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A panic attack causes a sudden sense of horror and terror that often strikes without warning. This sensation can occur at almost any time, and if you have ever had one- you know how debilitating it can be.

Many people describe a panic attack as a near-death experience that can make you feel short of breath, chest pain, sweating, and can cause tunnel vision. Some people faint during the experience, and others lose their balance and fall to the ground. They usually peak within a few minutes, and can last up to 30 minutes, and sometimes even longer.

If you have never had one before, having one can be a terrible experience. But several signs happen before they come on that can help you to know what is happening and how to handle it to the best of your ability. The following signs and symptoms are listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders.)

1. Chest pain.

Any time you feel chest pain, it’s time to seek professional help. It could be a panic attack, but it could also be something more serious. Most people describe it as a pressure and pain that is hard to ignore, and it likely will happen when you are on the verge of a panic attack.

2. Dizziness

When a panic attack is about to strike, you will likely feel lightheaded and dizzy. You may lose your footing and feel as though you cannot hold yourself up. You may also feel as though your vision is going away, similar to tunnel vision. When this strikes, sit down and try to remain as calm as possible.

3. Nausea

As the attack sets in, your stomach will likely begin to start churning. You may feel physically sick, as though you will vomit.

4. Chills

Some describe sweats and chills that happen during the moments of a panic attack. You may feel cold, even though your environment is not cold. Or you may feel as though the flu has suddenly come on.

5. Trembling

During a panic attack, you may begin to shake and tremble. You will have an uncontrollable sensation and as much as you want it to stop, you may find it difficult. I’ve actually felt like I was having a seizure before during a panic attack, and I am here to tell you- trembling is a seriously scary symptom or sign of a panic attack.

6. Fear of death.

Because of all of the strange and sudden symptoms that will set in during a panic attack and in the moments before, you may feel as though you are dying. The cluster of symptoms creates a perfect storm that can be horrifying to the person experiencing them.

7. Racing heart.

Your heart will likely start to beat rapidly. You will be able to feel it throughout your body and the sensation can become overwhelming.

8. Feeling a loss of control.

A panic attack can cause your mind and body to become overwhelmed and in turn, you will feel like you are unable to control anything. These thoughts will pass, but as they are happening, that doesn’t make them any less terrifying.

9. Feeling detached from yourself.

A panic attack may make you feel detached from your body, or as though you are having an out-of-body experience. This likely ties into the feelings of a loss of control and also due to the fears that will take over the forefront of your mind. Regardless- this symptom is serious.

10. Tingling and numbness in limbs.

You may find that your fingers, hands, feet, or arms become numb as a panic attack sets in. However, this can be a symptom of many conditions and should be addressed by your physician.

11. Fainting

This is my personal least favorite and is a symptom of a panic attack that happens to me pretty much every time I have a panic attack. Even though it has happened numerous times to me, I still go to a physician to get myself checked, because of how scary and dangerous fainting can be.

12. Not being able to breathe properly.

You will likely feel as though you are hyperventilating as a panic attack sets in. This can be quite scary. If this happens to you, try your best to control your breath and take deep breaths through your nose and out of your mouth until help arrives.

All of the above symptoms should be addressed by a professional. In most cases, a panic attack can be treated with anxiety medications and helpful coping techniques. But due to the degree of the symptoms and the fact that they are all serious – you should never try to handle them on your own.