The common physical signs of panic are a pounding heart, fast shallow breathing, sweating, shaking, a dry mouth, a churning stomach and tingling in the lips and fingers; they come from adrenaline and from breathing too fast, and they are frightening but not dangerous in themselves. Chest pain that spreads to the arm or jaw, fainting, confusion, or weakness on one side of the body should not be assumed to be panic and need to be treated as a medical emergency.
Panic produces a recognisable set of body changes, from adrenaline and from breathing too fast, and a few look-alike signs belong to medical emergencies.
Each Sign Has A Mechanical Cause
Adrenaline prepares muscles for hard effort. Reading the signs as preparation, not damage, makes them less alarming.
- Pounding or fast heart — adrenaline raises heart rate and the force of each beat to send blood to the large muscles.
- Fast, shallow breathing — more oxygen intake is wanted for the expected effort.
- Cold, pale or clammy hands and a dry mouth — blood is redirected away from skin and digestion toward the large muscles; sweating cools the body in advance.
- Shaking and weak legs — muscles are primed and tense, and adrenaline itself causes tremor.
- Churning stomach, nausea, urge to use the toilet — digestion is switched off or emptied.
- Wide pupils, sharpened or narrowed vision — see Tunnel Vision & Time Distortion.
Over-Breathing Causes Its Own Symptoms
If you breathe faster than the body needs, you blow off too much carbon dioxide. Lower carbon dioxide in the blood changes blood chemistry and narrows blood vessels supplying the brain, which produces:
- Tingling or numbness in the lips, hands and feet
- Light-headedness or dizziness
- Cramped hands, and a sense of not getting enough air
The feeling of “not enough air” is the opposite of the real problem: you are taking in plenty of oxygen but losing too much carbon dioxide. The fix is to slow down, not to gulp. See Box Breathing (4-4-4-4).
Method: Sorting Panic From A Medical Problem
Step 1: Check the pattern Panic signs usually build with fear, are present together, and ease as you slow your breathing and the situation feels safer.
Step 2: Look for the red flags Treat as a medical problem, not panic, if you or the other person has:
- chest pain or pressure that spreads to the arm, jaw or back
- fainting or near-fainting that does not clear when lying down
- confusion, slurred speech, or weakness or drooping on one side
- difficulty breathing that gets worse with breathing slowly and calmly
Step 3: When unsure, treat it as medical If you cannot tell, treat it as a medical problem and get help. See Shock Treatment for managing a person who is pale, clammy and faint.
Step 4: If it is panic, work the loop Slow the exhale, sit down, and unclench the hands and jaw.
Do not breathe into a bag
Breathing into a paper or plastic bag was once recommended for over-breathing. It can lower oxygen when the real cause is something else, so do not use it. Slow, controlled breathing is safer.
Common Mistakes
- Gulping air — it makes over-breathing worse. Breathe out slowly.
- Assuming every chest sensation is panic — heart attacks look different. Use the red flags above.
- Telling the person it is “only anxiety” — it is real, physical and frightening to them.
What’s Next
- Learn next: Breathing & Body Control — how to bring these signs down
- Combine with: Panic vs Fear — The Difference — knowing which state you are in