Understanding Panic Attacks: Causes and Healing

Panic attacks can feel sudden and overwhelming. However, they’re rarely random. These episodes occur when the body’s stress response becomes overloaded. It may misread normal sensations as danger or react to a buildup of unaddressed emotional and physiological pressure. Below is a comprehensive breakdown of the most common panic attack causes, including the often-missed role of cortisol dysregulation.

The Roots of Panic Attacks

1. Genetics and Family History

Some of us inherit a more sensitive nervous system or a tendency toward heightened stress responses. This doesn’t mean panic is inevitable. It simply means that the threshold for overwhelm may be lower. This makes the system more responsive to stress and internal sensations.

2. Chronic or Acute Stress

Long-term pressure without enough recovery keeps the nervous system in a state of vigilance. Acute stressors—like a big argument or an unexpected crisis—can create sudden overload. Both conditions weaken the body’s ability to regulate fear responses, increasing the likelihood of panic.

3. Unresolved Trauma

Traumatic experiences, especially those involving helplessness or threat, can shape how the brain interprets present-day cues. Panic can emerge when something, even subtly, reminds the body of past danger. This reaction often occurs before we are consciously aware of the trigger. Visit my EMDR or Brainspotting pages if you are interested in learning more about effective treatments for your unresolved trauma.

4. Cortisol Dysregulation — One of the Most Overlooked Panic Attack Causes

Cortisol helps regulate energy, stabilize blood sugar, and manage the stress response. When cortisol levels are either too high or too low, the body’s ability to interpret sensations accurately becomes compromised.

High Cortisol

Elevated cortisol can amplify heart rate, tighten muscles, heighten sensory awareness, and increase mental vigilance. These changes can create overwhelming sensations that feel like an imminent threat, setting off panic.

Low Cortisol

Low cortisol is surprisingly common in people with chronic stress or trauma histories. When cortisol drops too low, the body struggles to maintain stable blood sugar and regulate arousal. This leads to adrenaline surges, jitteriness, and rapid shifts in internal sensations—all of which can cascade into panic.

5. Sleep Deprivation

Poor sleep lowers emotional resilience and increases baseline adrenaline levels. Even one night of disrupted rest can make internal sensations feel more intense. This makes it easier for the fight-or-flight response to activate prematurely.

6. Hormonal Shifts

Fluctuations in estrogen, progesterone, testosterone, and thyroid hormones can influence how the brain processes stress. Certain phases—such as PMS, perimenopause, postpartum, or thyroid imbalance—can lower the threshold for panic by destabilizing the body’s stress regulation system.

7. Stimulants

Substances like caffeine, nicotine, energy drinks, and some medications stimulate the cardiovascular system. They can increase heart rate, trigger jitteriness, and mimic early signs of panic. The brain can misread these signals as danger, especially in sensitive individuals.

8. Medical Conditions

Certain physical conditions create sensations that are easy to mistake for panic. Irregular heartbeats, blood sugar drops, thyroid disorders, vestibular issues, or POTS can generate internal cues—like dizziness or palpitations—that trigger a fear response.

9. Hyperventilation and Breath-Holding

Breathing too quickly or holding the breath without realizing it can lower carbon dioxide levels in the blood. This creates dizziness, tingling, chest pressure, and a sense of unreality. These sensations can rapidly escalate into panic if misinterpreted.

10. Interoceptive Sensitivity

Some individuals experience internal sensations more intensely. This heightened awareness isn’t inherently harmful. However, if someone interprets these sensations as threatening, it can quickly spiral into a panic episode.

11. Substance Use or Withdrawal

Many substances calm the nervous system temporarily. However, once they wear off, the rebound effect can leave the body overstimulated. Withdrawals from alcohol, benzodiazepines, cannabis, or even excessive sugar intake can make panic more likely.

12. Phobic Triggers

Fear-related situations—heights, flying, enclosed spaces, medical procedures—can activate panic by tapping directly into the brain’s fear circuits. Even anticipating the situation can trigger symptoms for some people.

13. Major Life Transitions

Big transitions create uncertainty. Even positive changes alter routines, identity, or stability, which can put pressure on the stress response system. When the body feels unsure, the alarm system becomes more vigilant.

14. Attachment Stress

Relationship-related stress can activate deep-seated survival wiring, especially for those with histories of emotional neglect or abandonment. Panic can surface in moments of disconnection, conflict, or fear of loss.

15. Learned Associations

If someone experiences a panic attack in a certain environment—like a store, classroom, or car—the brain may mark that place as unsafe. Later exposure to the same setting or even a similar one can trigger another panic attack.

16. Perfectionism and High Self-Pressure

Holding oneself to impossible standards creates chronic internal tension. Over time, the body stays in a state of quiet hypervigilance. Even minor stressors can tip the system into panic.

17. Illness or Pain

Unexpected pain or illness, especially those affecting breathing or mobility, can activate the body’s alarm system. When sensations are confusing or unfamiliar, the nervous system may respond defensively with panic.

18. Feeling Trapped or Out of Control

Situations that limit escape—heavy traffic, crowded spaces, long meetings—can trigger the fear response. For many, the sense of being unable to move freely or access safety is enough to initiate panic.

Final Thoughts on Panic Attacks

Panic attacks aren’t signs of weakness or “losing control.” They are signals from a nervous system that has been overwhelmed or deprived of the regulation, support, or safety it needed in the moment. When we understand the physical, emotional, and hormonal pieces behind panic, the experience becomes far less mysterious and much more workable.

If you’re finding that panic attacks are becoming more frequent, more intense, or harder to predict, support is available. I help clients understand what their bodies are trying to communicate, heal the underlying patterns that fuel panic, and rebuild a sense of internal steadiness.

You’re welcome to explore my Trauma Therapy & Somatic Resourcing page if you want to learn more about how nervous-system–based work can help. You can also visit my Relationship Patterns & Boundary Healing page if your panic feels tied to attachment wounds or chronic relational stress. And if you’d like personalized support, you can submit a request through my Consultation Form to get started.