Panic attacks / Panic Disorder

What happens during a panic attack?

Panic attacks are associated with physical symptoms that include the following:

• Shaking / trembling
• Feeling that your heart is pounding or racing
• Sweating
• Chest pain
• Shortness of breath
• Feeling that you are choking
• Nausea
• Cramping
• Dizziness
• Out-of-body feeling / sense of things not being real (Depersonalisation / derealisation)
• Tingling or numb feeling in your hands, or feet
• Chills or hot flushes

These symptoms are caused by an increase in stress combined with inappropriate breathing patterns ie hyperventilation. Hyperventilation in effect floods the body with oxygen which in turn generates physical sensations are are often perceived as being threatening, which in turn increases the stress response, which in turn tends to increase the rate of breathing and so on.

As the panic escalates a person may also have an extreme fear of losing control, of being observed and losing control, going "crazy" or dying during a panic attack. It is very rare for a person to have all of these symptoms at once. However, the presence of at least 4 symptoms and they developing abruptly and reaching a peak within 10 minutes strongly suggests that a person is experiencing panic attacks.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines or nervous system. The similarities between panic disorder and other diseases may add to the person's fear and anxiety during and after a panic attack. It is not uncommon for people to have reported to casualty departments several times as a result of misinterpreting panic attack symptoms with symptoms of serious physical illness.

Second by second the following tends to happen during the course of panic escalation:

1. A stressful situation is encountered
2. Adrenaline, noradrenaline and cortisol levels increase
3. Rate of breathing increases
4. Oxygen level increase and there is an increase in blood alkalinity
5. This results in vaso-constriction (also an effect of cortisol)
6. Vaso-constriction reduces higher cognitive functioning (the ability to logically reason reduces)
7. Vaso-constriction also results in reduced ability to excrete CO2
8. Multiple sensations are experienced
9. Locus of focus is drawn to the sensations
10. Stress levels increase as internal dialogue becomes negative
11. The body is scanned to identify other symptoms of dis-ease
12. Sensations are amplified psychologically
13. Action is taken to get out of or escape the stressing situation
14. The stressing situation becomes associated with the panic state

If the escape behaviour is not actioned the panic state tends to subside naturally in about 20 minutes. (This feature of the panic response is utilised at some level in most forms of therapy at one stage or another).

Given that the symptoms may in fact be due to some form of organic disease it is essential that all physical causes are eliminated before commencing any form of psychological treatment. If you think that you are experiencing panic attacks you should consult your GP in the first instance.

Formal Diagnosis

It is important that physiological causes for panic attacks have been eliminated by a GP or consultant. Physiological causes include some forms of epilepsy, mitral valve prolapse, hyperthyroidism and hypoglycemia.

Panic disorder

When the panic attack response has become conditioned over time we begin to fear future occurences and become anxious in anticipation. This generates a negative self-fulfilling prophecy that can itself generate a panic attack. Panic attacks combined with anticipatory fear / anxiety is known as panic disorder. Agoraphobia may or may not be present.

Panic disorder is a common condition in which a person has episodes of intense fear or anxiety that occur suddenly (often without warning). These episodes - called panic attacks - can last from a few minutes to several hours. They may occur only once in a while, or they may occur really quite frequently. The cause, or "trigger," for these attacks may not be obvious or there may be a series of very specific triggers.

Just the fear of having a panic attack is often enough to trigger the symptoms. This is the primary basis for a condition known as agoraphobia. Those with agoraphobia find it difficult to leave home (or another safe area) because they are afraid of having a panic attack in public or not having an easy way to escape if the symptoms start.

Click here for the The Diagnostic & Statistical Manual of Mental Disorders definition of panic attacks and panic disorder.

Diagnostic and statistical manual criteria (DSM)

• Panic Disorder with Agoraphobia
• Panic Disorder without Agoraphobia
• Panic attack disorder as defined by the DSM (all definitions on one page)