Anatomy of a Panic Attack

A panic attack can be a very scary experience, especially if you’ve never had one before. Many of the symptoms resemble those of a heart attack or other medical emergency. In fact, panic attacks can be so frightening that people having them often fear they’re dying. But here’s what’s actually happening during a typical panic attack:

Step 1: The Trigger

One of the most frustrating things about panic attacks is that they seem to come out of the blue. You can be going about your day when all of a sudden you feel a rush of fear and dread you can’t explain. In contrast to normal feelings of stress, a panic attack is an overwhelming sensation of terror. It can happen at any time—when a person is at work, driving, doing chores, or even sleeping.

Step 2: The Attack

During a panic attack, your heartbeat speeds up, and you may begin to sweat. Your chest feels constricted (it may hurt), and you feel like you can’t get enough air. Shaking and gasping for breath, you feel dizzy and nauseous. You might feel either chilled or overheated. You realize that you’re terrified; your adrenaline is surging (this hormone causes your heart to beat faster). The shaking and hyperventilating—deep and rapid breathing—often continue for several minutes, during which time you may be nauseated and have trouble swallowing. You may wonder if you’re having a heart attack, since so many of the symptoms are the same.

Step 3: The Aftermath

Usually, the attack finishes after a few minutes, and the body starts to relax: Your heart rate gradually slows, the shakes stop, and the fear subsides. If you’ve gone to the hospital, you’ll probably be given an electrocardiogram (a test of the heart’s electrical activity) to make sure you haven’t had a heart attack. If it’s normal, you’ll be reassured that what you experienced was a panic attack. But although the physical attack may be over, the emotional trauma of what you’ve gone through can linger.

Who Suffers From Panic Attacks?

While there may be a genetic basis for panic attacks and panic disorder, they can affect anyone. Women experience panic attacks twice as often as men do, and people who’ve suffered some kind of major life stress are more vulnerable, although the attacks themselves happen when there is no sign of danger.

Subtle Warning Signs

Interestingly, a recent study of people with panic disorder found that, despite patients’ insistence that attacks occur with no warning, there are subtle changes that occur in the hour or so leading up to a panic attack: Researchers monitored panic disorder sufferers around the clock and captured slight shifts in breathing, heart rate, and other body functions before an attack occurred. This so-called physiological instability went unnoticed by the sufferers, who remained convinced their attacks came out of nowhere.

With panic disorder, seemingly innocuous activities may bring on symptoms that mimic those of panic attacks; in some cases it’s these symptoms that actually trigger the attack. For instance, drinking something containing caffeine or going for a run can cause your heartbeat to speed up. This can lead to anxiety, which then brings on a panic attack.

Understanding Triggers

It can be difficult to go about daily life once you’ve had a panic attack (or several). You may be scared of having further attacks and confused as to why they’ve occurred. In order to regain control, it’s important to try to figure out what may have been triggers for you. "Ask yourself, 'Did I see something on television, in the newspaper or on the street that reminded me of an event?'" suggests LeslieBeth Wish, EdD, MSS, a Florida-based psychologist, clinical social worker, and author of Smart Relationships. "'Is the date of [an upsetting incident] approaching? Does a person’s face or voice or clothing make me think of the event?'"

Wish offers an example of how several seemingly random occurrences can trigger a panic attack: "A survivor of a collision with a moving van might drive more carefully when she sees any kind of van on the road. She might even be able to drive by a moving van and not detect the increase in her heart rate. But then she experiences the perfect storm—the anniversary of her collision and a sighting of a van from the same company, with the same color and logo. Her reaction is to panic as though the situation is about to happen again."

Coping and Moving Forward

An occasional panic attack is not uncommon and not necessarily a reason to seek medical treatment. But if you suffer from repeated panic attacks, or the fear of experiencing more of them, consult a mental health professional. Talk therapy, which can help teach you to recognize triggers, may be very effective at tamping down attacks. Antidepressants or anti-anxiety medications also may be a necessary part of treatment.

LeslieBeth Wish, EdD MSS, reviewed this article.


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