Panic attacks typically involve overwhelming feelings of fear that come over you suddenly, usually without any obvious threat.
If you experience panic attacks, you’re not alone: Around 13.2% of people will have a panic attack at some point in their lifetime, and roughly two-thirds of people who have one panic attack will experience additional ones.
But many more people may experience milder episodes of panic that don’t quite meet the full criteria for a panic attack. These limited symptom attacks, also called subclinical or subthreshold panic attacks, may only involve two or three symptoms. Even so, they may feel awful, uncomfortable, or overwhelming — not to mention disrupt your daily life.
Read on to get the rundown on limited symptom attacks, including possible causes, what they feel like, and tips to manage them.
Panic attack vs. anxiety attack
Though many people use “panic attack” and “anxiety attack” interchangeably, these terms actually describe two different experiences.
- may have no obvious trigger and typically focus on the present
- have official DSM-5 criteria
Anxiety attacks, on the other hand:
- may have a specific trigger and typically focus on potential future threats
- involve mostly mental or emotional symptoms
- lack official DSM-5 criteria
Limited symptom attacks may appear as an early sign of panic disorder, a condition where you have recurring panic attacks. They may also happen during treatment for panic disorder, as your symptoms begin to improve.
Limited symptom attacks share many of the same risk factors as panic attacks, including:
According to a small 2020 study of university students, smoking reduces lung function, especially during physical exertion. This can cause a sense of choking or breathlessness, especially in stressful situations, which may prompt a fear of dying.
Secondhand smoke can also trigger limited symptom attacks. According to a 2015 study, adolescents whose parents had post-traumatic stress disorder (PTSD) and smoked were more likely to develop subclinical panic symptoms.
In fact, according to the researchers in the 2015 study mentioned above, a family history of anxiety conditions may have played a role in the participants’ subclinical panic attacks.
If a parent or sibling has panic disorder, your chances of having panic attacks is three to eight times higher than people who don’t have a close relative with panic disorder.
When you constantly feel on edge, it may take less stress to push you past your emotional limits. Given this pattern, you may have experience in recognizing unwanted physical and emotional symptoms. Sweating, shaking, and feelings of fear can suggest that something’s wrong, but without an obvious source of danger, you may not recognize exactly what.
You may feel even more worried as a result, and your unease can create a feedback loop that spirals into panic.
Differences in your biology may also contribute to panic symptoms.
According to a
- An overactive amygdala: This part of the brain helps regulate your fear response.
- Low levels of serotonin: This hormone helps keep anxiety in check.
- An unbalanced fight-or-flight response: This can mean your body goes from 0 to 100 in the face of stress.
- Atypical breathing patterns: Even at rest, you may breathe more deeply and at a faster pace than the average person.
The main difference between limited symptom attacks and full panic attacks lies in the number of symptoms you have. Limited symptom attacks involve three or fewer symptoms.
According to the most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5),” a full panic attack requires
- a rapid heart rate, pounding heart, or sudden palpitations. Your heart may feel as if it’s skipping or racing.
- increased sweating
- trembling and shaking
- difficulty breathing
- a sensation that you’re choking
- chest pain so bad you may believe you’re having a heart attack
- stomach pain or nausea
- dizziness and lightheadedness
- sudden chills or extreme warmth
- feelings of tingling or numbness in your body
- a sense of losing touch with reality or feeling disconnected from your body
- a sudden fear that you’ll lose control of your body
- a strong sense of doom, fear of death, or belief that you’re dying
In a full panic attack, your symptoms will likely intensify and peak within the first 10 minutes. The episode can last anywhere from 20 to 60 minutes.
Anyone can experience limited symptom attacks, so they don’t necessarily suggest an underlying mental health condition.
According to a 2020 study from Greece, people with subthreshold panic symptoms — limited symptom panic attacks, in other words — also experienced certain mental health symptoms at higher rates.
Among the people who reported limited symptom attacks:
- 53% had anxiety
- 42% had excessive worries
- 32% had a specific phobia
- 30% experienced symptoms of depression
- 25% experienced sleep issues
People who reported experiencing full panic attacks had even higher rates of these mental health concerns.
Having panic attacks also increases your risk of agoraphobia, or an intense fear of places or situations that you can’t easily escape, like crowds or packed buildings.
Research suggests this combination can pose more serious mental health consequences than panic attacks alone. More specifically, experiencing both panic symptoms and agoraphobia increases your chances of experiencing co-occurring mental health symptoms.
A panic attack can feel very frightening, no matter how many symptoms it involves.
It may help to keep in mind that they don’t cause any lasting physical health consequences, and they almost always pass on their own without any need for medical attention.
In the moment, you can use a number of strategies to help the episode pass more quickly and feel more bearable until it does.
Symptoms like chest pain and choking could lead you to mistake a panic attack for a heart attack or asthma episode. In fact, over 1 in 20 people who experience a panic attack seek out their primary care doctor, thinking they’ve had a medical event.
But as terrible as your symptoms may feel in the moment, if you’re experiencing a panic attack, they will pass.
During the episode, you may have a harder time believing that statement, but you will feel better before long — and repeating statements like, “I’m safe,” “I’m having a panic attack,” and “These feelings will pass,” could help you feel calmer in the moment.
When to get medical attention
Though anxiety and panic attacks may involve chest pain, an increased heart rate, and shortness of breath, you can also experience these symptoms if you’re having a heart attack.
Chest pain that happens during a heart attack may:
- get worse if you move around
- radiate to other areas, like your arms or jaw
- feel like pressure or squeezing in your chest
During a heart attack, you may also experience other symptoms, like nausea, back pain, or fatigue.
A heart attack is a medical emergency, so it’s best to get urgent medical attention for sudden, severe chest pain — especially if your symptoms last for more than a few minutes.
You’ve likely come across the recommendation to “take deep breaths” a time or two. That’s because your breathing really can make a difference.
Diaphragmatic breathing can, without a doubt, help pull your body out of panic mode — so long as you do it correctly. Breathing from the chest or trying to gulp in air as quickly as possible, could actually make your hyperventilation worse.
A few tips for deep breathing during a panic attack:
- Breathe in through your nose and out through your mouth.
- Steadily take in as much air as you can, but don’t strain yourself. Focus on the sensation of air in your body, rather than timing how many seconds each breath takes.
- After you breathe in, hold your breath for a few seconds to let your body absorb the oxygen.
- Breathe the air out gently. Relax your shoulders, letting them drop as you exhale.
- As you exhale, release as much air as you can, but you don’t have to empty your lungs completely — in other words, don’t force the process.
Remember to breathe with your abdomen, not your chest. It can help to put a hand on your stomach and feel it inflate and deflate like a balloon.
Progressive muscle relaxation
Progressive muscle relaxation, also called applied relaxation, is a technique that helps you relax the muscles of your body.
To get started, lie down and gradually move through the muscle groups in your body, starting from your toes and ending at your head. Squeeze each muscle group as tightly as you can for 5 seconds, then let go so your muscles can fully relax.
During a panic attack, your body winds itself up tighter and tighter, but research suggests progressive muscle relaxation can short-circuit that process and help pull your body out of its defense mode.
To put it another way, the transition from full tension to full release serves as a physical reset for each muscle group.
Since limited symptom attacks don’t meet the criteria for a full panic attack, a mental health professional most likely won’t diagnose panic attacks or panic disorder. Of course, therapy can still make a difference, whether you have an official diagnosis or not.
Learn more about how to find the right therapist for you.
Without treatment, limited symptom panic attacks may progress into full panic attacks or panic disorder. So, working with a therapist can have benefits even if your panic attacks only involve a few symptoms and feel relatively mild.
How cognitive behavioral therapy (CBT) can help
The first-line treatment for panic disorder is cognitive behavioral therapy (CBT), which helps you address thought patterns and behaviors that may contribute to panic attacks.
Up to 75% of people who participated in CBT for panic disorder noticed an improvement in their symptoms within 4 months.
According to a
The study primarily aimed to evaluate the cost-effectiveness of early intervention for subthreshold panic disorder — and researchers suggest that this early intervention may end up lowering overall costs of treatment for panic attacks or panic disorder.
Limited symptom attacks are panic attacks that involve three or fewer symptoms. Although they tend to be milder and shorter than full panic attacks, they cause the same symptoms, like trembling and chills.
Stress-reduction techniques like deep breathing and progressive muscle relaxation can help you cope with a limited symptom panic attack in the moment.
If you experience regular panic attacks, a mental health professional can offer more guidance and support, regardless of how many symptoms your attacks involve. Working with a therapist can help you identify possible triggers and explore options to lower your chances of experiencing panic attacks in the future.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.