Understanding Panic Attacks: Biological and Psychological Causes

Panic attacks stem from complex biological and psychological factors including neurotransmitter changes and nervous system activation, triggering intense physical and emotional responses that can be effectively managed through evidence-based therapeutic interventions and professional mental health support.

Your heart races, breathing quickens, and suddenly everything feels overwhelming – if you've experienced panic attacks, you're not alone in these frightening moments. Understanding the science behind these intense experiences can be the first step toward regaining your sense of control and finding effective ways to manage them.

What Happens During A Panic Attack: Mental And Physical Responses

The psychological causes of and biology behind panic attacks

Panic attacks may cause intense personal pain and fear. However, the biology behind panic attacks is often the same, regardless of the individual they are happening to.

Whether you have had panic attack before or know someone who has, it can be helpful to learn what happens during panic attacks and what you can do to make them more manageable in case they occur.

This article will explore the biological and psychological factors associated with panic disorder and related psychiatric illnesses.

Panic attacks are characterized by panic-like symptoms and distress signals that occur suddenly and unexpectedly. They create a physiological response that may include a sense of impending doom and bodily sensations associated with the fight-or-flight response, such as an increased breathing rate. But what causes panic attacks?

Individuals often associate panic attacks with anxiety. However, while people with anxiety disorders and panic disorder (PD) can experience panic attacks, panic attacks can happen to anybody at any time.

The origin of most panic attacks likely lies in the central nervous system, which can be activated by common fears or sudden stress, among other things.

According to a study published in 2023 examining biological theories regarding panic attacks, “A neurochemical imbalance of neurotransmitters in the brain, such as serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid (GABA), is thought to cause PD symptoms. This biological theory is evidenced by the symptom reduction effects of antidepressant or anxiolytic medication in many PD suffers.”

In other words, an imbalance in the serotonin system and other neurotransmitters that impact cognitive functioning may cause panic disorder. Effective treatments often include therapeutic interventions that address these imbalances through evidence-based approaches.

Other research suggests a multifaceted set of causes involving both genetic and environmental factors. For example, individuals who have first-degree relatives diagnosed with panic disorder may have a higher risk of developing the condition themselves. Likewise, neurobiological studies implicate various brain regions, including the prefrontal cortex and brain stem, as well as dysregulation in neural pathways associated with fear responses.

In some cases, panic attacks do not have a significant cause. However, there are a few mental illnesses, physical conditions, and factors that can lead to or coincide with panic attacks, including but not limited to the following.

Common conditions associated with panic attacks

Generalized anxiety disorder

Anxiety and anxiety disorders can cause panic attacks. While not everyone who has an anxiety disorder experiences panic attacks, the distress associated with anxiety disorders can lead to this symptom. Experiencing panic attacks may lead to more panic attacks, and some people with severe fear of having panic attacks may be diagnosed with panic disorder.

Autism spectrum disorder

Autism spectrum disorder is not a mental illness but a neurodevelopmental condition and form of neurodivergence. Autistic individuals may experience panic attacks and can be at a higher risk of developing mental health conditions like social anxiety disorder. In addition, some autistic people have difficulty with sensory input, such as specific tactile sensations, loud noises, or smells. Evidence suggests that approximately 40% of individuals living with ASD or another form of neurodivergence are also living with an anxiety disorder.

Phobias

Phobias are intense, irrational fears of a specific situation or idea. Although there is no one cause of phobias, researchers believe a traumatic event may sometimes cause phobias. However, some people with phobias may not have had a traumatic encounter–or any encounters–with the object or theme of their fear. Regardless, people with phobias may have panic attacks in response to exposure to–or even at the thought of exposure to–their specific fear.

For example, an individual with social phobia may find themselves in a vicious cycle because they fear entering social situations. This fear can elicit behavioral responses and cognitive symptoms associated with autonomic arousal, leading to panic attacks. This experience then tells their brain that the fear of going into social situations is valid, potentially increasing the phobia and related panic attacks in the future. This is known as fear conditioning.

Stress

While people with the above mental health conditions are at an increased risk for panic attacks, anyone can have a panic attack if they experience significant stress. Some situations may be highly stressful for many people, including being the survivor of or witness of a violent crime or traffic collision. Panic attacks can also occur in response to workplace stress, burnout, sensory overload, and other challenges.

The tendency to assume that panic attacks only happen to people with mental illnesses may be part of the reason some people without diagnosed mental health conditions mistake panic attacks for heart attacks and other challenges. For this reason, it can be helpful to educate yourself about common panic attack symptoms to know when they may be occurring to you or another person. Because panic attack symptoms are often primarily physical, they may not feel the same as anxiety.

Psychological symptoms of panic attacks

When you have a panic attack, you might become lightheaded, struggle to think, or become confused about your thoughts and ideas. You may also experience significant fear and worry. Some people believe they are dying from a physical condition, such as a heart attack, when a panic attack occurs.

While panic attacks can cause an intense fear of danger or death, this fear is imagined rather than real. Although you may believe you’re dying, panic attacks are not a cause of death. However, if you are genuinely concerned that you may be in danger, talking to a healthcare provider about your concerns may be helpful. Note that panic attack symptoms often resolve in 30 minutes to an hour. However, it is possible that they can continue past this time.

During a panic attack, it can be challenging to remember that you are not in danger and the attack will pass. However, reminding yourself and focusing on grounding can help you control your body so you can focus on the moment and prevent worsening symptoms.

The physical responses to panic attacks

The psychological causes of panic attacks, whether specific events or feelings, can differ for each individual. However, the common theme is that some stimulus convinces the mind that the body is in danger. When this response occurs, the body incites the “stress response.” Commonly called the “fight-flight-freeze” response, the stress response is a physiological process that prepares the body to run, fight, or freeze in a traumatic or stressful situation.

The stress response is an evolutionary carryover. In human ancestors, stressors such as predatory animals or severe weather were significantly dangerous. The response helped early humans survive threats. However, modern stressors are often more likely to be social or material rather than immediately life-threatening. People may not need to fight off their taxes or outrun their workplace demands.

or face physical threats, yet the body’s response is triggered just the same. This mismatch between perceived and actual danger is at the heart of panic attacks, producing overwhelming sensations that can feel uncontrollable and frightening.

Understanding both the mental and physical aspects of panic attacks can empower individuals to recognize symptoms early and seek appropriate care. Treatment options, ranging from cognitive-behavioral therapy to medication, target the biological and psychological underpinnings of panic attacks to reduce their frequency and intensity. Moreover, developing coping strategies such as grounding techniques, deep breathing, and mindfulness can help manage symptoms during an attack.

Ultimately, recognizing that panic attacks are a complex interplay between brain chemistry, genetics, environmental triggers, and learned responses allows for more compassionate self-awareness and effective intervention. While panic attacks can be deeply distressing, they are manageable with the right knowledge and support.

By learning what happens during a panic attack and how the body and mind respond, individuals can reclaim control and move toward a healthier, more balanced life.