What no one tells you about having a panic attack.

Panic attacks, “a sudden overwhelming feeling of acute and disabling anxiety,” are often described in terms of their physical symptoms.

An individual might experience a racing heart, tingling or numbness in their hands or fingers, nausea, chest pain, dizziness, weakness, difficulty breathing, feeling sweaty or feeling like they might faint.

Most people can say they’ve experienced something like this at some point in their lives. Perhaps it was before speaking in front of a group of people, going on a first date, or even just out of the blue late on a Tuesday night while struggling to sleep. Simply, these symptoms are the physical manifestations of anxiety.

But there is another side to panic attacks that we rarely talk about.

Rachel Gearinger, a panic attack sufferer herself, writes for The Mighty, “What people don’t realise is the physical experience of panic attacks isn’t always the worst part. There are some pretty terrifying things that can go on inside your head. Some of my worst panic attacks involve two symptoms no one really talks about.”

Those two symptoms are derealisation and depersonalisation.

Simpy, derealisation feels as though you are entirely detached from a situation and yourself. Your environment might seem foreign, and suddenly you cannot process any information from the world around you.

“The people I love feel like strangers to me during panic attacks,” Gearinger says. Some people in the midst of derealisation will feel as though they’re watching the world through a television screen, emotionally withdrawn from what they’re encountering.

Listen: We are living in the Age of Anxiety. Mia Freedman, Monique Bowley and I discuss on Mamamia Out Loud. (Post continues below…)

“Things around me appear foggy and fake,” Gearinger explains. “Becoming detached like this is terrifying. My brain is doing something incredibly strange I don’t understand and I’m stuck in my body, trying to make sense of it.”

It is a dissociation symptom known to accompany anxiety.

Depersonalisation is related to both anxiety and depression, and feels almost as though you’re watching yourself from above, or you’re stuck in a dream.

It’s a different sensation to derealisation, but they can occur at the same time.

Gearinger describes it as an “out of body” experience, like she’s “going through the motions with no purpose”. Others say it is as though they “no longer exist”.

It can be incredibly distressing.

Gearinger says that these two sensations are the most terrifying part of a panic attack, because she knows they are coming from her brain rather than her body. “They’re the symptoms no one else can see and this makes them ever scarier… both sensations are met with this overwhelming feeling of going ‘crazy’ and losing control over everything,” she explains.

Panic attacks go far beyond the physical.

It is sensations like derealisation and depersonalisation – which are extremely difficult to explain to anyone who has never experienced them – that can make panic attack sufferers feel like they just might be going mad.

But perhaps the more we talk about them, the less people who experience panic attacks will feel alone.

You can listen to the latest episode of Mamamia Out Loud, here.