A panic attack (serangan panik) is a sudden rush of intense fear with strong physical symptoms, such as a pounding heart, chest pain and feeling unable to breathe. It can feel like something terrible is happening, but according to the NHS, panic attacks are not dangerous and will not cause you physical harm. Most attacks last between 5 and 20 minutes. If they keep coming back, panic disorder is treatable with talking therapy, medicine or both. This guide explains the tanda panic attack, how it differs from an anxiety attack and a heart attack, cara tenangkan diri during an attack, and where to get help in Malaysia.
Need help now? If you have new chest pain and are not sure it is panic, or you are thinking about suicide or harming yourself, call 999 or go to the nearest emergency department.
You can also talk to someone: Talian HEAL 15555 (Ministry of Health mental health line) or Befrienders KL +603-7627 2929 (24 hours).
Apa itu panic attack?
According to the NHS, during a panic attack you get a rush of intense mental and physical symptoms. It can come on very quickly and for no apparent reason. Anxiety is a feeling of unease that ranges from mild to severe, and panic is the most severe form of anxiety.
Panic attacks are common. Cleveland Clinic reports that up to 11% of people in the United States have a panic attack each year. Not everyone who has a panic attack develops panic disorder, which is when attacks keep happening (see panic disorder). In Chinese, a panic attack is called 恐慌發作.
Women are affected more often. In a large US survey reported by the National Institute of Mental Health (NIMH), 3.8% of women had panic disorder in the past year, compared with 1.6% of men, and it was most common between the ages of 30 and 44.
Tanda panic attack: symptoms
According to the NHS, symptoms of a panic attack include:
| Body | Mind and feelings |
|---|---|
| A racing heartbeat; chest pain | A feeling of dread or a fear of dying |
| Shortness of breath; a choking sensation | Feeling like you are not connected to your body |
| Sweating, hot flushes or chills | |
| Trembling or shaky limbs | |
| Feeling faint or dizzy | |
| Nausea or a churning stomach; dry mouth | |
| Numbness, pins and needles, or tingling in your fingers |
Cleveland Clinic says symptoms usually peak within 10 minutes and then fade. The NHS says most panic attacks last 5 to 20 minutes, and some have been reported to last up to an hour. Some people have attacks once or twice a month, while others have them several times a week.
The NHS also points out that most of these symptoms can be caused by other conditions. For example, a racing or pounding heart (palpitations) can also be caused by caffeine, an overactive thyroid (tiroid), iron deficiency (kurang darah), menopause or a heart rhythm problem. This is why it helps to see a doctor after your first attacks.
Panic attack vs anxiety attack
People often use the two terms in the same way, but Cleveland Clinic explains the difference:
| Panic attack | Anxiety attack | |
|---|---|---|
| Is it a medical term? | Yes. A panic attack has a clinical definition: an attack with four or more typical symptoms, such as a racing heart, chest pain, sweating and a fear of dying | No. The DSM-5-TR, the main diagnostic manual, does not recognise or define it. It is usually an everyday term for a panic attack |
| How it starts | Typically suddenly and unexpectedly, sometimes for no clear reason | Anxiety is often triggered by particular stresses and may build up gradually |
| How it feels | An intense rush of fear with strong physical symptoms that peak within minutes | Ongoing worry that can cause tiredness, headaches, palpitations, muscle tension, shortness of breath or sweating |
If you feel anxious most of the time and it affects your daily life, it may be generalised anxiety disorder (GAD) rather than panic disorder. According to the NHS, symptoms of GAD include worry that is hard to control, difficulty sleeping (see our guide to susah tidur), feeling restless or tense, and getting tired easily. It is common to have more than one type of anxiety disorder at the same time.
Panic attack or heart attack?
Chest pain and a racing heart are frightening because they can also be signs of a heart attack. If in doubt, get checked.
According to the NHS, call 999 immediately if you have:
- sudden pain or discomfort in your chest that does not go away, which can feel like squeezing or pressure, burning or indigestion;
- pain that spreads to your left or right arm, or your neck, jaw, stomach or back;
- chest pain and you feel sweaty, sick, light-headed or short of breath;
- palpitations that do not go away, or that come with chest pain, shortness of breath or fainting.
The NHS chest pain guide lists an often sharp, continuous pain triggered by worries or a stressful situation, with a faster heartbeat, sweating and dizziness, as typical of anxiety or a panic attack. But many signs overlap, so do not try to tell them apart on your own the first time. NICE says people who go to an emergency department with a panic attack should have the minimum tests needed to rule out an acute physical problem and then be referred to primary care for follow-up. For more, see our guides to serangan jantung, sakit dada and sesak nafas.
Cara tenangkan diri during a panic attack
The NHS advises that the next time you feel a panic attack coming on, you should:
- stay where you are, if possible;
- breathe slowly and deeply;
- remind yourself that the attack will pass;
- focus on positive, peaceful and relaxing images;
- remember it is not life threatening.
A simple breathing exercise. The NHS breathing exercise for stress, anxiety and panic takes a few minutes and can be done anywhere:
- Sit or stand with your feet flat on the ground, roughly hip-width apart, and loosen any tight clothing if you can.
- Breathe in gently through your nose, letting the breath flow deep into your belly without forcing it. It may help to count steadily from 1 to 5.
- Let the breath flow out gently through your mouth, counting from 1 to 5 again.
- Keep going for at least 5 minutes. It works best if you practise it regularly, not only during an attack.
Cleveland Clinic suggests a few more steps: name it ("this is a panic attack, it will be uncomfortable, but it will end"), and use your senses to shift your focus, such as washing your face or smelling something pleasant.
Punca panic attack
According to the NHS, the exact cause of panic disorder is not fully understood, but it is thought to be linked to a combination of things, including:
- a traumatic or very stressful life experience, such as bereavement;
- having a close family member with panic disorder;
- an imbalance of neurotransmitters (chemical messengers) in the brain.
Cleveland Clinic adds that there is often no specific trigger. Some attacks are set off by a phobia, such as a fear of needles or flying, and for some people the fear of having another attack is enough to trigger one. The NHS says caffeine, alcohol, smoking and sugary food and drinks can all make attacks worse, so it may help to cut down on strong kopi, energy drinks and very sweet drinks if you notice a link.
Panic and depression often occur together, and NICE asks doctors to look out for both. In Malaysia, the National Health and Morbidity Survey 2023 found that about 1 million people aged 16 and above (4.6%) have depression, double the number in 2019. If you also feel low most of the time, see our guide to kemurungan.
Panic disorder: when attacks keep coming back
According to the NHS, someone with panic disorder has feelings of anxiety, stress and panic regularly and at any time, often for no apparent reason. You may be diagnosed with panic disorder if you have regular and unexpected panic attacks followed by at least a month of continuous worry about having more attacks.
The NHS describes how this can become a cycle of living "in fear of fear": you start avoiding places or situations that you think might trigger an attack, which adds to the panic. Without treatment, panic disorder can become very difficult to cope with, and it raises the risk of other problems such as agoraphobia or other phobias, or alcohol or drug problems.
Rawatan: therapy and medicine
The NHS says talking therapies and medicine are the main treatments for panic disorder. Treatment aims to reduce the number of attacks and ease your symptoms.
| Treatment | What the guidance says |
|---|---|
| Self-help | For mild to moderate panic disorder, NICE recommends self-help based on cognitive behavioural therapy (CBT), such as a workbook, with or without support from a professional |
| Cognitive behavioural therapy (CBT) | The main talking therapy. NICE recommends 7 to 14 hours in total, usually weekly sessions of 1 to 2 hours completed within 4 months. A therapist helps you change how you react to the symptoms of panic |
| Antidepressants | If medicine is needed, the NHS says a selective serotonin reuptake inhibitor (SSRI) is usually tried first. Antidepressants can take 2 to 4 weeks to start working and up to 8 weeks to work fully. Only stop them on a doctor's advice |
| Benzodiazepines | NICE says these sedatives are linked to a less good outcome in the long term and should not be prescribed for panic disorder. It also advises against sedating antihistamines for it |
| Specialist referral | If symptoms do not improve after CBT, medicine and support, the NHS says a doctor may refer you to a psychiatrist or clinical psychologist |
CBT in a Malaysian setting. Malaysian psychiatrists have adapted CBT to local culture and religion, using a CBT manual in Bahasa Malaysia. In one published case from Malaysia, a 34-year-old man with panic disorder and agoraphobia had sessions that combined slow breathing and relaxation (including Islamic prayer and Quran recitation) with standard CBT exercises, and his panic attacks and anxiety reduced markedly. This is a single case, but it shows that therapy can be shaped to fit your beliefs; ask your therapist about this if it matters to you.
If you are pregnant or breastfeeding, talk to your doctor before starting or stopping any medicine.
How to reduce panic attacks
According to the NHS, these may help prevent further attacks:
- a self-help book for anxiety based on CBT principles; ask your doctor to recommend one;
- activities such as yoga and pilates to help you relax;
- regular breathing exercises for stress;
- regular physical exercise to reduce stress and tension; NICE also says doctors should discuss the benefits of exercise with people with panic disorder;
- avoiding sugary food and drinks, caffeine and alcohol, and stopping smoking, as they can all make attacks worse.
Cleveland Clinic also suggests keeping a log of your attacks: when and where they happen, how long they last and anything that might have triggered them. Seeing attacks become shorter or less frequent can build confidence.
Where to get help in Malaysia
The NHS advises seeing a doctor if you have symptoms of panic disorder. The doctor will ask how often you get symptoms and how long you have had them, and may examine you to rule out other conditions. It can be hard to talk about your feelings, but try not to feel embarrassed: panic disorder is common and treatable.
- Klinik kesihatan or a private clinic: a doctor can check for physical causes and refer you for counselling, psychology or psychiatry services.
- Talian HEAL 15555: the Ministry of Health's mental health support line.
- Befrienders KL +603-7627 2929: emotional support, 24 hours.
- 999: for chest pain you are unsure about, or if you are in danger or thinking about harming yourself.
Frequently asked questions (FAQ)
Apa itu panic attack (what is a panic attack)?
A panic attack is a sudden rush of intense fear with strong physical symptoms, such as a racing heartbeat, chest pain, shortness of breath, sweating, trembling and a fear of dying. According to the NHS, most panic attacks last between 5 and 20 minutes. They are frightening but not dangerous, and an attack will not cause you any physical harm.
What is the difference between a panic attack and an anxiety attack?
A panic attack usually comes on suddenly, often without warning, and peaks within minutes. Anxiety attack is not a medical term: Cleveland Clinic notes that the DSM-5-TR, the main diagnostic manual, does not define it, and it is usually an everyday term for a panic attack. Anxiety itself tends to build up gradually in response to stress or worry.
Cara tenangkan diri semasa panic attack: what should I do during an attack?
The NHS advises staying where you are if possible, breathing slowly and deeply, reminding yourself that the attack will pass and is not life threatening, and focusing on positive, peaceful and relaxing images. Breathing in through the nose and out through the mouth while counting from 1 to 5 can help.
Is it a panic attack or a heart attack?
They can feel similar, so if you are not sure, get help. According to the NHS, call 999 if chest pain feels tight or like squeezing, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, light-headedness or shortness of breath. Do not self-diagnose new chest pain: a doctor can do the tests needed to rule out a heart problem.
Apa punca panic attack (what causes panic attacks)?
The exact cause is not fully understood. The NHS says panic disorder is thought to be linked to a traumatic or very stressful life experience such as bereavement, having a close family member with panic disorder, and an imbalance of chemical messengers in the brain. Caffeine, alcohol, smoking and sugary food and drinks can make attacks worse.
Can panic attacks be cured?
Panic disorder is treatable. The NHS says talking therapies and medicine are the main treatments. NICE recommends cognitive behavioural therapy (CBT), usually 7 to 14 hours in total over up to 4 months, and antidepressants such as SSRIs when medicine is needed. It advises against benzodiazepines for panic disorder.
Where can I get help for panic attacks in Malaysia?
Start with a doctor at a klinik kesihatan or private clinic, who can check for physical causes and refer you for therapy. You can also call Talian HEAL 15555, the Ministry of Health's mental health line, or Befrienders KL on +603-7627 2929 (24 hours). If you are in danger or thinking about harming yourself, call 999.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or mental health professional. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Panic disorder — NHS
- Generalised anxiety disorder (GAD) in adults: symptoms — NHS
- Breathing exercises for stress — NHS
- Cognitive behavioural therapy (CBT) — NHS
- Chest pain — NHS
- Heart attack: symptoms — NHS
- Heart palpitations — NHS
- Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations — NICE
- Panic disorder statistics — National Institute of Mental Health
- Panic attacks and panic disorder — Cleveland Clinic
- What's the difference between a panic attack and an anxiety attack? — Cleveland Clinic
- National Health and Morbidity Survey 2023: key findings — Institute for Public Health, Ministry of Health Malaysia
- Subhas N, Mukhtar F, Munawar K. Adapting cognitive-behavioral therapy for a Malaysian Muslim. Med J Islam Repub Iran. 2021;35:28
- Talian HEAL 15555 tawar sokongan mental mula beroperasi — Sinar Harian
- Befrienders Kuala Lumpur
