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The Anatomy of a Panic Attack

Panic attacks revolve around terror. Though people mainly associate them 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.

What is a panic attack?

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 from person to person.

Their hearts might race and throb.

They may feel that they cannot breathe.

Their limbs might tingle. Sometimes they shake.

They may grow nauseous.

Their chests could tighten, and some report a sensation of feeling they’re being choked. Some people experiencing panic attacks may suddenly feel hot and sweaty, others feel like they have the chills.

And then there’s the churning and destabilizing 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 they are having 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 who get panic attacks, 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 ten minutes, and usually fade within half an hour, although some people may feel lingering effects.

The experience can be traumatic, however, and people who have panic attacks 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 to 30 percent of people will have at least one panic attack in their life, only two to four percent will develop panic disorder, Dr. Schneier said. A subset of those people — roughly one in three — 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. This may occur when people become intensely afraid of the places in which they have had panic attacks before.

What causes panic attacks?

A diverse set of stressors — like traumatic events, financial worries or even public speaking — can prompt panic attacks. But they can also occur unexpectedly, with no discernible trigger.

When people experience intense stress, it activates the sympathetic nervous system, a network of nerves that trigger what psychologists call 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 our skin to release sweat.

Another network of nerves, called 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.

Who gets panic attacks?

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 that disparity exists.

How do you soothe a panic attack 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 realize that you are starting to have another, these tips can help anchor you in the moment.

It may be helpful to practice these coping strategies ahead of time, so that you can employ them the next time a panic attack hits:

Talk yourself through it.

Remind yourself that you have survived panic attacks in the past, and while scary, the panic itself is not dangerous.

Know who to call.

A trusted friend or family member can help talk you down when you feel a panic attack start. Just talking to someone about what you’re experiencing, and naming the sensations across your body, can help stabilize you in the moment.

Count colors.

Some therapists recommend a simple grounding exercise: Count and name the colors 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 anxiety mounting in your mind.

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 center you in the present; this also helps alleviate the uncomfortable warmth and sweating that some people feel during panic attacks.

Breathe like a baby.

Hyperventilating, a common feature of panic attacks, can make people feel dizzy, so taking slow breaths can be helpful.

Often, adults breathe from our chests; instead, it might be helpful to breathe from our diaphragms like a baby might, focusing on expanding our bellies.

This can slow and deepen our breaths, flooding the brain with oxygen and triggering the parasympathetic nervous system, which helps signal that we don’t need to fight, and reduces levels of distress.

How can you prevent future panic attacks?

If you experience recurrent panic attacks, you may want to seek out a therapist. Forms of cognitive behavioral 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, desensitizing you to the underlying distress that can trigger panic attacks.

Some medications, including antidepressants like selective serotonin reuptake inhibitors, or S.S.R.I.s, 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.

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