Panic
attacks revolve around terror. Though mainly associated with the mind, they are
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.
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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 is
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 it is 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 percent to 30
percent of people will have at least one panic attack in their life, only 2
percent to 4 percent 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 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.
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.
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
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 have not had a panic attack by age 45, you are less likely
to have an episode later in life.
Women are more than
twice as likely as men to get panic attacks, but researchers are not entirely
sure why.
Easing one in the moment
If you have not experienced a panic attack before, and you are 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.
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 stabilize you.
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 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 center 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, signaling that we do not need to fight.
Preventing future episodes
For recurrent attacks, you may want to seek 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
SSRIs, may also be helpful for managing panic attacks.
As disconcerting as panic attacks can be, it is 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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