Trembling or Shaking, & Other Symptoms of Panic Attacks

Panic Attacks Signs and Symptoms

Panic attacks are the main symptom of panic disorder, but can occur with other mental health and medical conditions. These attacks are characterized by a variety of physical, emotional, and cognitive symptoms. Here are the top 12 signs and symptoms of panic attacks.

Heart Palpitations or Accelerated Heart Rate

Senior man suffering from pain chest.

When experiencing a panic attack, many people feel as though their heart is pounding. Heart palpitations are often fearfully perceived, as many panic attack sufferers believe that this is a sign of a serious medical emergency, such as a heart attack or stroke. However, heart rate typically returns back to normal as the panic attack subsides.

Trembling or Shaking

When having a panic attack, a person may feel trembling sensations, especially in the arms, legs, hands, and feet. Similar to other panic attack symptoms, uncontrollable trembling and shaking are a result of the fight-or-flight reaction. This response is triggered frequently in people with panic disorder and often without cause. Fight-or-flight reactions prepare the body to either fight off or flee from a real or imagined threat in the environment.

Excessive Sweating

As anxious feelings arise, it is not uncommon for the panic sufferer to begin to sweat. Much like other anxiety-related symptoms, excessive sweating is part of the body’s innate stress response. This reaction signals the body to be aware of feelings of danger.


Hyperventilation involves shallow and restricted breathing that is brought on by panic and anxiety. During a panic attack, a person’s normal breathing pattern may change in a way that does not allow him/her to take full complete breaths. Instead, the person will take quick and short breaths. Hyperventilation may be accompanied by taking loud gasps for air, but may also be portrayed more subtly through coughing and rapid breathing.

Choking Sensations

As with hyperventilation, a person going through a panic attack may feel a sense of restricted breathing and shortness of breath. These may contribute to feelings of choking. Whether related to hyperventilation or not, choking sensations can intensify the panic sufferer’s anxiety.

Chest Pain

Many panic sufferers report that chest pain is one of the most frightening symptoms of panic attacks. People with panic disorder may experience chest pain caused by both cardiac and/or non-cardiac mechanisms. Chest pain is one of the most common symptoms of panic attacks that leads the person to seek immediate medical assistance.

Nausea or Abdominal Pain

Panic attacks can instigate sensations of discomfort or pain of the abdominal region. Other symptoms, such as hyperventilation and feelings of anxiety, may contribute to nausea and/or abdominal pain. Most panic sufferers do not vomit while having a panic attack, but it is not uncommon to feel nauseous until the attack subsides.

Dizziness and Lightheadedness

When going through a panic attack, a person may begin to feel dizzy and unsteady. This makes it hard for the person to focus and can heighten anxiety. Although uncommon, it is possible for a person going through a panic attack to faint from lightheadedness.

Derealization and Depersonalization

During a panic attack, a person may feel disconnected from themselves and/or the surrounding environment. When experiencing these symptoms, the person may view his/her surroundings as distorted, foggy, or unfamiliar. The person may feel as though he/she is robotic, outside the self, or just going through the motions. Derealization and depersonalization tend to negatively impact the panic sufferer and often leads to increased fear, panic, and anxiety.

Numbness and Tingling Sensations

Feelings of numbness and tingling is often accompanied with derealization and depersonalization, but can also be the result of the intense feelings of anxiety that occur during a panic attack. Areas of the body may have pins and needle sensations or feel completely frozen and numb. These symptoms can occur anywhere on the body and are most often felt in the hands, arms, legs, fingers, toes, and face.

Fears of Dying, Losing Control, or Going Crazy

It may not be surprising that the subjective experience of having a panic attack can be perceived as terrifying. As the panic attack escalates, the person may worry about his/her personal safety and experience a fear of dying. Additionally, panic attacks can make a person feel as though he/she is going to lose control of oneself or possibly "go insane." Such thoughts and fears often increase the intensity of panic and anxiety.

Chills or Hot Flushes

Getting the chills is often a sign that a person is frightened. Similarly, a person’s body temperature can rise when faced with a sense of danger. Feelings of anxiety may constrict blood vessels causing the person to feel hot flushes. Again, the fight-or-flight response is initiated, assisting the body to build strength to fight off or run from the threat. A person going through a panic attack can also oscillate between feeling excessively hot and cold. For example, hot flushes can lead to excessive sweating, which can potentially lead to the panic attack sufferer to experience cold chills.​


American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed., text revision. Washington, DC: Author.

Bourne, E. J. The Anxiety and Phobia Workbook. 5th ed. Oakland, CA: New Harbinger, 2011.

Huffman, J.C., Pollack, M. H., & Stern, T. A. (2002). Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Primary Care Companion Journal of Clinical Psychiatry, 4(2), 54-62.

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