What Causes a Sense of Impending Doom?

You may have heard people speak of a "sense of impending doom" in a number of ways. It's sometimes used to refer to a general sense that something bad is about to happen, but it can also be a symptom of a number of psychological and medical conditions.

Should you pay attention to this feeling if you experience it yourself? This article discusses what this symptom means, the conditions that may cause it, and what mechanisms can explain why a sense of impending doom happens.

What Is a Sense of Impending Doom?

Before going into the possible medical or psychological causes of a sense of impending doom, it's important to define and describe this symptom briefly. A sense of impending doom is a feeling of knowing that something life-threatening or tragic is about to occur.

There are several words and phrases people may use in addition to a sense of doom that describes this symptom. These include:

• A sense of urgency
• Being unable to "settle down"
• Desire to seek immediate medical care even though other symptoms don't warrant it
• Feeling anxious, discouraged, restless, or uncertain (to an extreme)
• Feeling that something bad or unusual is happening
• Sensing a premonition

Other Symptoms That Can Occur

A sense of impending doom may occur alone or along with other symptoms. Some of these symptoms (depending on the underlying cause) may include:

• Depersonalization (a sense of being detached from yourself)
• Heart palpitations (heart arrhythmias)
• Hot flashes
• Shortness of breath
• Sweating
• Tremors and shaking

Symptom vs. Saying

One of the difficulties in looking at the sense of impending doom is that this phrase is used in many different ways. It may be used literally to describe a feeling that something very bad is about to happen to you personally. In this way, the phrase would be considered a "symptom."

It may also describe your opinion about what is happening in the world in some way. In this case, the phrase might be used as a "prediction."

At other times the phrase may simply be used as a figure of speech. For example, a man may remark that he thought he was going to die when his boss stood to discuss company dress code having forgotten to zip his fly. When the man, as an employee, remarks on the irony of this to his boss, he may have a metaphorical sense of impending doom about the future of his employment.

Psychological Causes of a Sense of Impending Doom

This sense of impending doom is often fueled by the fact that the mind is a "meaning-making machine" that seeks patterns and attributes meaning to what we are experiencing, explains Alex Dimitriu, MD, double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine.

This can be useful in many cases but can also lead to mistakes and incorrect predictions. When people predict the wrong outcome, it can create what Dr. Dimitriu refers to as an emotional 'hallucination,' or delusion, a strongly held false belief. 

It is common for people to misattribute the source of their arousal. For example, you might be more likely to get upset with your partner if you have a headache. Or you might mistake the excitement you feel on an amusement park ride for feelings of attraction to the person you are riding with.

This can be seen in people who experience panic attacks, which are often accompanied by this sense of impending doom. People who experience these symptoms become overly aware of their physical reactions, such as rapid breathing, heart rate, and perspiration. "These, in turn, get fed back into the 'meaning-making machine,' which then interprets a confirmation of the belief that something bad will happen," Dimitriu explains.

Associated Psychological Conditions

A sense of impending doom can be a symptom of several mental health conditions, including:

• Bipolar disorder
• Depression
• Panic disorder (during panic attacks)
• Generalized anxiety disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Experiencing feelings of fear and misattributing the physical sensations you experience as a result can set off a cycle that worsens feelings of anxiety and contribute to a sense of impending doom. "The cycle between physical arousal or fear, then gets into a vicious loop with the mind's interpretation of danger—and the cycle can spin out of control," Dimitriu explains.

Intense emotional states, like panic attacks, can be very similar to being in an altered state of consciousness, Dimitriu notes. Because a person's beliefs are removed from reality, it becomes a self-perpetuating cycle that continues to feed itself.

Medical Causes of an Impending Sense of Doom

This sense of impending doom can also occur before serious medical situations. Certainly being in the midst of a life-threatening crisis may lead people to feel they may die, but this symptom may actually precede other obviously critical symptoms.

For example, for some people who have had serious allergic reactions (anaphylaxis), or who have developed Irukandji syndrome, (collection of symptoms that appear in response to a sting from Carukia barnesi, a type of jellyfish sting) the feeling of impending doom may occur before other serious symptoms which would make a person believe death is imminent.

Associated Medical Conditions

There are surprisingly few direct medical studies looking at a sense of impending doom as a symptom, given the frequency with which this symptom appears in the lists of "differential diagnoses" in medical textbooks or on hospital rounds.

Some conditions in which a sense of impending doom is listed as a symptom include:

• Anaphylaxis: A severe allergic reaction can bring a sense of impending doom.
  
• Blood transfusion reactions: Transfusions may trigger allergic reactions (anaphylaxis) with hemolysis (breakdown) of the transfused red blood cells. Symptoms of anxiety and impending doom occur before other symptoms like shortness of breath, palpitations, and blood pressure drop.
• Exposure to toxins and poisonings: This includes, in particular, the jellyfish stings noted earlier and cyanide poisoning, in which a sense of impending doom is often the first symptom.
• Intraoperative awareness: Sometimes people "wake up" during surgery, also called anesthesia awareness or unintended awareness.
• Pheochromocytoma: This type of adrenal gland tumor is often caused by a massive release of catecholamines such as adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine. These chemicals can cause a sudden increase in blood pressure, a rapid heart rate, sweating, and possibly a sense of impending doom.
• Pulmonary emboli: Pulmonary emboli are clots that travel to the lungs after breaking off in the legs (deep venous thrombosis). Other symptoms often include the sudden onset of sharp chest pain, which increases with a deep breath and may rapidly progress to lightheadedness and unconsciousness.
• Seizures: Both an epileptic aura and non-epileptic psychogenic seizures can cause a sense of impending doom.
• Heart attacks: A sense of doom may precede a heart attack.

Physiological Mechanisms

In addition to psychological factors that play a role in this symptom, several physiological explanations may help to explain the sense of impending doom and how this feeling arises.

A nervous system component could very well underlie this symptom in some cases. A sense of impending doom has been noted in many people with temporal lobe epilepsy and may also occur as part of an epileptic aura (focal aware seizures).

Certainly, the symptoms of a heart attack or another life-threatening condition may cause a sense of impending doom in a conscious rather than unconscious manner, as you recognize symptoms (such as a sudden severe drop in blood pressure and major chest pain) often associated with death.

Unsurprisingly, people may have a sense of impending doom when faced with a life-threatening medical condition, even without conscious thought. Our bodies respond in many ways to stress without conscious deliberation.

Another concept somewhat akin to the sense of impending doom that is similarly not well understood is near-death awareness. In near-death awareness, a person who appears unchanged to you may suddenly remark that they are going to die—and then die.

How to Get Help

If you are experiencing a sense of impending doom, it is a good idea to talk to your doctor or therapist. Your doctor can diagnose your condition, rule out potential medical causes, and recommend effective treatments that can help.

Dr. Dimitriu also suggests that finding some way to break the cycle and ground yourself in reality can be helpful. When experiencing a sense of impending doom, remind yourself that the feeling might not be rooted in fact and that what you think might not be accurate. 

"A key phrase I often use with my patients is, 'Don't believe everything you think,'" Dimitriu says. If you are experiencing this feeling due to a mental condition such as anxiety or depression, your doctor can work with you to identify thought patterns that contribute to cycles of anxiety and to develop new coping strategies that can help you manage these symptoms.