Silent Panic Attacks: Symptoms and Support

Written By Emily Todd, LMFT

Silent panic attacks are a type of panic attack that are often unnoticed by third parties. Unlike traditional panic attacks, individuals experiencing a silent panic attack will have the majority of their experience internally. Externally, there may be little to no signs of underlying discomfort, anxiety, or panic. We'll go through a bit about panic attacks including:

  • Panic Attacks vs Anxiety Attacks

  • What are Silent Panic Attacks?

  • Triggers and Causes

  • Silent vs Traditional Panic Attacks

  • Coping Strategies

  • Supporting Someone with Panic Attacks

  • Treatment Options

silent panic attacks

Panic Attacks vs Anxiety Attacks

First, I think it is important to understand what exactly a panic attack is generally, and how it differs from an anxiety attack. Although these two terms are often used coloquially to mean the same thing, anxiety and panic attacks are two different experiences. Both may produce a rapid heartbeat, shortness of breath, sweating and nausea, and chest pain, so they are often mistaken for the other.

Generally speaking, anxiety attacks develop more slowly and gradually. They may start as discomfort or unease, and grow into a more full-on anxiety attack. They may be triggered by specific events, situations, thoughts, or emotions. As they develop slowly, they may take a while to peak.

On the other hand, panic attacks start much more suddenly and peak more quickly. They often have more intense physical symptoms. Many people mistake the experience of a panic attack for a cardiac event or heart attack. Intense fear is common, and they generally last much shorter than anxiety attacks. Panic attacks can also arise suddenly and without much clear cause at first glance.

What are Silent Panic Attacks?

As you may guess from the name, silent panic attacks are panic attacks where the person is relatively silent. It's not that you don't speak, but the majority of your panic experience is internal. An individual experiencing a silent panic attack may have many different symptoms. Symptoms of silent panic attacks can include:

  • Depersonalization

  • Derealization

  • Racing Thoughts

  • Shallow Breathing

  • Nausea

  • Dizziness

  • Intense Fear


The symptoms of a silent panic attack may vary from one individual to the next. The psychological distress experienced may be strong, but others around the individual may not realize what they are experiencing. There may be subtle clues to the person's internal turmoil, but silent panic attacks are often unnoticed by surrounding people.

Triggers and Causes

The causes of silent panic attacks can vary from one individual to the next. People with underlying anxiety disorders, trauma, or depressive disorders are significantly more likely than their counterparts to experience panic attacks. These psychological factors play a big role, and can include simple things like underlying stress. There's also a genetic predisposition to anxiety and panic that we may inherit from our family.

There are also environmental factors. These are triggers that may play a role in triggering panic attacks, such as a tough day at work, a difficult situation where you don't feel heard in your relationship, or going through the process of moving.

And finally there are physical factors. These might include ingesting too much caffeine or nicotine, having a lack of sleep, misusing substances, or being malnourished.

It's important to steer clear of blaming one thing for silent panic attacks. It's generally accepted that they are the result of a combination of psychological, environmental, and physical factors. We can work with a professional to uncover these triggers, but be careful not to blame one thing or aspect of your being.

Silent vs. Traditional Panic Attacks

The difference between silent and tarditional lies in how noticeable they are. A traditional panic attack will often be noticed by those around them, while a silent panic attack is largely internalized. Individuals experiencing a silent panic attack might even appear composed on the outside. As such, it can be harder to get interventions, acknowledgement, and support.

Coping Strategies

So, what do we do to cope with silent panic attacks? I think there are really two pieces here: crisis intervention and long-term coping. Crisis intervention can be understood as what we can do to cope in the moment. When you're already having a silent panic attack, what can be done to support you?

First, acknowledging what is happening is key. Any solution or move toward relief must start with some recognition of what is going on. Once we recognize what is happening, we can take steps. Deep breathing exercises can be especially helpful. By extending your exhale and making it longer than your inhale, you actually engage your parasympathetic nervous system.

This helps tell your body you're okay, and disengages the so-called fight-or-flight response of the nervous system. To do this, try breathing in for 3 or 4 seconds to start, pausing, and breathing out for 5 or 6 seconds. You can lengthen the time as you're able, but try to keep the exhale longer than the inhale.

You also might check out my Somatic Exercises for Anxiety. All of these exercises will help during a silent panic attack. They are various grounding techniques you can use with yourself any time you feel panic coming on.

As for more long-term coping skills, we need to look further than the moment of panic. Many things are found to lessen the symptoms of panic and anxiety disorders, including:

It's important to understand that the building of long-term coping skills takes time. Working with a mental health professional may be the best option for many people. I'll talk more about when to seek professional help, but for now just remember that building both long-term coping skills and having methods of crisis intervention are both useful.

Supporting Someone with Panic Attacks

Similar to building personal coping strategies, there are multiple ways we can support someone who has panic attacks. First, we need to recognize the signs, especially with silent panic attacks. Then, we need to know how to provide immediate support in the moment. And finally, we can find ways to offer post-attack support.

Recognizing the Signs

Some panic attacks are quite obvious. However, silent panic attacks can be more subtle in their nature. Watch out for some of the observable symptoms such as:

  • Increased restlessness

  • Zoning out

  • Eye contact avoidance

  • Clenching jaws or fists

  • Shallow breathing

  • Pale looking in the face

None of these symptoms by themselves are enough to assume somebody is having a silent panic attack. They must be coupled with general knowledge that the person suffers from painc attacks. You also might be aware of other psychological or environmental factors present in their life.

Providing Support

The most important thing in providing immediate support is to stay calm. You don't want to get worked up and create more activation in the individual. Make sure to calm yourself and create a safe place. Once you are able to be calm, try to be mindful of what the other person may find calming. Move to a safer environment, listen without judgement, and try to focus on what they may need.

If you can offer one thing, it may be best to encourage some deep breaths. You my want to do so gently and calmly, without being too demanding. Also, some people may want to be touched, while others may not. So be sure to ask. Really though, the best thing is to just be present without judgement and let the other person know they're not alone.

Long-Term Support

Finally, you may want to encourage the individual to seek longer-term support. Do not do this during a panic attack or even in the moments after. Perhaps you can offer to help them find a therapist or professional. You can also offer a bit of a check-in, asking them from time to time how they're doing and reminding them you're there for support.

Finally, offer some sort of way to promote a lifestyle that may help better their symptoms of silent panic attacks. Offer to go on a walk with them, take up yoga, investigate meditation, etc.

Treatment Options

First, you should seek professional help if you feel panic attacks are getting in the way of your daily life. If you are feeling depressed or that you might harm yourself or someone else, please dial 988 from anywhere in the United States. Here are a few options you might seek out to help with silent panic attacks.

Individual Therapy

Individual therapy can be incredibly beneficial in working with anxiety and panic disorders. Specifically, cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have been found to be helpful in dealing with panic attacks. In therapy, you can discuss openly your experience, investigate grounding techniques, and build long-term habits to help lessen the symptoms of panic attacks.

Make sure you find the right therapist for you and your needs. Watch out for the warning signs of a bad therapist, and don't be afraid to try a few therapists to find the one that is right for you.

Group Therapy

In addition to individual therapy, you could try group therapy. Although a different dynamic, group therapy can offer a powerful way to connect with others with similar difficulties. You might also learn from each other and find ways to move forward and be proactive with the panic disorder.

Life Adjustments

As already mentioned in the section on coping skills, there are a number of things we can do to decrease our risk of having future panic attacks. These include eating a well-rounded diet, exercising more, and practicing mindfulness and yoga.

TMS

Although more research may be needed, transcranial magnetic stimulation may be efficient in reducing symptoms of panic disorder. Specifically, low-frequency repetitive transcranial magnetic stimulation (https://pmc.ncbi.nlm.nih.gov/articles/PMC6885044/) to the right dorsolateral prefrontal cortex may be an effective way to reduce symptoms of panic disorder. This is something you can talk about with your doctor.

Medication

Finally, there are a number of medications that are sometimes used to treat panic disorders in various phases. Some may be used as crisis intervention, while others may be used more in the medium or long term. These include benzodiazepines (alprazolam and clonazepam), SSRIs (fluoxetine and sertraline), SNRIs (vanlafaxine), and tricyclic antidepressants (imipramine and clomipramine). Again, please talk to your medical professional about these options.




Emily Todd, LMFT https://ThreeRiversTherapies.com
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