What is a panic attack
A panic attack, or panic disorder, is a situation characterized by a sudden and severe feeling of fear or anxiety that reaches levels of terror. It often comes out of nowhere and there is no obvious trigger. Oftentimes, people say something like
- “it happened all of a sudden”
- “I felt that I was going to die”
- “I was just talking with my friends and then I felt like I couldn’t breathe“
The name of the panic attack comes from the ancient Greek god Panas (in Greek these two words have the same root) who was supposed to be the protector of the farmers. He was tall, he had horns on his head and he used to hide in the bushes trying to scare passers-by.
How often do panic attacks happen?
Panic attacks may occur as often as several times a day or as a few times a year. Usually, they last from 7 to 12 minutes, and people who experienced them describe it as a complete loss of control or as a heart attack.
How common are panic attacks?
Panic disorders occur in about 2-3% of the general population. It seems to be associated with significant life events with great stress like graduation, marriage, having a first child, a disease, a significant loss, accident, etc. It is more common in women than men and it most commonly begins between adolescence and the age of 30.
What is the difference between anxiety and panic attacks?
First of all, what is anxiety? Anxiety is a normal emotion that motivates and protects us. Due to anxiety, we get up to go to work, prepare for a presentation, and shop to have food. This kind of anxiety of course is functional and helps us in our daily life, we call it moderate.
There is also the non-moderate, divided into "no anxiety" and "high anxiety". As you can imagine both of them are counterproductive because we are either going to worry very much or not at all.
But non-moderate anxiety is a feeling of intense discomfort, which pushes people to avoid frightening stimuli. It is a diffuse, unpleasant, often vague feeling that manifests itself with fear, tension, and anxiousness and that is accompanied by physical symptoms (e.g. heartbeat, heart arrhythmia, digestive disorders, dry mouth, pallor, tremor, headache).
Many people believe that anxiety and panic attacks are the same things because they share some common symptoms, but this is not true. Anxiety occurs by a specific trigger or event that is perceived as a threat from the person e.g homework, an upcoming test, a presentation, financial problems. Panic attacks on the other hand occur out of a sudden and the symptoms are more severe. Below we can see the main differences between anxiety and panic attack:
What are the symptoms of a panic attack?
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, usually around ten, and during which time four (or more) of the following symptoms occur
1. Palpitations, pounding heart, or accelerated heart rate
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying
Note: The abrupt surge can occur from a calm state or an anxious state.
Diagnosis of panic attacks and panic disorder
A panic disorder is diagnosed after physical disorders that can mimic anxiety are eliminated and when symptoms meet diagnostic criteria stipulated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Patients must have recurrent panic attacks (frequency is not specified) in which at least one attack has been followed by one or both of the following for at least one month:
- Persistent worry about having additional panic attacks or worry about their consequences (eg, losing control, going crazy)
- Maladaptive behavioral response to the panic attacks (eg, avoiding common activities such as exercise or social situations to try to prevent further attacks)
Understanding panic attacks better - what actually happens in our brain and body
Even though we tend to believe that we are going to die or go crazy when we have a panic attack, actually it’s our brain’s protection mode that is turned on. We believe that something bad is happening but this is far away from the truth.
Our autonomous nervous system is activated to protect us from a perceived threat. It is called autonomous because it operates on its own. When there is a threat in the environment this system activates all the physical sensations to prepare us to face the danger. It initiates a mode known as "fight or flight". Some researchers nowadays also add the word "faint" as many animals use faint as a way to face danger- they play dead so the hunter goes away.
In other words, you begin to experience increased heart rate because
- you feel like you have to run away from the threat or you feel your vision becoming narrower to focus on the threat to not get lost in other stimuli around (flight)
- or your arms and legs are getting numb because you feel like you have to fight-eliminate the danger (fight)
- or you feel like you will pass out to avoid the threat (faint)
From a biological perspective when we have to face a dangerous situation our body produces adrenaline in our blood. Adrenaline is a hormone that activates the body in many ways so it can handle a difficult situation, fight or avoid it. As soon as the danger goes away, our body returns to its normal levels. In situations of chronic anxiety and stress, the danger is as if it has never left and our body is in constant readiness - even in the absence of danger.
Reacting to threats then vs. now
This bodily way to react to threats made perfect sense many years ago when people were living out in the wild and had real dangers to face. Imagine living in those years when you had to go into the forest with all those wild animals. As soon as you encounter a bear you needed to decide what are you going to do - fight the bear, or run away from it. So the ‘’fight or flight’’ mode was there to help you with this threat, the bear.
When people used to live in the wild it made perfect sense to have this reaction. But why does this still happen today although we don’t have to fight bears anymore?
The answer is in the level of stress that everyone has individually. Stress is caused by the way we see and react to a situation. When someone feels, in general, stressed or anxious, their resilience against it decreases and the sensitive mechanism of the ‘’fight or flight ‘’reaction is more easily triggered, especially if there is a predisposition.
The vicious cycle of panic attacks
When a panic attack occurs in a given situation, the mind can easily learn to be afraid of that situation and the panic reaction is "adjusted" so that it is triggered by the situation.
The person affected may also contribute to the situation by misinterpreting some "normal" symptoms (e.g. heartbeat raise due to exercise, coffee, or medication) as symptoms of panic and eventually causing an attack himself/herself due to his/her anxiety. In more detail, someone who experiences panic attacks usually develops negative thoughts about this situation which affect him/her emotionally, physically, and behaviorally.
For example, if during a panic attack the person notices that the heart starts beating faster he/she is going to think that he/she is going to have a heart attack. This thought will make the person feel fear which is going to increase the adrenaline in the body. Adrenaline will cause other physical symptoms or make the heart beat faster. As a result, the individual is going to fear the situation even more next time and think that he/she might be right about the heart attack.
Eventually, to relieve the anxiety and fear, he/she will start avoiding anything related to a possible panic attack or will make sure that he/she is never left alone so that he can receive the necessary help in case he or she feels discomfort.
How to overcome panic attacks
There are various things you can do to tackle and overcome your panic attacks. Here are some strategies you can use:
1. Try to find out what the real trigger of the panic attack is
2. Try to accept the situation and the discomforting feelings
3. Write down your thoughts and rationalize them
4. Do not avoid situations because of fear. If you want to avoid something, then avoid the avoidance. The more you avoid, the more intense panic attacks are going to get
5. Remind yourself that a panic attack will last a maximum of 10 minutes. It's something that feels scary, but it will pass and not kill you
6. Try to distract yourself. For example, you can start counting from 20 to 1 or sing the lyrics of your favorite song
7. Try some breathing exercises. You can take a deep slow breath, hold it for a second and then slowly let it out. Repeat 5-8 times. This will make the breathing rhythm go back to normal which makes the mind believe that the threat has terminated
8. Do not take medication on your own
In case you experience intense and frequent panic attacks, your anxiety may be at such high levels that you can not deal with it on your own at the moment. A psychologist can guide you through these difficult situations through psychological interventions.
If the symptoms are more severe then it might be a good idea to visit a psychiatrist who can guide you appropriately by giving you medication, which helps treat anxiety-related disorders. Recent research has shown that the combination of medication and therapy sessions with a psychologist has the best possible outcome.
A panic attack is an anxiety disorder that makes a person's life difficult, as it is characterized by a number of disturbing mental and physical symptoms. If you have any symptoms of panic, after ruling out the existence of the organic disease, contact a specialized psychologist or psychiatrist.
Although it often seems like a terrifying situation during which we are helpless and that we are unable to overcome, panic attacks are not as dangerous as we think. Working on ourselves and the conditions of fear can help us overcome dysfunctional behavior and live our lives without panic attacks imposing major restrictions on us.