What Happens in the Brain During a Panic Attack?

Roughly one in three people will experience a panic attack at some point in their lives- including many who have never been diagnosed with an anxiety disorder. During an attack, the body is flooded with intense fear and a range of physical symptoms: trembling, shortness of breath, dizziness, a racing heart, chest pain, and nausea. People often report a sense of losing control, overwhelming dread, or a fear of dying. Panic attacks can feel life-threatening, similar to a heart attack or other medical emergencies. 

These episodes often occur without any real external danger, yet the fear and physical responses feel just as real and uncontrollable as if facing a genuine threat. This happens because panic attacks are driven not by the environment, but by the brain itself. Specifically, they reflect a malfunction in the brain’s threat-detection and regulation systems, where a false alarm triggers an urgent survival response in the body. Panic attacks are usually disproportionate, sudden, and extremely difficult to control. But what exactly happens in the brain during an attack?

What triggers the panic response?

A panic attack begins when the brain perceives a threat, even when no external danger exists. Often, the trigger is a subtle and unintentional change in the body’s internal state: an increase in heart rate or breathing, stressful thoughts, memories, or feelings of claustrophobia. The brain’s interoceptive system, responsible for sensing and interpreting internal signals, can become distorted in individuals prone to panic attacks, causing normal sensations to be misinterpreted as imminent danger. 

Susceptibility can be influenced by brain chemistry, genetics, past trauma, high stress levels, and other factors. Once the brain labels a sensation as threatening, it activates the panic response. This system has evolved to prioritise speed over accuracy, as responding to a false alarm is safer than failing to respond to real danger. During a panic attack, this system becomes hypersensitive, shifting the body into a state of emergency even in the absence of physical threat.

Key brain regions involved

The panic response involves the brain’s “fear network”, which detects and responds to perceived threats. Notable regions include the amygdala, hypothalamus, prefrontal cortex, and insula. 

The amygdala is essential for emotion processing, particularly fear and anxiety. Accordingly, studies report that individuals with anxiety show increased activity in the amygdala. In a simplified explanation, the amygdala becomes hyperactive during panic attacks, and sends urgent signals to other regions, including the hippocampus, brainstem, and importantly, the hypothalamus, which activates the sympathetic nervous system (a.k.a. fight-or-flight response). The adrenal glands then release stress hormones, amongst which are epinephrine and norepinephrine, commonly known as adrenaline and noradrenaline. 

• Amygdala → hypothalamus → adrenal gland → stress hormones

These hormones produce the physical symptoms of panic- racing heart, increased blood pressure, sweating, and more. Simultaneously, activity in the prefrontal cortex tends to decrease. This area is responsible for executive functions such as memory, rational thinking, decision-making, and regulating emotions or thoughts. This decline in activity makes it harder for the brain to think logically and recognise that no real danger is present.

The insula, which monitors internal body sensations, also becomes hyperactive, amplifying awareness of bodily changes such as rapid heartbeat or shortness of breath (both symptoms of a panic attack). These sensations can then be misinterpreted as signs of illness or further danger, fueling the panic response even more. This explains why panic attacks can escalate so quickly, seemingly from nowhere. 

In short, panic attacks operate as a positive feedback loop: heightened body sensations reinforce fear, and fear amplifies those body sensations, creating an overwhelming, uncontrollable physical distress response.

Works Cited

Cleveland Clinic. (n.d.). Panic attack & panic disorder. https://my.clevelandclinic.org/health/diseases/4451-panic-attack-panic-disorder

National Health Service (NHS) Inform. (n.d.). How to deal with panic and anxiety. https://www.nhsinform.scot/healthy-living/mental-wellbeing/anxiety-and-panic/how-to-deal-with-panic-and-anxiety/

Scientific American. (2021, March 18). What happens in the brain when we experience fear? https://www.scientificamerican.com/article/what-happens-in-the-brain-when-we-experience/

PubMed Central. (2012). The neurobiology of panic disorder. https://pmc.ncbi.nlm.nih.gov/articles/PMC3263394/

PubMed Central. (2013). Understanding the neurocircuitry of panic attacks. https://pmc.ncbi.nlm.nih.gov/articles/PMC3598964/

WebMD. (n.d.). Panic attack: What’s happening in your body. https://www.webmd.com/anxiety-panic/panic-attack-happening

YouTube. (2019, June 7). What happens in your brain during a panic attack? [Video]. YouTube. https://www.youtube.com/watch?v=YakyRLDdkQo