What Causes a Sense of Impending Doom?

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Psychological Explanations

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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.

Verywell / Cindy Chung

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:

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:

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 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.

A sense of impending doom is, in many ways, a “micro” delusion. It is a strongly held belief in an outcome that is quite removed from reality.—ALEX DIMITRIU, MD, PSYCHIATRIST AND FOUNDER OF MENLO PARK PSYCHIATRY & SLEEP MEDICINE

A sense of impending doom is, in many ways, a “micro” delusion. It is a strongly held belief in an outcome that is quite removed from reality.

—ALEX DIMITRIU, MD, PSYCHIATRIST AND FOUNDER OF MENLO PARK PSYCHIATRY & SLEEP MEDICINE

It is a vicious cycle that helps perpetuate and worsen the feelings of anxiety that contribute to this sense of impending doom.

Associated Psychological Conditions

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

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.

This is why anxiety conditions often worsen over time without intervention. It is also why it is so important to seek help if you are experiencing a sense of impending doom or other symptoms of severe anxiety.

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 alife-threatening crisismay lead people to feel they may die,but this symptom may actuallyprecedeother 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 fromCarukia barnesi, a type of jellyfish sting) the feeling of impending doommay occurbeforeother serious symptoms which would make a personbelieve 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:

In many cases, the sense of impending doom occurs before the symptoms that would indicate a true medical emergency is present.

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1:31

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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 release of catecholamines may occur as a primary factor (such as in pheochromocytoma),in response to the body recognizing a medical emergency (such as with a heart attack or pulmonary embolism), or in response to psychological stress (panic) as part of thefight or flight responseto stress.

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.

Dogs can sometimes detect some of the changes that precede seizures, which they are able to recognize before people. This is why people with seizure conditions may opt to have a seizure-alert service dog.

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.

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.

If someone is experiencing recurrent feelings of impending doom or symptoms of anxiety or panic attacks (which are really intense anxiety moments) that impact daily life, it is worth speaking with a professional. Sleep disturbance, thoughts of self harm, fear of losing control, or any emotion that feels too much and comes back too often should be addressed.—ALEX DIMITRIU, MD, PSYCHIATRIST AND FOUNDER OF MENLO PARK PSYCHIATRY & SLEEP MEDICINE

If someone is experiencing recurrent feelings of impending doom or symptoms of anxiety or panic attacks (which are really intense anxiety moments) that impact daily life, it is worth speaking with a professional. Sleep disturbance, thoughts of self harm, fear of losing control, or any emotion that feels too much and comes back too often should be addressed.

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.

When to Call Your DoctorUnless you commonly experience impending doom as part of an anxiety disorder, it may be best to call 911 if you have an overwhelming sense of impending doom.This is particularly true if you are also experiencing other symptoms of a potential medical emergency, such as chest pain, shortness of breath, heart palpitations, nausea, hot flashes, and sweating. Many people have stayed alive due to trusting their instinct and intuition.

When to Call Your Doctor

Unless you commonly experience impending doom as part of an anxiety disorder, it may be best to call 911 if you have an overwhelming sense of impending doom.This is particularly true if you are also experiencing other symptoms of a potential medical emergency, such as chest pain, shortness of breath, heart palpitations, nausea, hot flashes, and sweating. Many people have stayed alive due to trusting their instinct and intuition.

17 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Graeff FG.New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray.Braz J Med Biol Res. 2012;45(4):366-75.  doi:10.1590/S0100-879X2012007500036National Institute of Mental Health.Panic disorder: When fear overwhelms.Willadsen TG, Bebe A, Køster-Rasmussen R, et al.The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review.Scand J Prim Health Care. 2016;34(2):112-121. doi:10.3109/02813432.2016.1153242Figure of speech.Merriam-Webster Dictionary.Willis MA, Haines DE.The Limbic Systemin Haines DE, Mihailoff GA Eds. Fundamental Neuroscience for Basic and Clinical Applications (Fifth Edition).Elsevier.2018. doi:10.1016/B978-0-323-39632-5.00031-1Gershwin LA.Jellyfish: A Natural History.University of Chicago Press.2016.Harvard Health Publishing.Anaphylaxis: An overwhelming allergic reaction.Yu H, Wu D.Effects of different methods of general anesthesia on intraoperative awareness in surgical patients.Medicine(Baltimore). 2017;96(42):e6428.  doi:10.1097/MD.0000000000006428Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29. Published 2013 May 21. doi:10.11604/pamj.2013.15.29.2039Li W, Chen C, Chen M, Xin T, Gao P.Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.Medicine (Baltimore). 2018;97(22):e10944. doi:10.1097/MD.0000000000010944Stanford Health Care.Epilepsy.Iles-Smith H, Deaton C, Campbell M, Mercer C, McGowan L.The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary intervention.J Clin Nurs. 2017;26(21-22):3511-3518. doi:10.1111/jocn.13715Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29.  doi:10.11604/pamj.2013.15.29.2039Gilchrist PT, Ditto B.Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms.Biol Psychol. 2015;104:28-34.  doi:10.1016/j.biopsycho.2014.11.006Cedars-Sinai.Heart attack (myocardial infarction).Catala A, Cousillas H, Hausberger M, Grandgeorge M.Dog alerting and/or responding to epileptic seizures: A scoping review.PLoS One. 2018;13(12):e0208280. doi:10.1371/journal.pone.0208280Anaphylaxis.American Academy of Allergy Asthma & Immunology.

17 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Graeff FG.New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray.Braz J Med Biol Res. 2012;45(4):366-75.  doi:10.1590/S0100-879X2012007500036National Institute of Mental Health.Panic disorder: When fear overwhelms.Willadsen TG, Bebe A, Køster-Rasmussen R, et al.The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review.Scand J Prim Health Care. 2016;34(2):112-121. doi:10.3109/02813432.2016.1153242Figure of speech.Merriam-Webster Dictionary.Willis MA, Haines DE.The Limbic Systemin Haines DE, Mihailoff GA Eds. Fundamental Neuroscience for Basic and Clinical Applications (Fifth Edition).Elsevier.2018. doi:10.1016/B978-0-323-39632-5.00031-1Gershwin LA.Jellyfish: A Natural History.University of Chicago Press.2016.Harvard Health Publishing.Anaphylaxis: An overwhelming allergic reaction.Yu H, Wu D.Effects of different methods of general anesthesia on intraoperative awareness in surgical patients.Medicine(Baltimore). 2017;96(42):e6428.  doi:10.1097/MD.0000000000006428Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29. Published 2013 May 21. doi:10.11604/pamj.2013.15.29.2039Li W, Chen C, Chen M, Xin T, Gao P.Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.Medicine (Baltimore). 2018;97(22):e10944. doi:10.1097/MD.0000000000010944Stanford Health Care.Epilepsy.Iles-Smith H, Deaton C, Campbell M, Mercer C, McGowan L.The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary intervention.J Clin Nurs. 2017;26(21-22):3511-3518. doi:10.1111/jocn.13715Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29.  doi:10.11604/pamj.2013.15.29.2039Gilchrist PT, Ditto B.Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms.Biol Psychol. 2015;104:28-34.  doi:10.1016/j.biopsycho.2014.11.006Cedars-Sinai.Heart attack (myocardial infarction).Catala A, Cousillas H, Hausberger M, Grandgeorge M.Dog alerting and/or responding to epileptic seizures: A scoping review.PLoS One. 2018;13(12):e0208280. doi:10.1371/journal.pone.0208280Anaphylaxis.American Academy of Allergy Asthma & Immunology.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Graeff FG.New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray.Braz J Med Biol Res. 2012;45(4):366-75.  doi:10.1590/S0100-879X2012007500036National Institute of Mental Health.Panic disorder: When fear overwhelms.Willadsen TG, Bebe A, Køster-Rasmussen R, et al.The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review.Scand J Prim Health Care. 2016;34(2):112-121. doi:10.3109/02813432.2016.1153242Figure of speech.Merriam-Webster Dictionary.Willis MA, Haines DE.The Limbic Systemin Haines DE, Mihailoff GA Eds. Fundamental Neuroscience for Basic and Clinical Applications (Fifth Edition).Elsevier.2018. doi:10.1016/B978-0-323-39632-5.00031-1Gershwin LA.Jellyfish: A Natural History.University of Chicago Press.2016.Harvard Health Publishing.Anaphylaxis: An overwhelming allergic reaction.Yu H, Wu D.Effects of different methods of general anesthesia on intraoperative awareness in surgical patients.Medicine(Baltimore). 2017;96(42):e6428.  doi:10.1097/MD.0000000000006428Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29. Published 2013 May 21. doi:10.11604/pamj.2013.15.29.2039Li W, Chen C, Chen M, Xin T, Gao P.Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.Medicine (Baltimore). 2018;97(22):e10944. doi:10.1097/MD.0000000000010944Stanford Health Care.Epilepsy.Iles-Smith H, Deaton C, Campbell M, Mercer C, McGowan L.The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary intervention.J Clin Nurs. 2017;26(21-22):3511-3518. doi:10.1111/jocn.13715Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29.  doi:10.11604/pamj.2013.15.29.2039Gilchrist PT, Ditto B.Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms.Biol Psychol. 2015;104:28-34.  doi:10.1016/j.biopsycho.2014.11.006Cedars-Sinai.Heart attack (myocardial infarction).Catala A, Cousillas H, Hausberger M, Grandgeorge M.Dog alerting and/or responding to epileptic seizures: A scoping review.PLoS One. 2018;13(12):e0208280. doi:10.1371/journal.pone.0208280Anaphylaxis.American Academy of Allergy Asthma & Immunology.

Graeff FG.New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray.Braz J Med Biol Res. 2012;45(4):366-75.  doi:10.1590/S0100-879X2012007500036

National Institute of Mental Health.Panic disorder: When fear overwhelms.

Willadsen TG, Bebe A, Køster-Rasmussen R, et al.The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review.Scand J Prim Health Care. 2016;34(2):112-121. doi:10.3109/02813432.2016.1153242

Figure of speech.Merriam-Webster Dictionary.

Willis MA, Haines DE.The Limbic Systemin Haines DE, Mihailoff GA Eds. Fundamental Neuroscience for Basic and Clinical Applications (Fifth Edition).Elsevier.2018. doi:10.1016/B978-0-323-39632-5.00031-1

Gershwin LA.Jellyfish: A Natural History.University of Chicago Press.2016.

Harvard Health Publishing.Anaphylaxis: An overwhelming allergic reaction.

Yu H, Wu D.Effects of different methods of general anesthesia on intraoperative awareness in surgical patients.Medicine(Baltimore). 2017;96(42):e6428.  doi:10.1097/MD.0000000000006428

Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29. Published 2013 May 21. doi:10.11604/pamj.2013.15.29.2039

Li W, Chen C, Chen M, Xin T, Gao P.Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.Medicine (Baltimore). 2018;97(22):e10944. doi:10.1097/MD.0000000000010944

Stanford Health Care.Epilepsy.

Iles-Smith H, Deaton C, Campbell M, Mercer C, McGowan L.The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary intervention.J Clin Nurs. 2017;26(21-22):3511-3518. doi:10.1111/jocn.13715

Lalitha R, Opio CK.A missed diagnosis or a masquerading disease: back to the basics.Pan Afr Med J. 2013;15:29.  doi:10.11604/pamj.2013.15.29.2039

Gilchrist PT, Ditto B.Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms.Biol Psychol. 2015;104:28-34.  doi:10.1016/j.biopsycho.2014.11.006

Cedars-Sinai.Heart attack (myocardial infarction).

Catala A, Cousillas H, Hausberger M, Grandgeorge M.Dog alerting and/or responding to epileptic seizures: A scoping review.PLoS One. 2018;13(12):e0208280. doi:10.1371/journal.pone.0208280

Anaphylaxis.American Academy of Allergy Asthma & Immunology.

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