Dr. Angela Hanford
Valerie was walking at a slow pace on her typical route home from work. It was a sunny day and she enjoyed being out in the cool fresh air. Out of nowhere, Valarie suddenly experienced difficulty breathing and her heart started to race and her body felt hot. Her surroundings no longer felt real and she became dizzy.
This happened so quickly, that Valerie felt very afraid and she did not know what was wrong with her. Was she having a heart attack or an asthma attack? Someone near to Valarie saw that she was struggling and asked if she needed help. This passerby called 9-1-1 as she tried to help Valerie calm down.
After running many medical tests, the results indicated that she was physically fine. The doctors concluded that this was a panic attack. Valerie felt embarrassed about all the commotion, but also very afraid that it would happen again.
Sam, a 12 year-old boy, was sitting in class when he started to feel hot and had a hard time catching his breath. His thoughts were racing and he feared that he would faint or that his face was turning red and that everyone would notice.
He had to get out of there so he quickly ran out of the classroom and went to the bathroom where he locked himself in a stall and started crying and hyperventilating. He was scared and unsure of what was happening or what to do.
These “episodes” happened several more times – once during a school break, another before a big game, and then on his way to church. His fear of the attacks grew increasingly acute and he started to be afraid to leave his house. His parents were with him on this last occurrence and, after he was calm, he opened up about what had been happening. After medical evaluation and a visit to a therapist, Sam learned about panic attacks.
Everyone knows what is like to experience fear and to feel your heart rate increase in an emergency. These feelings can be unpleasant but are necessary for survival. For example, we need to be alerted if there is an emergency because we need to react quickly.
Fear of losing one’s job can be a motivation to meet deadlines. Panic attacks, however, are different and can be terrifying. In fact, sometimes people who have a panic attack fear that they are having a heart attack or are dying. They are also incredibly exhausting to experience. The consequences of panic attacks can be huge, especially if important activities are avoided in an attempt to prevent them from occurring.
Symptoms of a Panic Attack
The symptoms of a panic attack are described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (APA, 2013). Someone who has a panic attack experiences a quick onslaught of symptoms that typically reach a height in a matter of minutes. Specific symptoms include (APA, 2013):
- Increase in heart rate, pounding of the heart
- Chest pain
- Feeling short of breath
- Feeling as if one is choking
- Increased sweat
- Shaking of the body
- Nausea or other stomach symptoms
- Dizziness or feeling light-headed
- Feeling hot or chilled
- Numbness or tingling sensations in the body
- Feeling as though things are not real or feeling detached from self
- Fear that one is dying
- Fear that one is “going crazy”
At least four symptoms must be present for a panic attack to be diagnosed. Panic attacks are not specific disorders but can occur as part of other diagnosable disorders such as depression, post-traumatic stress disorder, or social anxiety disorder. Also, some people may have one or two panic attacks during their lifetime but not have a recurrence. Recurrent panic attacks may also be diagnosed as a panic disorder.
Someone with panic disorder, as the name implies, experiences panic attacks (APA, 2013). In panic disorder, the panic attacks are unexpected and lead to either intense worry about having a panic attack or the consequences of a panic attack (e.g., fear of dying) or significant changes in behavior that are not adaptive due to the panic attacks. These changes could include avoidance of situations that one fears will result in a panic attack.It has been estimated that 4.7% of adults in the United States experience panic disorder at some point, and is diagnosed more in women than in men (Harvard Medical School, 2007).
In a study conducted by Jorge et al. (2016), the reported rate of panic attacks was 13.2% at some point during their lifetime. This set of researchers found a 1.7% lifetime rate of panic disorder. Regardless of the precise statistics, it is clear that panic disorder affects many people and that even more experience panic attacks.
Causes of Panic Disorder
As with most mental health conditions, there is not one specific cause that has been linked to someone developing panic disorder. In fact, it is likely a combination of factors that lead to panic disorder. There are some factors that have, however, been associated with someone developing panic disorder, such as (Mayo Clinic Staff, 2018; NIMH, 2016):
- Genetic factors: There is some evidence that panic disorder can run in families. However, not all people who experience panic disorder have a family history.
- Personality/Temperament: People who tend to be more highly sensitive to anxiety and or negative thought patterns may have a higher risk.
- Major stressors: Examples of stressors include abuse, divorce, any major loss, or even situations such as giving a speech.
- Brain functioning: You have likely heard of the flight-flight-freeze response. This system is activated in response to a threat, with symptoms that can be similar to a panic attack (e.g., increased heart rate). One hypothesis for panic disorder is that the brain triggers this system in situations that are not actually threatening. Thus, the situation is misinterpreted as dangerous.
- Misinterpretation of body sessions: Some researchers have suggested that panic disorder develops due to people misinterpreting body sensations as threats when, in fact, they are not. (NIMH, 2016).
Coping with Panic Attacks
There are strategies that may be helpful for learning to cope with panic attacks and emotions that trigger panic attacks.
- Breathing: Using a paced breathing exercise or other breathing technique can help to slow down breathing. When someone hyperventilates, this creates a build-up of carbon dioxide in the blood stream and not enough oxygen, which can perpetuate the anxiety.
- Progressive Muscle Relaxation: This strategy of tightening and loosening muscles can help your body to relax.
- Grounding Techniques: These strategies help bring you back to the present moment and calm emotions by bringing your attention to something in the present moment. An example of a grounding technique is to label five things in the room or to describe what it is like to touch something in the room. Even doing simple math problems in your head can work as a grounding technique.
- Examination of your diet: Excessive caffeine intake can lead to symptoms of a panic attack. If this is the case, check with your doctor on the safest way to withdrawal from caffeine.
- Self-care: Making sure that your self-care is on point, such as eating and sleeping behaviors.
- Stress management: Chronic stress can be a trigger, so learning to cope with emotions can be helpful.Examples of such strategies include:
- Mindfulness: learning to be fully present in the moment verses allowing anxious thoughts to be in control.
- Meditation on Scripture: Isaiah 41:10 – “Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.” (English Standard Version)
- Examination and Planning: Learn what your triggers are for anxiety and stress and then make plans on how you will cope with these triggers.
Treatment for Panic Attacks
Panic attacks are treatable. If you believe that you or a loved one is experiencing panic attacks, it may be time to also look for a therapist who knows how to treat panic attacks and panic disorder. He or she will take a history and inventory of symptoms to help you to label what is occurring and develop a treatment plan.
Since symptoms of panic attacks can look like other life-threatening medical conditions, such as a heart attack, it is important to receive assessment and treatment immediately (e.g., go to the emergency room if you fear a heart attack). Furthermore, a medical doctor can help to rule out potential physical causes to the panic attacks (e.g., thyroid problems), along with determining if medication may be helpful.
A psychotherapist can help you to learn strategies to cope with panic attack symptoms, such as relaxation techniques. He or she can also help you to discover which situations trigger your panic attacks and possible causes for your panic attacks.There are different therapy approaches that may be helpful, depending on the roots of your panic attacks. For example, cognitive behavioral therapy (CBT) can help an individual learn strategies that address thoughts, feelings, and behavior so that you may react to the symptoms of a panic attack in a different way.
CBT helps an individual challenge maladaptive thoughts that may fuel panic attacks. Eye Movement Desensitization and Reprocessing (EMDR) may be recommended if some type of trauma is underlying the anxiety symptoms. In addition, by targeting the initial panic attack with EMDR, a therapist can help reprocess that experience so that it no longer holds the emotional intensity that it once did.
Remember, panic attacks and panic disorder are treatable and you do not have to go through this struggle alone. If you are experiencing panic attacks, we are here to help and are ready to walk with you towards healing.
The Anxiety and Phobia Workbook, 6th Edition – Edmund Bourne (2015)
The Panic Workbook for Teens: Breaking the Cycle of Fear, Worry, and Panic Attacks – Debra Kissen (2015)
The National Institute of Mental Health – nimh.hih.gov
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Harvard Medical School (2007). National Comorbidity Survey (NCS). (2017, August 21). https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort. Retrieved on 11/23/18.
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Mayo Clinic Staff (2018). Panic attacks and panic disorder. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021. Retrieved on 2/22/19.
National Institute of Mental Health (NIMH) (2016). Panic disorder: When fear overwhelms. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml. Retrieved on 2/22/19.
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