 
• Hot or cold flashes
• Fear of dying, losing control, or going crazy
• Trouble swallowing
• Sense of impending doom or danger

One of the worst things about panic attacks is the intense fear that you'll have another one.  You may fear having a panic attack so much that you avoid situations where they may occur.  You may even feel unable to leave your home (agoraphobia) because no place feels safe.

Signs and symptoms of panic disorder

Many people experience panic attacks without further episodes or complications.  There is little reason to worry if you've had just one or two panic attacks.  However, some people who've experienced panic attacks go on to develop panic disorder.  Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.  Panic disorder affects approximately 6 million adults, or 2.7% of the U.S. population.  Women are twice as likely to be affected as men.

• Experience frequent, unexpected panic attacks that aren't tied to a specific situation.
• Worry a lot about having another panic attack
• Are behaving differently because of the panic attacks, such as avoiding places where you've previously panicked.

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint.  If you have panic disorder, the recurrent panic attacks take an emotional toll.  The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life.  Eventually, this leads to the following panic disorder symptoms:

• Anticipatory anxiety: Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense.  This anxiety stems from a fear of having future panic attacks.  This "fear of fear" is present most of the time, and can be extremely disabling. 
  

• Phobic Avoidance: You begin to avoid certain situations or environments.  This avoidance may be based on the belief that the situation you're avoiding caused a previous panic attack.  Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack.  Taken to its extreme, phobic avoidance becomes agoraphobia.

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces.  However, it is now believed that agoraphobia develops as a complication of panic attacks.  With agoraphobia, you're afraid of having a panic attack in a situation where escape would be difficult or embarrassing.  You may also be afraid of having a panic attack where you wouldn't be able to get help. 

Because of these fears, you start avoiding more and more situations.  For example, you might begin to avoid crowded places such as shopping malls or sports arenas.  You might also avoid cars, airplanes, subways, and other forms of travel.  In more sever cases, you might only feel safe at home.

Treatment for panic attacks and panic disorder

Panic attacks and panic disorder are treatable conditions.  Cognitive behavioral therapy is generally viewed as the most effective form of treatment for panic attacks, panic disorder, and agoraphobia.  Cognitive behavior therapy focuses on the thinking patterns and behaviors that are sustaining or triggering the panic attacks.  It helps you look at your fears in a more realistic light.  Medication can be used to temporarily control or reduce some of the symptoms of panic disorder.  However, it doesn't treat or resolve the problem.  Medication can be useful in severe cases, but it should not be the only treatment pursued.  Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.

Phobias

A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger.  Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long-lasting, causes intense physical and psychological reactions, and can affect your ability to function normally at work or in social settings.

Common phobias and fears include closed-in places, heights, highway driving, flying insects, snakes, and needles.  However, we can develop phobias of virtually anything.  Most phobias develop in childhood, but they can also develop in adults.

If you have a phobia, you probably realize that your fear is unreasonable, yet you still can't control your feelings.  Just thinking about the feared object or situation may make you anxious.  And when you're actually exposed to the thing you fear, the terror is automatic and overwhelming.  The experience is so nerve-wracking that you may go to great lengths to avoid it - inconveniencing yourself or even changing your lifestyle.

Understanding your phobia is the first step to overcoming it.  It's important to know that phobias are common.  Having a phobia doesn't mean you're crazy.  It also helps to know that phobias are highly treatable.  You can overcome your anxiety and fear, no matter how out of control it feels. 

Common types of phobias and fears

• Animal phobias: Examples include fear of snakes, spiders, rodents, and dogs.
• Natural environment phobias: Examples include fear of heights, storms, water, and fear of the dark.
• Situational phobias: Examples include fear of enclosed spaces, flying, driving, tunnels, and bridges.
• Blood-Injection-Injury phobias: The fear of blood, injury, needles or other medical procedures.

Social phobia and fear of public speaking

Social phobia, also called social anxiety disorder, is fear of social situations where you may be embarrassed or judged.  If you have social phobia you may be excessively self-conscious and afraid of humiliating yourself in front of others.  Your anxiety over how you will look and what others will think may lead you to avoid certain social situations you'd otherwise enjoy.

Fear of public speaking, and extremely common phobia, is a type of social phobia.  Other fears associated with social phobia include fear of eating or drinking in public, talking to strangers, taking exams, mingling at a party, and being called on in class.

Signs and symptoms of phobias

The symptoms of a phobia can range from mild feelings of apprehension and anxiety to a full-blown panic attack.  Typically, the closer you are to the thing you're afraid of, the greater your fear will be.  Your fear will also be higher if getting away is difficult. 

Physical signs and symptoms of a phobia

• Difficulty breathing
• Racing or pounding heart 
• Chest pain or tightness
• Trembling or shaking
• Feeling dizzy or lightheaded
• A churning stomach
• Hot or cold flashes, tingling sensations
• Sweating

Emotional signs and symptoms of a phobia

• Feeling of overwhelming anxiety or panic
• Feeling an intense need to escape
• Feeling "unreal" or detached from yourself
• Fear of losing control or going crazy
• Feeling like you're going to die or pass out
• Knowing that you're overreacting, but feeling powerless to control your fear

Treatment for phobias and fears

Any phobia that interferes with daily living and creates extreme disability should be treated.  With proper treatment, the vast majority of phobia patients can completely overcome their fears and be symptom-free for years, if not for life.  Effective relief can usually be gained through either cognitive behavior therapy, medication, or a combination of both.

Desensitization or exposure therapy focuses on changing your response to the object or situation that you fear, and bay be helpful for specific phobias.  Gradual, repeated exposure  to the cause of your phobia may help you learn to conquer your anxiety.  Cognitive behavioral therapy involves learning ways to view and cope with the feared object or situation differently.  You learn alternative beliefs about your fears and the impact they have on your life.  There's special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.