Panic Attacks in Teenagers: The Wave of Fear That Strikes at School or in an Exam

How can you recognise panic attacks in teenagers? Read the signs of a fear attack at school or in an exam, what to do in the moment and how families can help.

The second session of a mock exam. Pen in hand, halfway through the questions, their heart suddenly starts pounding as if it will burst out of their chest. They feel they can't breathe, their hands tingle, and the classroom walls seem to be closing in on them. With the thought "I'm going to faint" or "I'm dying", they leave the room and the teacher takes them to the school nurse. A few minutes later everything gradually passes, but a deep fear is left behind: what if it happens again? Panic attacks in teenagers often appear in exactly this sudden and shaking way, for both the young person and the family. In this article we look at how panic attacks show up in young people, why they can be triggered in school and exam settings, what can be done during and after an attack, and how therapy helps in this process.

What Are Panic Attacks in Teenagers?

A panic attack is an episode of intense fear or distress that peaks within a few minutes. During it, the body sounds the alarm as if there were real danger: the heart races, breathing quickens, the muscles tense. Yet there is no real danger. The attack usually subsides on its own within ten to twenty minutes.

Panic attacks often appear for the first time in late adolescence or young adulthood. For this reason, panic attacks in teenagers are by no means rare. However, young people often cannot name what they have been through. They describe it with sentences such as "I thought I was having a heart attack", "I thought I was going to go mad" or "It was like being in a dream." Families may also confuse the symptoms with physical problems such as heart trouble, asthma or low blood sugar.

Having a single panic attack does not mean having panic disorder. Panic disorder is defined by recurrent, unexpected attacks together with a fear of having another attack and related avoidance lasting at least several weeks. Making this distinction is the job of a mental health professional. We discussed the symptoms in adults in detail in our article on panic attack symptoms.

Symptoms of Panic Attacks in Teenagers: How Do Young People Describe Them?

During a panic attack, several of the following symptoms may appear together:

• Palpitations, feeling that the heart is "skipping" or "about to stop"
• Shortness of breath, a choking sensation, being unable to take a deep breath
• Pressure or pain in the chest
• Trembling, sweating, hot flushes or chills
• Dizziness, light-headedness, feeling about to faint
• Nausea, stomach ache
• Numbness or tingling in the hands, feet or lips
• The surroundings or one's own body feeling unreal
• Fear of losing control, "going crazy" or dying

Young people usually describe these symptoms in different words from adults: "My head went foggy", "The classroom felt really far away", "Suddenly everything was too loud", "My hand didn't feel like my own." Some young people, out of embarrassment, never talk about what happened at all; they just say, "I felt sick, I went to the nurse."

When the first attack happens, it is important for a doctor to assess whether there is a physical cause. Ruling out conditions involving heart rhythm, thyroid function or blood sugar is necessary both for safety and for the young person's peace of mind. However, once the tests come back clear, going to hospital again and again can turn into a cycle that feeds anxiety.

Why Do They Happen? Triggers Specific to School, Exams and Adolescence

There is no single cause of panic attacks. Genetic predisposition, temperament and life experiences come together. In adolescence, however, certain triggers stand out:

Exam and performance pressure

The LGS and YKS (Turkey's national high-school and university entrance exams) process is a long and intense period of stress. Constant mock exams, score calculations and sentences like "If we lose this year, a whole year goes to waste" keep the young person's body alarm switched on for a long time. Attacks sometimes come right in the middle of an exam, and sometimes after it has finished, at a moment when tension suddenly drops. For the overall picture of exam anxiety, you can take a look at our article on exam anxiety.

Lack of sleep and irregular eating

Studying until late at night, going to school in the morning without breakfast and eating little throughout the day reduce the body's resilience to stress.

Caffeine and energy drinks

Energy drinks, strong coffee or caffeinated drinks consumed to stay awake while studying can increase symptoms such as palpitations and trembling. In sensitive young people, these symptoms can be the spark that sets off a panic attack.

Perfectionism and the need for control

Young people who cannot tolerate making mistakes and want to keep everything under control can panic more easily when they feel a change in their body that they cannot control.

Difficult life events

Traumatic experiences such as parents' divorce, the loss of a loved one, moving house, peer bullying or an earthquake can make it easier for the body's alarm to go off. After the 6 February 2023 earthquakes, a sudden sensation of shaking or being in an enclosed space was able to trigger panic attacks in some young people.

Substance use

Some substances can cause panic-like symptoms or trigger panic attacks. When attacks start suddenly, this possibility may also need to be discussed gently and without blame.

Panic Attacks at School or in an Exam: What Can Be Done in the Moment?

For the young person

• Name what is happening: Say to yourself, "This is a panic attack. It's frightening but it isn't dangerous. It will pass in a few minutes." Writing this sentence on a piece of paper in advance and keeping it in your pencil case can help.
• Slow your breathing: Breathe in through your nose for a count of four, pause briefly, and breathe out through your mouth for a count of six. Breathing out for longer than you breathe in calms the body. Trying to take deep, fast breaths, on the other hand, can make the symptoms worse.
• Plant your feet on the floor: Feel the soles of your feet touching the ground. Touch the coolness of the desk and count five objects you can see around you. This brings the mind back to the present moment.
• Try waiting instead of escaping: If possible, try staying where you are for a few minutes rather than leaving the classroom immediately. If you need to leave, that is not a failure, but returning when possible is important.

For teachers and the school

• Take the young person to a calm place away from the crowd, but do not leave them alone.
• Speak in a calm, slow voice: "I'm here, it will pass, let's breathe together."
• Protect them from the curious stares of the other students.
• Once the attack has passed, allow the young person to return to class if they wish.
• Inform the family; with the young person's permission, create a plan with the school counselling service.

For a student with a known history of panic, a simple plan discussed with the school in advance (for example, a quiet area where they can step out briefly and do a breathing exercise when needed) helps the young person feel safer.

The Cycle After an Attack: Fear of Fear and Avoidance

As hard as the panic attack itself is the fear that follows: "What if it happens again?" This fear leads the young person to monitor every small change in their body as if it were a danger signal. A slightly faster heartbeat, or even getting out of breath after climbing stairs, is perceived as the forerunner of a new attack. This constant state of alertness in turn increases anxiety and makes new attacks more likely.

Then avoidance begins. The young person hesitates to enter the classroom where the attack happened, the mock exam, the school bus, a crowded shopping centre or an enclosed hall. Some young people cannot go out without always carrying a water bottle, sweets or their phone; some feel safe only when their mother is with them. These safety behaviours bring relief in the short term, but they strengthen the young person's belief that "I can't cope without these."

Let's say a seventeen-year-old, after having an attack in Friday's mock exam, says they are "ill" and skips the next mock exam. Then they stop going to their private tutoring centre, and at school they try to get a medical note during exam week. Within a few months, it is no longer the panic attack itself but what they do to escape it that starts to narrow the young person's life. This is why getting support early after a panic attack is so important.

A panic attack is not dangerous; what is dangerous is life gradually shrinking in order to escape it.

For Parents: How to Support Panic Attacks in Teenagers

• Stay calm: Watching your teenager have an attack is frightening. But your panic increases theirs. Speaking slowly, sitting beside them and saying "It will pass, I'm here" is the greatest support.
• Don't dismiss the symptoms: Saying "There's nothing wrong with you, you're exaggerating" denies the real physical experience the young person is going through. Saying "I know it's very frightening, but it isn't dangerous" is more balanced.
• Don't arrange everything for them: Getting a medical note so they don't have to take an exam, driving them to and from school, keeping them away from every crowded place may look protective; but in the long run it reinforces avoidance.
• Support daily routines: Regular sleep, not skipping meals, limiting energy drinks and regular physical activity balance the body's stress levels.
• Review exam pressure: Scores discussed at home, comparisons and "What will we do if you fail" scenarios can add to the burden on the young person. It may be necessary to talk again about goals in light of the young person's capacity and health.

When Should Professional Support Be Sought?

Seeking support from a mental health professional is recommended in the following situations:

• If attacks recur, or the young person is constantly afraid of having a new attack
• If they have started to avoid going to school, exams, the school bus or social settings
• If sleep, appetite and school performance have been noticeably affected
• If the panic attacks are accompanied by depressive symptoms, hopelessness or withdrawal
• If the young person turns to alcohol or other substances to protect themselves from attacks
• If they talk about thoughts of harming themselves or ending their life

If thoughts of self-harm or suicide are involved, do not put it off; in an emergency, call 112 (emergency services).

These signs do not in themselves mean a diagnosis; but they may show that the young person's anxiety has gone beyond a level they can cope with on their own. Where considered necessary, an assessment by a psychiatrist is also recommended. Work in the area of anxiety and panic can guide the young person and the family through this process.

How Are Panic Attacks in Teenagers Addressed in Therapy?

In the treatment of panic attacks and panic disorder, Cognitive Behavioural Therapy (CBT) is among the leading approaches whose effectiveness is well established by research. When working with young people, this approach is applied in age-appropriate language and with the family taking part in the process.

The first step is psychoeducation. The young person learns what happens in their body during a panic attack, how the alarm system works and why the symptoms are not dangerous. This information alone noticeably reduces fear in many young people. Then catastrophising thoughts such as "My heart is going to stop" or "I'll faint and humiliate myself" are examined, and more realistic interpretations are developed.

An important part of therapy is gradually approaching bodily sensations and avoided situations. For example, exercises that raise the heart rate in a controlled way are done in the session so that the young person learns not to fear these sensations. Then they return to the settings they have been avoiding in small steps agreed together in advance. Breathing and relaxation techniques are also used as supporting tools in this process.

Clinical Psychologist Eda Erkan Alapala has completed the four-year CBT training of the Association for Cognitive and Behavioural Therapies (KDTD) to EABCT standards and has received training in child and adolescent psychotherapy. In sessions with the family, how parents can respond during an attack and attitudes that unknowingly support avoidance are addressed. Sessions can take place face to face or online.

Frequently Asked Questions

Can a panic attack damage a teenager's heart?

In a healthy young person, the palpitations experienced during a panic attack do not damage the heart; the body enters a short-lived state of alarm and then returns to normal. Still, at the first attack it is important for a doctor to assess physical causes. Once the tests come back clear, the focus should shift to coping with anxiety.

Should my teenager who has panic attacks sit their exam?

This decision should be made according to the young person's situation; but avoiding exams altogether usually makes the fear grow. As skills for coping with attacks are gained, continuing to sit exams with appropriate support is generally more helpful. This process can be planned together with a professional.

Do panic attacks in teenagers go away completely?

With appropriate support, many young people learn to cope with panic attacks, and the attacks decrease noticeably or stop. Symptoms may be felt again from time to time during stressful periods, but the skills learnt in therapy make these periods easier to get through. It is not possible to give a definite timeframe; the process varies from person to person.

Can they also have panic attacks that wake them from sleep at night?

Yes, some young people may wake suddenly at night with palpitations and fear. This can be linked to stress accumulated during the day and irregular sleep. Night-time attacks are addressed with similar methods to daytime attacks; if they recur, it is helpful to speak to a professional.

• #anxiety disorders
• #exam stress
• #anxiety at school
• #teen mental health

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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