What Is a ‘Feeling of Impending Doom’? And Why Does It Happen?

Ever had a feeling like something is terribly wrong, but you can’t put your finger on it? Or feel like the walls are closing in and you can’t escape?

Medical professionals call this a “feeling of impending doom.” And it can be a sign of a serious medical issue.

“It’s an overwhelming sense that something catastrophic is about to happen,” says emergency medicine physician Thomas Waters, MD. “And there are times it could point to acute physical distress.”

We talked with Dr. Waters and clinical psychologist Dawn Potter, PsyD, about what may be behind that feeling and when to seek emergency care.

Note: If you’re experiencing a feeling of impending doom along with symptoms of a heart attack, severe allergic reaction (anaphylaxis) or other medical emergency, call 911 or emergency services in your area.

What is a feeling of impending doom?

A feeling, or sense, of impending doom is a visceral, deep-in-your-bones feeling that something is terribly wrong.

It’s different from typical anxiety or rumination, Dr. Potter says. “When we’re anxious, we feel a sense of worry or stress, and we might replay scenarios over and over in our heads. Impending doom is more like a sudden sinking feeling, like the floor is dropping out from under you.”

Behind the scenes, a sense of impending doom is the result of your nervous system getting bombarded with signals warning it that something is wrong. Even if you don’t know what exactly the problem is, or even if the threat is real.

“When our fight-or-flight response gets activated, hormones and neurotransmitters like epinephrine and norepinephrine increase,” Dr. Waters explains. Your heart may race, you might sweat or start to breathe more shallowly. That sends a cascade of messages to your brain that something is going awry.

“Your brain starts to interpret all these intensely powerful signals as an immediate threat, even if you don’t consciously understand what’s happening,” he continues.

That flurry of biochemical activity can give rise to a feeling that something is horribly wrong, but you just don’t know what.

What does it feel like?

“Most people don’t walk into my office and say I get feelings of impending doom,” Dr. Potter clarifies. “That’s the language we as clinicians use to put words to those feelings.”

Instead, you might explain it like:

• An intense feeling of fear, terror or dread that stops you in your tracks
• A strong sense that something very bad is about to happen
• Feeling trapped or like there’s no escape
• A sudden feeling that you’re losing control
• A sense that you need to get away immediately

These feelings may also be accompanied by physical symptoms, such as:

• Chest tightness or pressure
• Cold sweats
• Trembling
• Dizziness
• An inability to catch your breath

What causes a sense of impending doom?

You might be tempted to think of a feeling of dread as something like anxiety. And there are times when impending doom can accompany anxiety disorders, including:

• Panic attacks and panic disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

But there’s another reason medical professionals take a feeling of impending doom very seriously: Under certain circumstances, it can be a red flag for a life-threatening medical emergency.

“A new, sudden, unexplained or unusually intense sense of impending doom deserves prompt medical attention,” Dr. Waters says. “Don’t assume what you’re feeling is ‘just’ anxiety.”

Especially when accompanied by physical symptoms, a feeling of impending doom can be a warning that you’re experiencing a life-threatening event, like:

• Aortic dissection (tearing in the lining of your aorta)
• Anaphylaxis (serious allergic reaction)
• Dangerous arrhythmia (changes in your heart rhythm)
• Heart attack
• Hemorrhagic shock (severe blood loss that keeps your organs from getting enough oxygen)
• Pulmonary embolism (a blood clot in your lungs)
• Severe asthma

When to seek emergency treatment

Seek emergency care if you have a feeling of impending doom along with symptoms of a medical emergency, like:

• Chest pain or pressure
• Difficulty breathing
• Fainting (or feeling like you’re about to faint)
• Intense abdominal or back pain
• Neurologic symptoms, such as trouble speaking, vision changes or loss of coordination
• Severe weakness
• Throat or tongue swelling
• Very rapid or irregular heartbeat
• Wheezing
• Widespread hives

These symptoms — or others that cause you significant distress — should prompt you to seek emergency care.

Even if you have a history of similar symptoms in the past, it’s important to stay vigilant for signs of a life-threatening situation. And when in doubt, seek emergency care.

“Panic attacks and medical emergencies can produce remarkably similar symptoms,” Dr. Waters acknowledges. “Keep in mind that you can have both a panic attack and a medical emergency at the same time. You don’t want to ignore it.”

Coping strategies

If you’re absolutely 100% sure you’re not having a medical emergency, there are some tricks you can use to help calm your nervous system and ride out a sense of impending doom. Dr. Potter recommends these strategies:

• Practice mindfulness. Try 5-4-3-2-1 grounding or breathwork techniques, like box breathing.
• Disconnect. Stop doomscrolling, turn off the news and avoid emotionally upsetting situations.
• Move your body. Take a walk or do some gentle stretches to clear your head.
• Talk it out. Call a trusted friend or family member who can help remind you that you’re safe. “Talking to somebody can distract you and reassure you,” Dr. Potter advises. “The goal in that moment is to move past your panic, not to dissect your feelings and triggers.”
• Seek mental health support. Repeated feelings of impending doom that don’t have a physical reason can be a sign of panic disorder or other mental health concerns. Therapy and medication can help.

But again, err on the side of caution. If you have any reason to believe your feeling of impending doom could be an emergency, treat it as such.

“Most people can’t be expected to reliably distinguish between panic and a medical emergency on their own,” Dr. Waters says. “If you have any doubt, get emergency treatment.”