Panic Attacks

Understanding panic attacks

Although human beings are often exposed to feelings of fear and dread in what is known as the fight or flight response when, as prehistoric creatures, we would have been readying ourselves in the wild for a possible confrontation, panic attacks are more severe. What distinguishes such an attack of panic from the usual sense of fear we might feel in fearful situations is tricky to define, however. This is because how we all rate our sense of fear is subjective. It is a bit like asking two people to describe their pain. No one can really say who is in more pain or simply better able to cope with it. As such, the defining characteristics of a panic attack are heart palpitations, sweating, shaking, breathlessness and dread or numbness. When two or more of these symptoms are felt at once for anything from a few seconds to half an hour, then a panic attack will be said to have occurred.

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Yes and no. There has been plenty of research into anxiety disorders which tend to conclude – although they are by no means always in agreement – that there is a hereditary link between people in the same family and their predisposition to anxiety attacks. It is known, for example, that certain chromosomal characteristics are linked to phobias and that phobias themselves are also linked to panic attacks. The RBFOX1 gene has been found to play a part in these sorts of attacks, as well, when researchers looked for it in twin studies. That being said, there are numerous environmental factors that will play their part in whether you happen to suffer a panic attack or not. Consequently, whatever hereditary link there may be, it can only be a part of the story. Research is ongoing in this area, and it is too early to say whether any genetic treatment might ever be developed to help people with diagnosed anxiety disorders.

It is unlikely that a panic attack will occur for no reason whatsoever. Nevertheless, the reason that one starts may not be obvious. As such, many people who suffer from them will find that there is no apparent reason for them. Psychiatrists will use a variety of techniques to try and learn from the subconscious of their patients what may be setting off, or triggering, a panic attack. Even so, years of psychotherapy may never reveal the ultimate cause of a panic attack. If you know the situations and stimuli that cause your panic attacks, then it becomes much easier to avoid them or to react positively to the early warning signs of an impending attack. However, many people find that they never get to grips with the causes of their attacks and simply have to find coping mechanisms to deal with them when they occur.

No, they are not. It is often thought that suffering a panic attack may be a sign of mental illness, but this is not correct. According to numerous public health systems around the world, including the NHS, the mental condition most associated with panic attacks is panic disorder. Some people will suffer a panic attack or two but not develop this mental disorder, whereas others might. The symptoms of panic disorder include panic attacks but are not limited to them. Others include a constant state of anxiety, often referred to as a chronic fear of fear itself. One of the key assessments that medical practitioners need to make to diagnose panic disorder is to understand the frequency of your attacks of panic as well as the severity of them. This will usually mean discussing personal things and emotions in an open way with your doctor, something that is not always easy.

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Some panic attacks will last a few seconds, while others will go on for much longer periods of time. In the main, they will last somewhere between ten minutes and half an hour before their symptoms have subsided enough for normality to resume. Some people report much longer episodes, however. A panic attack lasting an hour or more is not uncommon. However, it is much rarer for a panic attack to last anything more than a few hours. Therefore, when people report that they've suffered a panic attack over several days, it is often met with scepticism. Of course, it is impossible to rule out such a phenomenon, but – in some cases, at least – it seems more likely that the individual has suffered from chronic anxiety interspersed with more acute attacks. This may indicate anxiety disorder, but a professional diagnosis should be sought because other explanations for these symptoms are possible.

Panic attacks are caused by a range of phenomena, usually psychological. Some people may suffer them after they have been exposed to stimuli that provoke a phobic response. Someone who has arachnophobia might suffer a panic attack if they suddenly find themselves surrounded by spiders' webs, for example. In other words, there is a known psychological cause that leads to the symptoms associated with panic attacks. And yet, many people find that they start 'out of the blue' with no apparent cause. Usually, this is because of a subconscious reaction to something we are not even aware of. Over time, and with multiple attacks, it can become possible to work out the cause and to notice the early warning signs of an impending attack which, in turn, means being better able to manage them. Often, the first symptom people feel is a sense of dread that manifests itself in a tightening of the chest.

When we are tucked up in bed, there should be fewer stimuli to cause the adverse mental reactions that might lead to a panic attack. However, as you have already read, the subconscious is at play when it comes to panic attacks. Consequently, it is when we feel out of control – such as when we give in to slumber – that we can also be most anxious. What might happen as we sleep? Is something out there? These are the sorts of thought patterns that many children have, and they can last into adulthood, too. Dwelled upon too much, and they can cause problems with sleeping. Even when we are asleep, dreams may explore our subconscious in ways we cannot always truly comprehend. As such, you might be exposed to your triggers in your dreams which can induce panic attacks. Most psychotherapists would agree that dreams are a way that our subconscious selves try to deal with things we are fearful of, which makes dream interpretation a useful tool.

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According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is the textbook most professionals use in the diagnosis of a range of disorders, panic attacks are defined as a period of intense fear or mental anguish. A range of symptoms - such as nausea, sweating, trembling, dizziness, accelerated heart rate, hot flushes and fear of insanity – are all taken into account in the diagnostic process. However, what clinicians are looking for is a combination of these symptoms that come on almost at once. We can all have heart palpitations or hot sweats at any time, after all. When it comes to a properly diagnosed panic attack, there must be more than one symptom, and they must be acutely felt. Some related symptoms, like headaches, stiff necks or crying, are not counted as contributory factors in the diagnosis of panic attacks, however.

Like other highly emotive states, a panic attack will cause stress hormones to be released into the brain. It is these that may lead to headaches. However, since headaches have so many other causes, they are not used in the diagnostic process with panic attacks. Stress hormones have a range of physiological reactions in the body. Just one of them is the sense of tightening we sometimes feel around the chest and abdomen. They can also lead to a drop in libido. Insofar as the brain is concerned, research is still ongoing. Much of it is focused on serotonin levels. People who suffer from attacks of panic frequently often have high levels of serotonin which is known to have a negative effect on mood and outlook unless it can be counterbalanced by other natural hormones, such as melatonin or dopamine, for example.

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Yes, they can often have a big impact on the severity of attacks as well as the number of them you might have. For example, if you are in the habit of consuming lots of caffeine, perhaps drinking multiple mugs of coffee each day, then this can increase the likelihood that you will suffer from a panic attack. Cut down on your coffee intake, and you may well find that the severity of your attacks begins to fall away. Releasing more positive endorphins by leading a less stressful life will also tend to help. Stress management can be achieved in numerous ways, of course, including trying mindfulness based stress reduction techniques, such as daily meditation sessions. Learning how to refrain from hyperventilating is also a good lifestyle change you can make by consciously thinking about the control you have over the oxygenation of your blood.

As mentioned, breathing deeply and slower will help to avoid hyperventilation. Grabbing at the air with short breaths quickly can induce a panic-like state. If you have ever had a panic attack before, then you may recognise the shortness of breath you felt at the same time. Consequently, hyperventilating can be associated in your mind with a panic attack. Therefore, breathing in this way can cause a mild sense of anxiety to grow into a full attack. By learning breathing exercises, you can empower yourself to control these situations. Breathing into a paper bag, which gets progressively less oxygenated, is another way to regain control of your anxiety levels.

Psychoanalysis is a therapeutic option that tends to be reserved for people with the worst cases. Object relations theory, which explores the psyche of a patient and their childhood memories, tends to be a preferred technique used by many psychiatrists for treating attacks. However, CBT cognitive behavioural therapy and other talking therapies are also often used, which tend to get results much more quickly even if they might not get to the root cause of the issue. In addition, someone who suffers from attacks of panic can also be treated with drug therapies. Typically anti-depressants and benzodiazepines are prescribed. They should only ever be taken under professional medical guidance, however.

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According to the pregnancy and neonatal charity Tommy's, a panic attack that is suffered during pregnancy can be extremely worrying. That said, they can often be a one-off, sometimes put down to the changing hormones that are experienced at such times. Many women will feel anxiety during the pregnancy and – in the worst cases – bouts of depression. All of this can make some mothers-to-be concerned for their own welfare as well as that of their unborn child. However, a panic attack that is suffered during pregnancy will not be dangerous to either the mother or the baby in its own right. Seek reassurance from a medical professional and learn to manage them with breathing techniques if they recur. It is important to understand that a panic attack is not unusual in pregnancy, as at other times in life, despite the concern they may understandably cause.

To summarise, a panic attack is an acute sense of fear that goes hand in hand with a raft of physiological symptoms. One panic attack may include sweating profusely, while another may feature dizziness. They can be varied, and one person may suffer in a completely different way from another. What they all tend to have in common, however, is that they last for a short period of time, they come with a sense of dread, and they are associated with quickening heart rates. For a panic attack to be a panic attack, it must have a quick onset and not build up slowly, however. People who suffer them and who feel high levels of worry between them may be suffering from a related condition known as panic disorder, a mental health complaint.

Furthermore, a panic attack will be caused by something, even if it is not immediately what it might be. Both things we know we are scared of, as well as things that are buried deep within our unconsciousness, can cause them to trigger. Over time, many people find that they can cope with them better, especially if they make lifestyle changes that help to diminish their severity. Although deeply unpleasant, most types of panic attacks are not inherently dangerous. That said, seeking professional medical help from your GP initially is advisable if you find that they are occurring more frequently or interfering with your daily life to a greater extend. There is plenty of help available to deal with them.