The anatomy of a panic attack

If you have had panic attacks in the past, and you realise that you are starting to have another, these tips can help anchor you in the moment



By Dani Blum

Published: Tue 22 Nov 2022, 9:28 PM

Panic attacks revolve around terror. Though mainly associated with the mind, they’re actually constellations of symptoms, both physical and cognitive. Your brain is seized by fear; your body responds, and it can be hard to make sense of it all.

Most experts define a panic attack as a sudden onset of intense fear, as opposed to a condition like general anxiety, which usually manifests as almost constant worry.

People having panic attacks are bombarded by mental and physical symptoms, which can vary. Their hearts might race. They may feel that they cannot breathe. Their limbs might tingle. Sometimes they shake. They may grow nauseated.

Their chests could tighten. Some people may suddenly feel hot and sweaty, others feel like they have the chills.

And then there’s the churning and destabilising fear. In the throes of a panic attack, people may worry that they are going insane, losing control of their minds and bodies. They may think it’s a heart attack or even that they are going to die.

Most people who regularly experience panic attacks do not experience all of these symptoms, but may have many of them. A small subset of people, however, have limited symptom panic attacks, in which they encounter three or fewer.

And, almost as suddenly as panic attacks come on, they typically dissipate. Symptoms mount over the course of 10 minutes, and usually fade within half an hour, although there may be lingering effects.

The experience can be traumatic, however, and people may start to fear sensations that remind them of their symptoms, like feeling out of breath after climbing a flight of stairs. They might also avoid anything that reminds them of the episode — the grocery store where their heart pounded, the food they were eating when the panic hit.

Some people may develop panic disorder, which psychologists define by repeated, unexpected panic attacks that interfere with daily functioning. While 15 per cent to 30 per cent of people will have at least one panic attack in their life, only 2 per cent to 4 per cent will develop panic disorder, said Dr. Franklin Schneier, co-director of the Anxiety Disorders Clinic at New York State Psychiatric Institute. A subset of those people — roughly 1 in 3 — also develop agoraphobia, an anxiety disorder that can involve extreme fear of public or crowded places, public transit, standing in line or leaving one’s home at all.

The causes

A diverse set of stressors — like traumatic events, financial worries or even public speaking — can prompt panic attacks. But they can also occur unexpectedly.

Intense stress activates the sympathetic nervous system, a network of nerves that trigger the “fight or flight” response to perceived danger. The body releases chemicals like epinephrine, also known as adrenaline, and norepinephrine, which cause the heart to go into overdrive, pupils to swell and skin to release sweat. The parasympathetic nervous system returns the body to its original state. If it does not activate after some time, a panic attack can suspend a person in that heightened state of arousal.

Many researchers believe that panic attacks might occur when the brain isn’t properly able to send messages between the prefrontal cortex, which is associated with logic and reasoning, and the amygdala, which governs emotional regulation. During a panic attack, the amygdala is hyperactive, while the prefrontal cortex is less responsive, causing us to spiral.

Anyone can experience a panic attack. The risk, however, is highest for teens and people in their 20s. If you haven’t had a panic attack by age 45, you’re less likely to have an episode later in life.

Women are more than twice as likely as men to get panic attacks, but researchers aren’t entirely sure why.

Easing one in the moment

If you have not experienced a panic attack before, and you’re having chest pain and shortness of breath, you should go to the emergency room to confirm that you really are having a panic attack, instead of a cardiac issue. But if you have had panic attacks in the past, and you realise that you are starting to have another, these tips can help anchor you in the moment.

Talk yourself through it: Remind yourself that you have survived panic attacks.

Know who to call: A trusted friend or family member can help talk you down. Just talking to someone can help stabilise you.

Count colours: Some therapists recommend a simple grounding exercise: Count and name the colours around you. Say each one out loud, or just note them in your mind, as you register that the carpet is blue, or your shirt is red. Doing this can help distract you from the mounting anxiety.

Grab something cold: Reach into your freezer and hold an ice cube, or place a damp, cool washcloth over your wrist. The shock of cold can help centre you.

Breathe like a baby: Hyperventilating, common in panic attacks, can make people feel dizzy, so taking slow breaths can help. This can flood the brain with oxygen and trigger the parasympathetic nervous system, signalling that we don’t need to fight.

Preventing future episodes

For recurrent attacks, you may want to seek a therapist. Forms of cognitive behavioural therapy, in which a clinician prods you to challenge the fears and sensations you might experience during a panic attack, can be among the most effective treatments. The process can help change your thought patterns, desensitising you to the underlying distress that can trigger panic attacks.

Some medications, including antidepressants like selective serotonin reuptake inhibitors, or SSRIs, may also be helpful for managing panic attacks.

As disconcerting as panic attacks can be, it’s important to remember that they are highly treatable, and that, as suddenly as they can crop up, they begin to fade.

This article originally appeared in The New York Times


More news from Mental Health