Is a Sense of Impending Doom a Real Symptom?

Medical Causes of a Sense of Impending Doom

sense of impending doom
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You may have heard people speak of a "sense of impending doom" in a number of ways, but the truth is that this feeling can be a real medical symptom. What medical conditions may cause this symptom, and what mechanisms might explain why it occurs? Should you pay attention to this feeling if you experience it yourself?

What Is a Sense of Impending Doom?

Before going into the possible medical or psychological causes of a sense of impending doom, it's important to briefly define and describe this symptom.

A sense of impending doom is a feeling of knowing that something life-threatening or tragic is about to occur. Certainly being in the midst of a life-threatening crisis may lead people to feel they may die, but this symptom may actually precede other obviously critical symptoms.

For example, for some people who have had serious allergic reactions (anaphylaxis), or who have developed Irukandji syndrome, (collection of symptoms that appear in response to a sting from Carukia barnesi, a type of jellyfish sting) the feeling of impending doom may occur before other serious symptoms which would make a person believe death is imminent.

Symptom vs. Saying

One of the difficulties in looking at the sense of impending doom is that this phrase is used in many different ways. It may be used literally to describe a feeling that something very bad is about to happen to you personally. In this way, the phrase would be considered a "symptom."

It may also be used to describe your opinion about what is happening in the world in some way. In this case, the phrase might be used as a "prediction."

At other times the phrase may simply be used as a figure of speech. For example, a man may remark that he thought he was going to die when his boss stood to discuss company dress code having forgotten to zip his fly.

When the man, as an employee, remarks on the irony of this to his boss, he may have a metaphorical sense of impending doom about the future of his employment.

How Long Have We Known a Sense of Impending Doom May Have Medical Significance?

While most emergency medicine physicians, critical care physicians, and paramedics will tell you that a feeling of impending doom should be taken very seriously, the understanding that a sense of impending doom is a legitimate medical symptom came about long before scientific Western medicine took hold of the developed world.

This symptom has been reported as having had medical significance all the way back in ancient Greek and Roman literature. A sense of impending doom was feared in the 1400s and 1500s as a symptom which foreshadowed other symptoms related to the deadly plague (at that time referred to as sweating sickness). Today, in the 21st century, the complaint of a sense of impending doom can be met with the same concern in the eyes of the person experiencing the symptom as well as those of the health care professionals faced with the confession of the feeling by their patients.

What Medical and Psychological Conditions May Cause a Sense of Impending Doom?

There are surprisingly few direct medical studies looking at a sense of impending doom as a symptom, given the frequency with which this symptom appears in the lists of "differential diagnoses" in medical textbooks or on hospital rounds. Some conditions in which a sense of impending doom is listed as a symptom include:

  • Anaphylaxis (severe allergic reactions)
  • Exposure to toxins and poisonings: This includes, in particular, the jellyfish stings noted earlier and cyanide poisoning, in which a sense of impending doom is often ​the first symptom.
  • Pulmonary emboli: Pulmonary emboli are clots that travel to the lungs after breaking off in the legs (deep venous thrombosis). Other symptoms often include the sudden onset of sharp chest pain which increases with a deep breath and may rapidly progress to lightheadedness and unconsciousness.
  • Heart attacks
  • Pheochromocytoma (a type of adrenal gland tumor): These tumors often cause a massive release of catecholamines such as adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine. These chemicals, in turn, can cause a sudden increase in blood pressure, a rapid heart rate, sweating, and possibly a sense of impending doom.
  • Blood transfusion reactions: Blood transfusion may lead to allergic reactions (anaphylaxis) with hemolysis (breakdown) of the transfused red blood cells. Symptoms of anxiety and impending doom may occur before other symptoms such as shortness of breath, palpitations, and a fall in blood pressure.
  • Seizures, or as part of an epileptic aura
  • Non-epileptic psychogenic seizures
  • Intraoperative awareness (where people "wake up" during surgery) is also called anesthesia awareness or unintended awareness.
  • Depression
  • Anxiety disorders such as panic disorder (during panic attacks), generalized anxiety disorder, post-traumatic stress disorder, and more.
  • Bipolar disorder

Symptoms Associated With a Sense of Impending Doom

A sense of impending doom may occur alone (as it did prior to other symptoms with the plague in the middle ages) or along with other symptoms. Some of these symptoms (depending on the underlying cause) include:

  • Sweating
  • Hot flashes
  • Tremors and shaking
  • Shortness of breath
  • Heart palpitations (heart arrhythmias)
  • Depersonalization (a sense of being detached from yourself)

Physiological Mechanisms Underlying the Sense of Impending Doom

There are a number of physiological explanations that may help to explain the sense of impending doom and how this feeling arises.

A release of catecholamines may occur as a primary factor (such as in pheochromocytoma), in response to the body recognizing a medical emergency (such as with a heart attack or pulmonary embolism), or in response to psychological stress (panic) as part of the fight or flight response to stress.

A nervous system component could very well underlie this symptom in some cases. A sense of impending doom has been noted in many people with temporal lobe epilepsy and may also occur as part of an epileptic aura.

Certainly, the symptoms of a heart attack or another life-threatening condition may cause a sense of impending doom in a conscious rather than unconscious manner, as you recognize symptoms (such as a sudden severe drop in blood pressure and major chest pain) that are often associated with death.

It is not so surprising that people may have a sense of impending doom when faced with a life-threatening medical condition, even without conscious thought. We know that our bodies respond in many ways to stress without conscious deliberation. We know there are changes, for example, which precede seizures, that dogs can sometimes recognize before people (and are the reason behind seizure alert service dogs).

Another concept somewhat akin to the sense of impending doom that is similarly not well understood is near death awareness. In near-death awareness, a person who appears unchanged to you may suddenly remark that they are going to die—and then die.

Studies on a Sense of Impending Doom in Medical Care

Surprisingly, there are few studies directly looking at the importance of a sense of impending doom as a symptom of various medical conditions, despite the fact that this symptom is mentioned fairly often in the lists of symptoms in medical literature. That said, designing a study to look separately at this symptom would be very difficult.

Most studies have looked at this symptom only indirectly. For example, a Chinese study found that emergency physicians were more likely to determine that a patient required emergency care for a cardiac condition if the patient complained of a sense of impending doom, and in fact, this symptom carried more weight than other symptoms in making that decision. While studies such as this tell us that physicians are heeding and acting on this symptom, they don't really tell us the significance of the symptom.

Bottom Line on the Symptom of a Feeling of Impending Doom

While we don't really understand the significance of a sense of impending doom, we do recognize this feeling as being important medically at times. The mechanisms which could underly this symptom also support that impending doom may be a legitimate medical symptom. Finally, the intuition of physicians spanning the years from ancient Greece to the 21st century tells us that a sense of impending doom deserves to be heeded, at least until we know more.

Unless you commonly have the feeling of impending doom as part of an anxiety disorder, it may remain best to call 911 if you have an overwhelming sense of impending doom. Many people have stayed alive due to trusting their instinct and intuition. If you are uncertain, ask yourself, "what is the worst thing that could happen?" If your symptom means nothing, you may waste your day and the cost of an emergency room visit. On the other hand, and unlike modern video games, our body's don't have a "restart" button if you choose to ignore a symptom that is signaling a life-threatening condition.

Sources:

Greyson, B., Fountain, N., Derr, L., and D. Broshek. Out-of-Body Experiences Associated with Seizures. Frontiers in Human Neuroscience. 2014. 8:65.

Huppert, D., Oldelehr, H., Krammling, B., Benson, J., and T. Brandt. What the Ancient Greeks and Romans Knew (And Did Not Know) About Seasickness. Neurology. 86(6):560-5.

Iles-Smith, H., Deaton, C., Campbell, M., Mercer, C., and L. McGowan. The Experiences of Myocardial Infarction Patients Readmitted Within Six Months of Primary Percutaneous Coronary Intervention. Journal of Clinical Nursing. 2017 Jan 2. (Epub ahead of print).

Song, L., Yan, H., Hu, D., Yang, J., and Y. Sun. Pre-Hospital Care-Seeking in Patients with Acute Myocardial Infarction and Subsequent Quality of Care in Bejing. Chinese Medical Journal. 2010. 123(6):664-9.

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