Panic attacks involve very intense periods of fear, anxiety, dread, and/or unease that take place over a short (discrete) period of time. These attacks hit a person quickly (usually reaching a peak within a few minutes). Although short-lived, attacks can feel pretty terrifying due to the intense nature of physical symptoms that occur. As a result, people often assume they are in the midst of a medical emergency (e.g., having a heart attack). Some people even think they are about to die.
People can experience various symptoms and physical sensations during a panic attack. Some of the more common ones are:
- Fast or and/or pounding heart beat
- Chest pain and/or tightness
- Shortness of breath
- Perceived temperature changes in the body, i.e., feeling hot or having chills
- Trembling or shaking
- Churning stomach
- Nausea (feeling physically sick)
- Tingling or numbness sensations
- Feeling ‘detached’ from the situation- feeling like the situation is not real
- Having catastrophic thoughts (e.g., ‘I’m going crazy’, ‘I’m having a heart attack’, or ‘I’m going to die’).
Panic disorder can develop suddenly or more gradually. The frequency of panic attacks can also vary to a large degree: A person many experience several per day for a period, then not suffer from any for weeks or months. There are many potential reasons for this variation (e.g., a change in stress levels). In clinically-significant panic, people can experience huge disruption to their work, home and social lives. At times, people feel compelled to take particular steps to ‘protect’ themselves from perceived danger (e.g., some people will refuse to leave the house unless someone they trust travels with them).
Around one in five people will experience at least one panic attack during their lifetime (1). While some people may experience one or two panic attacks in their lifetime, other people can suffer from hundreds as is the case with panic disorder. Panic disorder is the term given to the situation where a person experiences on-going panic attacks involving at least distinct symptoms (as described in the earlier symptom list). In panic disorder, however, the occurrence of attacks are accompanied by persistent worry of having future attacks, worry about their negative consequences (e.g., health problems, social rejection), and a change in behaviour due to these attacks (2). This means that panic disorder results in a lot of additional worry and also messes around with normal life. What distinguishes clinically significant panic from less severe forms of anxiety is, not only the intensity of the above symptoms, but also the fear of having future attacks, and the presence of catastrophic thoughts when panic is being experienced. Many of the above symptoms are associated with other forms of anxiety, however, it is the high severity of these symptoms experienced over short periods of time that distinguishes panic from other forms of anxiety.
Panic symptoms are a product of the body's ‘fight or flight response’. This is an in-built mechanism in the body’s nervous system that prepares us to respond effectively to danger in order to preserve our lives. The reason why, for example, heart rate increases is to supply the body with enough blood and oxygen to either stay and fight, or escape as fast as possible. In other words, the physical sensations you experience is the body gearing up to respond to danger. This fight or flight response can occur when there is no actual danger. In other words, the body can produce a false alarm. This is what is happening during a panic attack. The part of our nervous system responsible for the fight or flight response is known as the autonomic nervous system. This system is divided into two branches; sympathetic and parasympathetic. The sympathetic system kicks off the fight or flight response and the parasympathetic system dials this response back again. This effectively means that the parasympathetic system is our in-built ‘kill switch’ that ensures a panic attack must eventually stop (i.e., they are ‘self-limiting’).
Fortunately, panic is treatable. If you suspect you might be suffering from panic attacks, it is important that you seek some help as soon as possible. First, see your GP to rule out any underlying medical conditions. There are several that can mimic a panic attack, so get a medical all-clear as a first priority. Once you have done this, I would recommend that you get to a Clinical Psychologist who take you through an evidence-based treatment program.
Seeing a qualified professional is often the best option, especially if your problem has persisted for some time. However, if you cannot or simply refuse to see a professional, then another option is to try one of several self-help books. Two I recommend are Derrick Silove's book 'Overcoming panic and agoraphobia', published by Robinson. Another book is called 'Mastery of your anxiety and panic' by David Barlow & Michelle Craske. Both of these books utilise cognitive behavioural techniques and can be found on Amazon (amongst other sources) where ebook versions are available.
(1) Wittchen, H., et al. (2010). Agoraphobia: A review of the diagnostic classificatory position and criteria. Depression and Anxiety, 27, 113-133.
(2) American Psychiatric Association (APA) (2000). Diagnostic and statistical manual of mental disorders- text revision. Washington: APA.