What’s it like to have a silent panic attack?

Panic attacks are sudden episodes of intense fear and anxiety. They’re typically accompanied by physical symptoms, like sweating, trembling, and trouble breathing. But with silent panic attacks — also known as covert or internal panic attacks — there aren’t any observable signs of mental distress.

Silent panic attacks are less common — or less frequently diagnosed — than traditional panic attacks, but they can be just as debilitating. If you think you’ve experienced a silent panic attack, understanding the subtle signs and symptoms may help you manage or prevent future attacks. With the right support and strategies, you can regain control and reduce the impact of these attacks on your life.

Subtle symptoms of silent panic attacks

Silent panic attacks are panic attacks that don’t include any of the typical external physical symptoms, like sweating and hyperventilating. During a silent panic attack, a person may appear calm and composed on the outside while struggling internally with intense fear or discomfort. Silent panic attacks usually develop suddenly and typically last for 5 to 20 minutes.

Possible signs of a silent panic attack include:

• Sudden, overwhelming sense of fear or dread
• Feeling detached from yourself and your surroundings 
• Fear of losing control
• Fear of dying 
• Feeling faint, dizzy, or lightheaded 
• Numbness or tingling sensations 
• Feeling hot or cold
• Racing or pounding heart
• Nausea
• Chest pain

Silent panic attacks vs. other types of episodes 

If you’re wondering how silent panic attacks compare to other types of panic attacks and anxiety episodes, here’s what to know. 

• Typical panic attacks: The difference between panic attacks and silent panic attacks is that the latter don’t involve external physical symptoms. 
• Limited-symptom panic attacks: Limited-symptom panic attacks involve fewer and less severe symptoms than silent panic attacks. 
• Anxiety attacks: Panic attacks typically occur suddenly and without warning, while anxiety attacks are triggered by specific stressors. Panic attacks involve more severe symptoms, but anxiety attacks can last longer.

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What quiet panic attacks could mean

Silent panic attacks may seem to occur randomly and without reason. Some people experience one or two attacks per day, while other people will have one every few years. 

In many cases, silent panic attacks are caused by panic disorder. They’re also associated with other mental health conditions, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). 

Other possible risk factors include brain chemistry, adverse childhood experiences, stressful life events (like losing a loved one), and a family history of panic attacks or panic disorder. 

Regardless of the cause, silent panic attacks can significantly impact your quality of life. Other people may not be able to see your symptoms, but they can still have consequences for your confidence, self-esteem, and interpersonal relationships. In some cases, symptoms may even lead to unhealthy coping mechanisms, like harmful substance use or self-harm.*

*The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.

How to manage a silent panic attack

You may not be able to fully prevent silent panic attacks, but you can learn how to reduce the severity of your symptoms. Here are five strategies to consider next time you experience an episode.

1. Move to a safe location. Silent panic attacks can occur anytime — even in situations that might seem calm, like driving or having dinner with friends. If this happens, it can be helpful to pull the car over to a safe spot or step away for a moment. Moving to a calm and quiet environment may help reduce the intensity of your symptoms and allow you to regain control.
2. Try to relax. Relaxation exercises can reduce stress and encourage you to ground yourself in the present moment. Deep breathing, guided imagery, and progressive muscle relaxation are all effective techniques for coping with panic attacks. 
3. Choose a positive mantra. The next time you feel a silent panic attack coming on, consider reciting a positive mantra, like, “I’m safe,” or, “This will pass.” Focusing on a simple and supportive statement can help you calm your mind, prevent anxiety spirals, and remember that the feeling is temporary.
4. Shift your focus. Another way to redirect your attention from your symptoms is to focus on something unrelated to your own body. This could be a mug, book, or specific tree in your backyard. Make an effort to really notice this object, thinking about what it looks and feels like and where it came from, for example.
5. Tell a friend. Silent panic attacks can be isolating, so consider sharing your experience with people you trust. This insight can help them recognize your triggers and learn how to help you feel safe. 

Professional help for silent panic attacks

There’s no way to cure silent panic attacks, but it’s possible to learn how to manage your symptoms and improve your quality of life. If you’ve experienced silent panic attacks, the first step is to meet with a qualified mental health professional. After discussing your symptoms and reviewing your health history, they can work with you to create a treatment plan that addresses your panic attacks and any underlying concerns.

Depending on what’s causing your panic attacks, treatment may involve a combination of therapy and medication. Talk therapy techniques for panic attacks include: 

• Cognitive behavioral therapy (CBT) is an effective tool for helping people identify and change unhelpful thoughts and behaviors that may be contributing to their panic attacks. 
• Acceptance and commitment therapy (ACT) is another type of therapy that helps people accept — rather than avoid — difficult thoughts and feelings. With ACT interventions, you can learn how to increase self-awareness and self-acceptance. 
• Eye movement desensitization and reprocessing (EMDR) combines traditional talk therapy and bilateral stimulation techniques to help people identify and process traumatic memories. It’s been shown to decrease the frequency and severity of panic attacks in people with panic disorder. 

In addition to therapy, your therapist may suggest healthy lifestyle changes, like regular physical activity, a healthy diet, and consistent sleep. This may also include limiting potential panic attack triggers, like caffeine, alcohol, and social media.

Find care with Rula

Silent panic attacks can cause an overwhelming sense of fear and dread. And while they may not involve physical symptoms, like sweating and shaking, they can still be incredibly distressing and disruptive to your daily life. If you’re looking for the tools to manage future panic attacks or to understand what’s causing these episodes, know that help is available. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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