The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) describes a panic attack as "an abrupt surge of intense fear or discomfort" that peaks in a matter of minutes. A panic episode is accompanied by four or more physical symptoms. The following symptoms can be found in these patients: palpitations, sweating, trembling or shaking, chills or heat sensations, feelings of choking or shortness of breath, nausea or abdominal distress, chest pain or discomfort, derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of losing control or "going crazy," and fear of dying.Attacks without prior warning are a defining characteristic of panic disorder