A silent panic attack, also known as an internal panic attack, can be one of the most unsettling experiences a person can go through. Unlike a typical or “regular” panic attack (which may involve obvious physical symptoms such as shaking, crying, sweating, trembling, chest pain, or hyperventilating), a silent panic attack occurs entirely within the body and mind.
From the outside, it might appear as though everything is fine. Inside, however, the person may be experiencing intense fear, intense anxiety, overwhelming feelings, heart palpitations, rapid heartbeat, dizziness, or a feeling of impending doom. These are all panic symptoms that can be just as distressing as those experienced during more visible episodes.
Silent panic attacks are often misunderstood or overlooked because they don’t manifest through obvious, outward signs. Panic attacks manifest differently for everyone; some are silent attacks that are internal and hard to detect. This can make them especially isolated. People may fear that others won’t believe how bad they feel or that they’re “overreacting.”
But stressful life events can trigger both silent and traditional panic attacks. Understanding what silent panic attacks are, how to recognize them, and how to manage them is an important step toward better mental health and emotional well-being.
Signs of a Silent Panic Attack
The symptoms of a silent panic attack are just as real and distressing as those of a visible one. However, silent panic attacks may not display physical symptoms. Instead, they can include emotional symptoms that are just as distressing.
Rapid Heartbeat or Chest Tightness
A pounding heart, heart palpitations, or tightness in the chest is often one of the first symptoms of a silent panic attack. It may feel like your heart is skipping beats or pounding too hard, which may lead to worries about having a heart attack.
Shortness of Breath or Feelings of Suffocation
Even without visible hyperventilation, a person might feel like they can’t get enough air. This sensation can feed into anxiety, intensifying panic.
Dizziness or Lightheadedness
The sudden rush of adrenaline during a silent panic attack can cause dizziness, tunnel vision, or an out-of-body feeling. This can lead to the fear that something is seriously wrong.
Nausea or Upset Stomach
Many people experience stomach discomfort or nausea during silent panic attacks due to the body’s fight-or-flight response. This redirects blood flow away from the digestive system.
Sweating or Chills
Even though a person might remain still on the outside, their body can go through sudden temperature changes. They may feel flushed, clammy, or chilled for no apparent reason.
Tingling or Numbness
A surge of stress hormones can cause tingling sensations, particularly in the hands, feet, or face. This can feel disorienting and frightening.
Sense of Derealization or Detachment
A silent panic attack can make the world feel unreal, distorted, or dreamlike. People often describe it as watching themselves from outside their body
Overwhelming Fear Without Obvious Cause
A signature symptom of panic attacks (silent or otherwise) is overwhelming feelings. The person may feel dread or doom that doesn’t match the situation. The brain goes into overdrive, scanning for danger even when none exists.
Silent panic attacks can last anywhere from a few minutes to over half an hour. But the aftereffects, such as fatigue, confusion, or emotional exhaustion, can linger much longer.
How to Tell if Someone Else is Having a Silent Panic Attack
Recognizing a silent panic attack in someone else can be difficult. Silent panic attacks can be especially challenging for loved ones to recognize, as the signs are often hidden. A friend or family member may feel helpless or unsure how to help, making it difficult to provide the right support during these moments.
If you suspect someone is having a silent panic attack, stay calm. Pushing them to talk about it immediately or forcing them to stay in a stressful situation can make things worse. Instead, provide gentle reassurance and give them space to regulate their breathing and thoughts.
Subtle cues can reveal when someone is struggling internally. Knowing what to look for can help you respond with compassion and support.
Sudden Change in Facial Expression or Body Language
The person may go quiet, appear tense, or seem “spaced out.” They might avoid eye contact or suddenly withdraw from conversation.
Unusual Stillness or Fidgeting
Some people freeze when panic hits, while others may repeatedly shift positions, tap their fingers, or grip something tightly to self-soothe.
Difficulty Speaking or Responding
Someone in the midst of a silent panic attack might have trouble forming words or responding clearly. Their voice may sound shaky or distant.
Pale Skin or Sweating
Even if they’re sitting still, you might notice their face becomes pale or slightly flushed. They may also appear to sweat unexpectedly.
Requests to Leave or Isolate Themselves
People experiencing silent panic attacks often seek an exit or excuse to be alone. They might step outside, go to the restroom, or suddenly end a conversation.
How to Help Calm a Silent Panic Attack
Whether you’re helping yourself or someone else, managing a silent panic attack starts with creating safety (both physically and emotionally). These strategies can help manage symptoms of silent panic attacks and are important for reducing the impact of anxiety. Incorporating stress management techniques, such as relaxation practices and lifestyle adjustments, is also essential for coping healthfully with and preventing silent panic attacks.
Focus on Breathing
Deep breathing is a practical grounding exercise that can provide immediate relief during a silent panic attack. Slow, deep breaths signal to the body that the danger has passed. Try the “4-7-8” technique:
- Inhale for 4 seconds
- Hold for 7 seconds
- Exhale slowly for 8 seconds
This helps activate the body’s relaxation response and reduce the intensity of panic.
Ground Yourself in the Present
- Identify five things you can see
- Four things you can touch
- Three things you can hear
- Two things you can smell
- One thing you can taste
Relax Your Muscles
Tension in the body can feed anxiety. Gently unclench your jaw, drop your shoulders, and loosen your hands. Progressive muscle relaxation (tightening and releasing different muscle groups) can also help calm your nervous system.
Remind Yourself That You’re Safe
- “This feeling will pass.”
- “I am safe right now.”
- “My body is reacting, but I am okay.”
Engage in Calming Distractions
Sometimes, redirecting your focus can break the cycle. Try listening to soft music, holding a comforting object, or watching something lighthearted.
Avoid Overanalyzing the Attack
Create a Plan for the Future
- Having a calming playlist ready
- Keeping grounding objects (like smooth stones or essential oils) nearby
- Informing trusted friends or coworkers about how they can help
Signs You May Have an Anxiety Disorder
While occasional panic attacks can occur in anyone, frequent silent panic attacks may signal an underlying anxiety disorder. Frequent panic attacks are often a symptom of panic disorder and can significantly impact daily life. Recognizing the broader symptoms can help you seek appropriate treatment and support.
Lifestyle changes, such as maintaining adequate sleep and engaging in regular exercise, are important for mental health and can help reduce the frequency of panic attacks. These healthy habits often play a key role in preventing silent panic attacks by supporting stress management and overall well-being.
It is important to consult a healthcare professional for diagnosing and treating anxiety disorders, as well as for treating mental health concerns in general. Comprehensive treatment plans tailored to your needs can ensure you receive the most effective care.
Persistent Worry or Fear
You may find yourself constantly worrying about everyday situations or fearing that something bad will happen without a clear reason.
Ongoing Physical Symptoms
Chronic tension, headaches, stomach problems, or muscle pain are common when anxiety keeps your body in a state of stress. This can affect both your mental and physical health over time.
Sleep Disturbances
Anxiety often leads to trouble falling asleep, staying asleep, or waking up feeling unrefreshed.
Avoidance Behaviors
You might start avoiding certain people, places, or activities that could trigger feelings of anxiety or panic.
Difficulty Concentrating
Anxiety can make it hard to focus, complete tasks, or remember details. Your mind may constantly jump from one thought to the next.
Feeling “On Edge” Most of the Time
People with anxiety disorders often describe feeling restless or unable to relax, even during calm moments.
If these symptoms interfere with your daily life, relationships, or work, it’s important to talk with a mental health professional. Anxiety disorders are highly treatable with the right combination of therapy, lifestyle changes, and sometimes medication.
Receive Mental Health Support at First Steps Recovery
If you or someone you love experiences silent panic attacks, you’re not alone. Many people struggle in silence, unsure of what’s happening or afraid to seek help.
At First Steps Recovery in Fresno County, California, we provide compassionate, evidence-based care to help individuals manage anxiety, panic disorders, and co-occurring substance use issues. Our team understands that panic attacks (silent or otherwise) can feel overwhelming and isolating. Through personalized mental health treatment programs, we help individuals regain control of their thoughts, emotions, and physical responses.
We offer evidence-based options such as exposure therapy and dialectical behavior therapy (DBT) to address anxiety and related conditions. Our comprehensive approach not only supports the individual but also helps family members understand and cope with the challenges, improving relationships and communication.
If silent panic attacks are disrupting your life or you suspect that you have an anxiety disorder, professional treatment can help you find lasting relief and peace of mind. Reach out to First Steps Recovery today to learn more about our anxiety treatment and mental health programs.
Dr. Curl is the Medical Director and primary on-site provider for First Steps Recovery. He is a Board Certified Internist and Addiction Medicine Specialist having attended the David Geffen School of Medicine at UCLA and completing his residency at Mount Auburn Hospital with Harvard Medical School. Following several years work as an internist and physiatrist (physical medicine and rehabilitation). Dr. Curl completed the Addiction Medicine Fellowship at Howard University in Washington DC and participated as a RAM Scholar (Research in Addiction Medicine). While part of the fellowship, Dr. Curl pursued research investigating the barriers to expanding and improving medication for opioid use disorder. Following his fellowship, Dr. Curl spearheaded the Opiate Use Disorder outpatient clinic and worked in the Department of Psychiatry and Behavioral Sciences within the Howard University Hospital. In 2023, Dr. Curl completed his Board Certification in Addiction Medicine.
