Something feels dangerously wrong. A few minutes ago, something felt off, but you weren't sure what it was. Then it got worse. You started to feel weak. Your heartbeat started to race. Suddenly it starts to cascade out of control. You feel lightheaded - maybe a little dizzy - and your brain doesn't seem like it's working correctly. Your legs may feel weak, you may have a bit of chest pain - you can't seem to get a full breath.
It starts to get worse. Now you're certain something's wrong. The symptoms are getting worse and you're barely able to hold it together. This is the end, you're sure of it. You might die - you know it. You have an instant feeling of pure dread …
… then it sort of fades away.
You're left wondering what happened. You're left believing that you may have just had a heart attack, or a brain aneurism, or some sort of terrible cancer. But what you really had was a panic attack - an anxiety attack so severe that it caused a combination of intense physical and emotional symptoms.
Introduction to Panic Attacks
Panic attacks are severe attacks of intense anxiety. For those that haven't experienced them before, the intensity can be so overwhelming that you may have a hard time believing that what you suffered from was caused by your mind. But panic attacks are very real, and have nearly nothing to do with your overall health.
Many people get their first panic attacks during times when they are suffering from severe stress. But panic attacks can occur randomly, and be caused by nothing at all. Don't let the word "panic" fool you either. This isn't just someone "being scared." This is an experience that causes very real physical symptoms that mimic more serious problems.
Panic attacks can cause dozens of different symptoms, most of which lead to a severe fear, and a feeling that something is seriously wrong. Some of the symptoms include:
- Rapid heartbeat/tachycardia.
- Squeezing around the heart.
- Chest pains.
- Hot flashes and sweating.
- Trouble breathing/shortness of breath.
- Muscle tingling, weakness, or burning.
- Feelings as though you're losing control.
- Feelings of intense doom.
- De-personalization (feeling like you're outside yourself).
- Feeling like you're going crazy.
- Nausea, or some type of stomach discomfort.
- Feeling as though you need to defecate or urinate.
- Head pressure/headache.
Often you experience one or some of these symptoms, react with a feeling of anxiety, and then experience a worsening of symptoms and additional symptoms as the attack progresses further.
Most panic attacks peak around 10 minutes and then begin a slow and steady decline that can cause you to feel completely drained of energy, often worried about what just happened and feeling helpless to overcome it.
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What Causes Panic Attacks?
Panic attacks are complex, in that the cause is not entirely clear. There appears to be a strong genetic component - if your parents had panic attacks, you are at risk for getting them - but this only accounts for a fraction of the number of people that develop panic.
Another issue is stress. Stress causes the mind to focus on the negatives and assume worst case scenarios, so it's possible that some people develop panic disorder during these periods of stress. Others may have poor breathing habits and health anxiety - the combination of which can lead to panic disorder. Still others may develop it for no reason at all.
There are even those that believe that panic attacks are more common in the highly intelligent, because those with a sharp mind appear to be more prone to misinterpreting physical sensations - possibly because they're more prone to "living inside their head."
Whatever the cause, panic attacks can be debilitating.
What makes it worse is that panic attacks tend to cause themselves. After the first panic attack, many people live in fear of another attack. This fear actually creates more panic attacks and an increase in daily anxiety. In addition, panic attacks cause something known as hyper-sensitization - becoming oversensitive to the way your body feels so that you can't ignore it. Those that have hyper-sensitization feel every sensation their body makes, and often experience a cascade anxiety when they feel those sensations.
In worst case scenarios, panic attacks may also cause agoraphobia - the fear of going outdoors. The fear of experiencing another panic attack becomes so strong that people avoid leaving their home because they're worried they'll have another attack and be unable to escape.
What Triggers These Panic Attacks?
Panic attacks may have subtypes, as not all panic attacks are the same. Generally, there are three recognized types of panic attacks:
- Unexpected Panic Attacks Also known as "uncued panic attacks," these are panic attacks that occur for no apparent reason or cause.
- Situationally Bound Panic Attacks Also known as "cued" panic attacks, these are panic attacks that occur as a result of exposure to something that causes severe anxiety, or the idea that the exposure will occur.
- Situationally Predisposed Panic Attacks These are similar to cued attacks, except they do not occur in every situation. For example, you may only occasionally get panic attacks while riding in a car, indicating that riding in a car is not necessarily - but may be - a trigger for panic attacks.
These are the most widely recognized types of panic. Personally, I believe there should be two additional types of panic attacks added to the list:
- Limited Symptom Attacks These are recognized in psychological research as panic attacks of fewer than four symptoms. In a way, these are not "full blown" panic attacks but still cause stress and a feeling as though the panic attack may occur. It's possible that these are panic attacks that simply never managed to reach the peak as well.
- Reactionary Panic Attacks Missing from the above list is a common type of panic attack that is reactionary to physical sensations in the body. Many people develop panic attacks when they feel some type of physical sensation, like pain or weakness.
The biggest problem with panic attacks is that they can hit out of nowhere. It's possible to experience a panic attack with no warning at all. Panic attacks may also come as the result of severe stress. But recurring panic attacks often fall under a common pattern:
- Panic attacks cause anxiety over experiencing another panic attack.
- That anxiety causes mind physical symptoms (such as a slight increase in heart rate).
- Over-sensitization causes those symptoms to feel more severe.
- That added severity leads to further anxiety.
- That anxiety leads to more symptoms.
- Another panic attack occurs.
It should also be noted that for reasons that are not quite clear, panic attacks can actually alter the way you breathe. In some cases, you may be breathing too shallow, and that change in breathing can also lead to symptoms that create - and contribute to - panic attacks.
What Panic Attacks Feel Like
Despite the term "panic," panic attacks are mostly physical experiences. There is certainly an anxiety component, because many people experience severe fear of impending doom (as though they're going to die), but those fears are often caused by the physical symptoms.
That's why panic attacks often contribute to the development of health anxiety, because the experience of a panic attack is not unlike many other serious health problems, such as:
- Heart Attacks
- Multiple Sclerosis (MS)
- Brain Tumors
- Heart Failure
- Lyme Disease
Panic attacks are not dangerous. Panic attacks cannot kill you. But they certainly feel like they can, because they create many of the very same symptoms that those with real health problems experience. Many people become hospitalized during one of their first panic attacks believing that something is seriously wrong with their health.
It's for those reasons that anyone that has panic attack should still visit a doctor. Only a doctor can distinguish panic attacks from another more serious problem - and in some cases, visiting the doctor can reduce some of the severity of your panic.
Note: Unfortunately, panic disorder makes it very hard to trust a doctor's diagnosis completely, and causes a lot of "what if" thinking. Don't expect the doctor's visit to cure your concern that something is wrong with your health. It's one of the problems with living with panic disorder, and something you'll have to learn to overcome separately.
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What Causes the Physical Symptoms?
Pinpointing each and every cause of your panic attack symptoms is impossible. Panic attacks are extreme levels of stress, and during times of extreme stress, your body goes through a whole host of different hormonal changes and neural firing that can cause numerous physical ailments, all of which lead to the symptoms of panic attacks.
But a common cause of many of the symptoms of panic attacks is hyperventilation.
While the body needs oxygen to survive, it also needs a healthy level of carbon dioxide. During periods of hyperventilation, your body breathes out too much carbon dioxide, leaving not enough in your body.
Unfortunately, this creates the opposite feeling in your body - it feels like you're not getting enough oxygen, even though the opposite is true. That causes you to feel like you can't get a deep breath, so you try to compensate by taking deeper breaths. This makes the hyperventilation worse, and leads to more symptoms.
The symptoms of hyperventilation are the most common "worrying" symptoms of panic attacks:
- Chest pains
- Rapid heartbeat
- Shortness of breath
- Weak limbs
- Trouble Thinking
These symptoms all get worse the more you try to overcompensate for the shortness of breath by breathing more air, and this is what causes many - if not most - of the symptoms of panic attacks.
Those with panic attacks have a tendency to hyperventilate. It may occur in many different ways:
- Poor Breathing Anxiety tends to cause poor breathing habits, with faster, shallow breaths that may be expelling too much CO2. This may be one of the causes of unexpected panic attacks. Hyperventilation means "too much ventilation," so you may be breathing in a way that is slow and appears healthy, but is still breathing poorly for your body.
- Fast Breathing During times of severe fear or stress, many people breathe too quickly. This may also lead to an expulsion of too much CO2. Often this occurs during a panic attack as well, but it may also be the cause of panic attacks when in situations that cause immense anxiety, like when confronting a phobia.
- Conscious Breathing Those with panic disorder have a tendency to think about their breathing. When breathing is conscious, you have a tendency to take deeper breaths than your body needs. Yawning or trying to take immense amounts of oxygen is common, and while you may not be breathing quickly, this type of breathing can still cause hyperventilation.
Many people associate hyperventilation just with breathing too quickly, but hyperventilation can be caused by any type of breathing that takes in too much oxygen, or dispels too much carbon dioxide. And unfortunately, since during a panic attack many people feel they have to take deeper breaths, those same deep breaths tend to make hyperventilation worse.
When anxiety causes hyperventilation, it is NOT dangerous. Your body simply needs to go back to healthy carbon dioxide levels. Yet there is no denying that hyperventilation can make it feel like something is seriously wrong, and that is one of the many reasons that panic attacks are hard to control, and even harder to conquer.
Panic attack symptoms are caused by more than just hyperventilation. Stress can make your body do very strange things, and anxiety itself - especially if you have comorbid anxiety issues, like generalized anxiety disorder - can also create thoughts and physical experiences that lead to strange sensations. But hyperventilation is clearly one of the most common issues.
How to Reduce Panic Attack Severity
One a panic attack starts, they can be nearly impossible to stop. The anxiety tends to rush over you, and even if you know it's a panic attack, it's hard to feel as though you have any control over the outcome. But there are things you can do to make a panic attack less severe.
Why is less severe important? Because when your panic attacks are weaker, you start to fear them less, and when you fear them less, you get fewer panic attacks. In addition, a weaker panic attack makes it easier to recover. If you feel a panic attack coming on, try the following:
- Regain Control of Your Breathing Earlier we mentioned the importance of taking to a doctor. It's not just because you should make sure that you're in good health - it's also because you'll need to do things that go against your instinct. One of which is trying to avoid hyperventilation by regaining control of your breathing. It's not the easiest task, but try to slow down your breathing into more controlled breaths. Hold your breath when you have a lot of air in you, and release very slowly. Don't worry about expanding your chest or trying to yawn. Just breathe in slowly, hold, and breathe out slowly.
- Create Distractions Distractions are the key to reducing a panic attack severity. Remember that being inside your own head makes panic attacks worse, and is one of the theories that people have about why panic attacks are more common in those with a high IQ. Somehow you need to make sure that you're not in your own head. It may be a bit embarrassing, but you can do this by going for fast walk outside, turning on the TV and the radio, or talking to whoever is next to you and telling them you have a panic attack. The latter point is key - if you're trying to talk about something else, you'll still be in your own head thinking about the attack. If you talk about the panic attack, it'll be easier.
- Call a Friend A great distraction, and one that allows you to tell someone easily that you're having a panic attack - is to call a friend or relative that you care about and talk to them. It should be someone that knows you have panic attacks and is happy to take your call. Call them and say that you're having one and talk it out. They don't need to fix it. The simple act of talking on the phone is very distracting, because it forces you to hold a phone and maintain a conversation. Also, a soothing voice on the other end can ensure that you feel safe - like someone is there to call an ambulance if something goes wrong.
- Drink Some Water Water has a strange anti-anxiety quality about it. It has a way of calming the mind and body, and the act of drinking water helps you feel like you're still able to go about your daily life. Panic attacks may also contribute to hyperventilation, so refueling your body is always a healthy idea.
- Do Something When It's Over If you can't control the panic attack at its peak, try to control your reaction to it. Once a panic attack is over it's uncommon to immediately get another one. Remind yourself that what you suffered from was anxiety (if it was a heart attack, you probably wouldn't have recovered) and then try to do something active that improves your mood. Moping, which is what most people want to do after an anxiety attack, gives the panic attack more power. If you can walk, jog, talk to friends, or go out and do something fun right after, motivate yourself to do it.
These may not sound like cures, but that's because they're not cures. These strategies alone are not going to prevent panic attacks from occurring. What they will do is reduce their severity so that you aren't as crippled by them, which is an important step in overcoming them in the future.
How to Prevent Panic Attacks Forever
Ultimately, you'll eventually want to find a way to stop panic attacks forever. Distractions alone are not going to be enough, and repeated doctor's visits won't help either. You need to learn how to prevent these panic attacks from ever coming back.
This is a considerable process, and it's highly recommended that you don't immediately turn to medicines to cure it. Medicines for panic attacks are woefully inadequate. They cause psychological dependency, along with a host of side effects that ultimately will not make your life much better.
Even if the medicines work for you, you can't take them forever, and once you stop the medications the fear of getting a panic attack will come back, except this time you'll be out of practice with coping. Medications have their place, but they should be a last resort.
You'll need to take several steps towards fighting your panic attacks and preventing them from ever coming back. You'll need to start exercising - as exercise is one of the most powerful anti-anxiety tools available. You'll also need to make lifestyle changes to reduce overall anxiety. Even though you can get panic attacks when no anxiety and stress are present, your life anxiety will always play a role in how you control your panic attack symptoms.
You'll also need to take my 7 minute anxiety test. The test was designed to look at your symptoms, compare them to others suffering from anxiety, and provide you with tools based on your symptoms that will help you treat it.
Now that you're ready, take the test here.
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Clark, David M. A cognitive approach to panic. Behaviour research and therapy 24.4 (1986): 461-470.
Margraf, Jurgen, et al. Panic attacks in the natural environment. Journal of Nervous and Mental Disease; Journal of Nervous and Mental Disease (1987).
Clark, David M., Paul M. Salkovskis, and A. J. Chalkley. Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry 16.1 (1985): 23-30.
Author: Micah Abraham, BSc Psychology, last updated Sep 28, 2017.