A sense of impending doom is a sudden, overwhelming feeling that you’re in danger or that something bad is going to happen. Your body might react to these disturbing thoughts, going into self-protective survival mode. Other symptoms, such as racing heart, breathing difficulties, and chest discomfort, can accompany these attacks of panic and fear.

Several physical and mental health conditions can bring on this sensation. These include serious conditions like heart attack (myocardial infarction) and treatable psychological conditions like panic disorder. Because of this, it’s critical to recognize when you have a sense of impending doom and understand what can cause this uncomfortable feeling.

Depending on what’s bringing on a sense of impending doom, this feeling can cause a range of emotional and physical symptoms. Different people also experience it in different ways.

Emotional Effects

Most immediately, a feeling of impending doom can cause a range of emotional symptoms, affecting mood and behavior. You may experience:

• Sudden overwhelming fear, anxiety, or panic, even in the absence of a specific trigger
• Feeling that everything is out of control or will go badly
• Fear of sudden death, serious injury, or that a catastrophe is about to happen
• Concern and anxiety about attacks returning
• Feeling detached or removed from yourself, or that you’re “losing” your mind

Over time, repeated attacks of these symptoms can affect your daily life, significantly reducing your emotional well-being. This is why panic and anxiety disorders, common causes of the sense of impending doom, are closely linked to depression. According to research, about 45% of people with anxiety also have depression.

Physical Effects

In many cases, a sense of impending doom causes physical symptoms. These often resemble symptoms of panic or anxiety attacks or an oncoming heart attack and include:

• Rapidly beating or pounding heart
• Discomfort, squeezing, or pain in the left side of the chest
• Breathing difficulty
• Trembling or chills
• Lightheadedness, dizziness, or weakness
• Numbness or tingling sensations in your hands
• Pain or discomfort in the jaw, wrists, one or both arms, neck, back, or stomach
• Sweating
• Nausea, vomiting

Research into the exact causes of a person’s sense of impending doom is ongoing. Researchers have linked some of the physical symptoms that accompany this sense to the vasovagal response: the body’s system-wide reaction to stress or fear. This response involves a sudden drop in blood pressure and vasodilation—a decrease in blood flow throughout the body.

Various conditions and diseases trigger a sense of impending doom and the vasovagal response. This feeling is often a sign of a mental health condition, but there may be physical causes.  

Anxiety Disorders

Anxiety disorders are characterized by feelings of excessive worry and fear that don’t go away. A sense of impending doom can be a central feature of attacks of these conditions, including specific phobias. Common types include:

• Panic disorder: Panic disorder causes recurring attacks of intense fear and discomfort, and a sense of impending doom can occur before the attacks. Additional signs of a panic attack include a racing or thumping heartbeat, sweating, trembling or shaking, breathing difficulties, stomach pains, tingling or numb hands, and chest pains.
• Generalized anxiety disorder (GAD): GAD is persistent anxiety and fear that interferes with daily living. It leads to restlessness or agitation, fatigue, and difficulty concentrating. It can also cause insomnia (an inability to fall or stay asleep) and physical symptoms like headaches or stomachaches. 
• Post-traumatic stress disorder (PTSD): PTSD develops in response to a traumatic or frightening event. It causes a wide range of symptoms, including flashbacks, distressing dreams, thoughts or memory lapses about the event, difficulty concentrating, aggressiveness or irritability, and sleep difficulty.

Bipolar Disorder

Bipolar disorder (BD) causes dramatic changes in mood, energy level, and concentration. People shift from “manic” episodes, in which they feel elated, energetic, and irritable, to “depressive” episodes.

A sense of impending doom can accompany depressive episodes, along with loss of interest in activities, sadness, hopelessness, worthlessness, suicidal thoughts, and sleeping too little or too much.

Depression

Sometimes called clinical depression or major depressive disorder (MDD), depression is another common cause of uncontrollable feelings of dread and fear. A disabling and chronic condition, typical signs include chronic feelings of sadness, worthlessness, hopelessness, indifference, and guilt.

Physical symptoms like headaches can arise, as well as sleeping difficulties, difficulty concentrating or remembering, and suicidal thoughts.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental health disorder that causes obsessions, compulsions, or both. A sense of impending doom can be linked to an obsession—an uncontrollable urge, repeated thought, or mental image that causes anxiety. Examples of obsessions include:

• A fear of contamination or germs
• Anxiety about losing or misplacing something
• Intrusive, unwanted thoughts or those involving “taboo” subjects (e.g., sex, religion, death)
• Fear of losing control of your behavior
• Desire to have items arranged symmetrically or in an orderly fashion  

Compulsions often occur in response to obsessions. They are intense desires to do certain repetitive behaviors, such as washing hands or cleaning, counting, repeatedly checking doors or latches, saying certain words, and arranging items in a particular order.

Heart Attack

A heart attack (myocardial infarction) is a potentially fatal condition that occurs when heart muscles die due to poor or blocked blood circulation. A sense of impending doom can be an early sign of a heart attack, often preceding physical symptoms. Other warning signs include:

• Discomfort, tightness, squeezing, or pain in the chest (angina)
• Nausea, vomiting, lightheadedness, or dizziness
• Pain in the jaw, neck, or back
• Pain or tightness and discomfort in the shoulder or arm
• Breathing difficulty (e.g., breaths are rapid or shallow)

Anaphylaxis

A feeling of sudden, overwhelming doom can be a sign of anaphylaxis, a severe, life-threatening allergic reaction. Anaphylaxis is a medical emergency that causes your body to go into shock. Additional signs include:

• Itchiness
• Hives or rash
• Swelling, often in the face, lips, or limbs (sometimes the tongue)
• Breathing difficulty, shortness of breath, hoarseness, wheezing, or coughing
• Light-headedness, fainting
• Elevated heart rate
• Hypotension (low blood pressure)
• Nausea and vomiting
• Confusion

Epilepsy Aura

Epilepsy is a neurological (brain and nerve-related) disorder that causes sudden bursts of abnormal brain activity called seizures. A focal seizure is a type of seizure that can occur when or just before someone has auras—periods of altered sensation and perception.

A sense of impending doom is one type of epilepsy aura. Depending on the part of the brain affected, other sensations include visual hallucinations like swirling lights, hearing music, déjà vu (feeling like you’ve experienced something before), or experiencing a memory you can’t control.

Other signs of focal seizure include:

• Loss of consciousness
• Staring off into space
• Automatic or repeated behaviors, twitches, or tics
• Involuntary movements of the mouth, eyes, or other parts of the body
• Sudden mood shifts
• Tasting, smelling, seeing, or hearing things that aren’t there

Pulmonary Embolism

A pulmonary embolism (PE) occurs when an artery of the lung gets blocked, often caused by a loose piece of blood clot from another part of the body.

Panic and a sense of impending doom can be signs of this medical emergency, along with symptoms like shortness of breath, chest pain, fainting, persistent cough, coughing blood, and irregular heartbeat.

If your sense of impending doom isn’t tied to a mental health condition or anxiety disorder, this symptom can be a sign of a medical emergency. Call 911, especially if you’re also experiencing symptoms of medical emergencies like a heart attack or seizure, such as:

• Chest pains
• Breathing difficulties
• Irregular or rapid heartbeat
• Pain or discomfort in the arm or shoulder
• Nausea
• Loss of consciousness

If you have anxiety or experience panic attacks, contact your provider if your symptoms get worse or affect your overall quality of life. They can help develop or adjust your treatment plan as needed.

Diagnostic Tests

Several tests can help healthcare providers determine the cause of symptoms like a sense of impending doom, including:

• Symptoms assessment: Providers diagnose anxiety disorders and conditions like depression primarily by assessing your symptoms based on established criteria. They’ll ask about the nature, frequency, and severity of your case. A physical exam typically includes assessing movement-related symptoms, such as stiffness or inability to move.
• Medical history: This includes carefully reviewing your current health status, medications and supplements, and medical history.
• Blood tests: Clinical assessment of blood samples may help diagnose physical conditions like heart attacks as well as mental health conditions like panic attacks.
• Electrocardiogram (EKG or ECG): In cases of heart attacks, healthcare providers track the heart’s electrical activity using electrodes on the chest.
• Echocardiogram: This imaging method maps blood flow through the heart using soundwaves to identify blocked or damaged arteries.
• Angiogram: Healthcare providers track blood circulation in the lungs and through the heart using X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) scans.
• Chest X-ray: X-ray imaging of the chest may be necessary, especially in cases of pulmonary embolism. MRI and other imaging tests are also options.

Treatment for a sense of impending doom depends on the underlying cause. If the feeling has physical causes, such as a heart attack, pulmonary embolism, or seizure, it goes away when that condition is treated.

Psychotherapy and medications are treatment options for cases caused by mental health conditions. You may try therapies like cognitive behavioral therapy (CBT), which focuses on changing your thinking and behaviors to help you better cope with anxiety. Your provider may also prescribe antidepressants, anti-anxiety medications, or beta-blockers for mental health symptoms.

Anxiety, panic attacks, and other moments of uncontrolled fear can take a significant toll on your health and quality of life. This is why getting medical support and managing your condition is critical.

Possible coping strategies include the following:

• Track and log information about your medications
• Learn healthy ways to relax and cope with anxiety, such as gentle exercise, yoga, meditation, or mindfulness exercises
• Engage in regular physical activity
• Focus on nourishing your body with nutritious food
• Ensure you’re getting enough restful sleep
• Seek support from loved ones or family members
• Look for social media groups dedicated to anxiety and depression
• Join a support group

A sense of impending doom can cause intense fear. It can be a sign of many different conditions, including mental health conditions like panic disorder or anxiety or physical conditions like a heart attack or seizure.

Treatment depends on the underlying cause. Psychotherapy and medications are the primary treatments for mental health conditions. You can also take steps to manage this symptom by reaching out to others for support and practicing self-care, including quality sleep, nutrition, physical activity, and mindfulness.