Tuesday, 17 May 2011

How Panic Attacks Work

You're walking through the park on an ordinary day when suddenly, without warning, you're stricken with acute fear. The world starts to spin. Everything around you seems unreal. Your heart beats so hard that it quakes in your chest, and your throat tightens.

Frantic for your own breath, your mind screams, "Am I having a heart attack? Am I going crazy?" And, worst of all, "Am I about to die?" The panic keeps escalating until you feel like you just can't stand it anymore. Then, finally, it starts to sink away from you. Confused and embarrassed, you retreat to your car and go home where you know it's safe. You'll never return to that park again, you think. And then a more fearful thought pops into your head: "What if this happens again -- somewhere else?"


If you've ever had a panic attack, you're familiar with this kind of experience. Your body mysteriously triggers the fight-or-flight response when no danger really exists. Basically, you get the same sensations you might get if you heard a burglar break into your house in the middle of the night. Only, nothing nearly that frightening or threatening has actually occurred.

Although many people have only isolated panic attacks, others suffer from recurring attacks, which is a symptom of panic disorder. This disorder is fairly common; 2.7 percent of Americans 18 and up have it, which makes it more common than bipolar disorder, schizophrenia and obsessive compulsive disorder [source: NIMH]. Panic attacks can last anywhere from a few minutes to a half-hour, and they're gravely frightening and confusing for the victim. If left untreated, recurring episodes can lead to agoraphobia, where the fear of having an attack becomes so intense that the sufferer avoids all public places.

So, why would your body launch into a fight-or-flight response when no obvious danger exists? What's going on inside your body to trigger such an extreme physical reaction? Keep reading to understand the physiological processes behind the panic attack.

Panic Attack Symptoms

When you have a panic attack, you generally experience at least four of the following symptoms, according to standards set by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV):
  • Heart pounding
  • Shaking
  • Dizziness
  • Sweating
  • Choking feeling
  • Nausea
  • Short, shallow breath
  • Chest pain
  • Numbness or tingling
  • Chills and hot flashes
  • A feeling of unreality
  • A feeling of going crazy
  • A feeling you are about to die
[source: Encyclopedia of Mental Disorders]

A doctor might diagnose you with panic disorder if you experience four panic attacks within four weeks or one attack followed by about four weeks of either consistent fear of having another attack or a dramatic change in behavior [source: MedicalCriteria.com].

So, what is happening inside your body as you experience these panic attack symptoms?
Put simply, a panic attack is a fear reaction minus any obvious danger to the person experiencing the attack. Physiologically, a panic attack works much the same way fear does.

As you might have learned in How Fear Works, your autonomic nervous system (ANS) maintains the involuntary functions in your body. It takes signals from your central nervous system to various organs, including your heart, kidneys and eyes. In this way, it can control hormone secretions, heart rate, blood vessels, muscles and pupil size. The ANS has two parts: the sympathetic and parasympathetic nervous systems. Your parasympathetic nervous system controls normal functioning of your internal systems when your body is calm. Your sympathetic nervous system takes over when you become excited.

When you're afraid, your sympathetic nervous system sets off certain reactions in your body. At the onset of a panic attack, the sympathetic nervous system causes your muscles to tense up. It also sends a message to your adrenal glands to release the hormone adrenaline. This adrenaline has many effects on your body: It produces sweat and increases your heart rate. With your chest and throat muscles contracted and tense, you might find it even more difficult to breathe. To learn more about adrenaline, read How can adrenaline help you lift a 3,500-pound car?

Normally after the onset of fear, your parasympathetic nervous system quickly kicks in to calm your body down by lowering your heart rate and blood pressure. But that does not happen during a panic attack. For some unknown reason, the parasympathetic system doesn't work properly during an attack, which leaves you to face disturbingly prolonged bodily panic [source: The Anxiety and Panic Disorder Center of Los Angeles].

The fear reaction has advantages in life-threatening situations. All that adrenaline and those juiced muscles could help you escape an attacker or swim to safety. But during a panic attack, when no apparent danger exists, that fear reaction seems completely uncalled for and out of place. For this reason, people who have panic attacks often think they're going insane. That, be assured, is definitely not the case.

Now that we understand how the body creates the incredibly uncomfortable panic attack symptoms, we'll take a look at what causes panic attacks. Have researchers solved the mystery?  

Causes of Panic Attacks

Unfortunately, doctors don't know exactly what causes panic attacks, but they do have some theories.
Some researchers theorize that life-changing events or generally stressful periods cause panic attacks. Studies have shown that a significant number of people with panic disorder experienced traumatic childhood events, such as the death of a parent [source: Campbell]. Other research suggests that it isn't just environmental, but rather is genetic. For instance, studies found that identical twins are more likely to share the disorder than fraternal twins [source: Encyclopedia of Mental Disorders]. However, other data contradict that theory, so the matter is still up for debate.


Picture of brain
The same parts of the brain that are active during fear response are active during panic attacks.

Researchers also look to the neurological functions behind fear and panic attacks to find an explanation. Some believe that when this fear system in the brain is overused -- when it is called into action too intensely or too often -- it becomes excessively sensitive so that only small triggers set it off [source: Bourne]. Others note that when you are tired, your brain produces sodium lactate or carbon dioxide. When sodium lactate or carbon dioxide levels increase, the brain mistakenly believes you are suffocating and sends signals to increase your breathing rate to get more oxygen [source: Encyclopedia of Mental Disorders]. This can trigger a panic attack.

Another theory has to do with the neurotransmitters serotonin and gamma aminobutyric acid (GABA), which play a part in calming the brain [source: Encyclopedia of Mental Disorders]. People who suffer from panic disorder appear to have fewer serotonin receptors than others [source: NIMH]. Medications that increase the supply of serotonin and GABA, which we'll discuss more in the treatment page, prove effective in combating panic disorder.

Usually, panic disorder strikes people in their twenties, but children can suffer from it as well. Twice as many women develop panic disorder as men. The fear of an attack can actually trigger one; when this happens too frequently, it can lead to agoraphobia. Luckily, panic attacks are very treatable, and those who suffer from them have a few effective options.

Panic Attack Treatment

close-up of prozacJonathan Nourok/Getty Images
Prozac is one of the most common antidepressants
How can people overcome panic attacks? They have three effective options: antidepressants, anti-anxiety drugs and therapy. Medication and therapy are about equally effective -- they work between 60 percent and 90 percent of the time [source: American Psychiatric Association].

SSRI antidepressants, like Paxil and Zoloft, help prevent panic attacks for many people. SSRI stands for selective serotonin reuptake inhibiters. Essentially, SSRI antidepressants increase the amount of serotonin in your brain. They usually take effect two to four weeks after the patient begins taking them [source: Bourne]. Tricyclic antidepressants also treat panic disorder. These antidepressants increase the amount of norepinephrine in the brain. But these antidepressants cause more negative side effects than SSRIs. Both of these kinds of antidepressants are safe to take for years, but they should be gradually tapered off, not stopped suddenly.

If antidepressants don't work, anti-anxiety drugs, such as Xanax, might. Xanax is a benzodiazepine, which works as a tranquillizer. It increases the activity of the neurotransmitter GABA, which stabilizes anxiety [source: Bourne]. Unlike antidepressants, anti-anxiety drugs work almost immediately, but they are usually best to only take for a few weeks to a few months. They quickly cause a dependency, which means that if you stop taking them cold turkey, episodes of intense anxiety might ensue. For this reason, doctors generally recommend that patients taper off anti-anxiety medications if they decide to stop using them.

The third option is therapy, which can be used as an alternative to or in conjunction with medication.

Cognitive behavioral therapy has proved helpful for people trying to overcome panic attacks. The American Psychiatric Association explains that this kind of therapy consists of five parts:
  • Learning: Learning about panic disorder, its symptoms and possible treatment can give you hope and help you recognize that you are not alone.
  • Monitoring: You start to record when your symptoms come up and the environment in which they occur.
  • Breathing: Learning breathing exercises helps you prepare for a panic attack.
  • Rethinking: Your therapist teaches you to take on a new outlook and see your attacks realistically.
  • Exposing: You gradually learn to face panic-inducing situations.
Your therapist will guide you through all of these steps. Overall, the goal of cognitive behavioral therapy is to change how you think about your attacks. The more you learn about the condition, the better you understand it and realize that panic attacks are not dangerous and won't kill you. If you know what situations typically instigate an attack and what breathing techniques to use, you'll be better prepared and will begin to fear the attacks less. Finally, simulating the feelings or situations where attacks occur will perhaps let you overcome attacks completely. [source: helpguide.org].
If all else fails and you experience a panic attack, don't be discouraged: There are still some methods that can help you get through it as smoothly as possible.

Coping with Panic Attacks

man clasping chest
Stockbyte/Getty Images
Be sure to seek medical attention if what you are feeling might be a heart attack.
A panic attack can be the most terrifying experience of your life. But even if you can't prevent an attack, you can control your reaction to it.
Breathing techniques help to relieve panic attacks. People who experience panic attacks usually breathe with their chest, but they should breathe from their diaphragms. If you experience panic attacks, practice breathing from your diaphragm to strengthen those muscles.

Here's a breathing exercise you can try, from Anxietypanic.com:
  1. Lie on your back with pillows under your knees and head
  2. Put one hand on your stomach and another on your chest
  3. Slowly breathe in with your stomach rising, but with your chest still
  4. Slowly breathe out as you clench your stomach muscles
To make sure you're really breathing from your diaphragm, put a weight, such as a book, on your stomach, and watch it rise and fall. After you get better at this kind of breathing, you'll be able to do it more easily whenever an attack strikes.

In addition to breathing techniques, other steps can help you get through an attack. Mentally changing your perspective on the experience will help you conquer it [source: Anxiety and Stress Disorder Institute]. First, acknowledge that you are having a panic attack. This will help you accept it and conquer it. Repeat to yourself that you are alright and the attack will pass. Think of it as a wave that will crest and will subside. Mentally accepting the attack will stop it from getting worse.

If you're merely a spectator and realize that someone around you is having a panic attack, stay positive and encouraging as you talk that person through the experience. Remind him or her that everything is all right. Advise the person experiencing the attack to breathe slowly and deeply with his or her diaphragm.

Given the similarity of the symptoms, it's very common for people to fear they are having a heart attack during a panic attack. Since Center for Disease Control and Prevention reports that heart disease is the leading cause of death in the United States, accounting for 29 percent of deaths, it's important to not take any chances.

The American Heart Association (AHA) offers a few tips to recognize a heart attack. The most common symptom of a heart attack is chest pain -- pressure on the center of your chest that either persists longer than a couple of minutes or goes away and then returns. This pressure can be accompanied by shortness of breath, pain in the arms or pain in other areas of your upper body. You may feel nauseous or faint, as well. The AHA advises that if you are in doubt, call 911 for emergency assistance. An ambulance can usually get you to the hospital much faster than a friend or family member can drive you.

Sources:
  • "Ask the Experts: Panic Attack or Heart Attack?" Anxiety Disorders Association of America. (Feb. 21. 2008)http://www.adaa.org/gettinghelp/newsletter/2006/
    PanicAttackorHeartAttach.asp.
  • Bakewell, S. "The Automatic Nervous System." Addenbrooke's Hospital, Cambridge. (Feb. 25, 2008)http://www.nda.ox.ac.uk/wfsa/html/u05/u05_010.htm.
  • Bourne, Edmund J. "The Anxiety & Phobia Workbook." New Harbinger Publications: 2005. (Feb. 21, 2008)
    http://books.google.com/books?id=Cobbd_XjZrYC&printsec=frontcover
    &dq=panic+attack+parasympathetic+nervous+system&source=
    gbs_summary_r
  • Berman, Carol W. 100 Questions & Answers About Panic Disorder. 2005 (March 12, 2007)
    http://books.google.com/books?id=Fg9LPM_T_wsC&pg
    =PA2&dq=%22anxiety+attack%22+%22panic+attack%22+dsm&ei=
    y6DWR9mcKobCyQSG6PSABA&sig=YBdF47V9r3PS_NOEPsIsAJC2zAg
  • Campbell, Nancy. "Panic Disorder." Capstone Press: 2001. (Feb. 21, 2008)
    http://books.google.com/books?id=WHZqnqOPiXMC&printsec=
    frontcover&dq=causes+of+panic+disorder&lr=&source=gbs_summary_r
  • "Dealing with Panic Attacks." Anxiety and Stress Disorder Institute of Maryland. (Feb. 21, 2008)
    http://www.anxietypanic.com/breathing.html
  • "Diaphragmatic breathing." Anxietypanic.com. (Feb. 21, 2008) http://www.anxietypanic.com/breathing.html
  • "DSM-IV Diagnostic Criteria for Panic Disorder With or Without Agoraphobia." MedicalCritera.com. (Feb. 21, 2008) http://www.medicalcriteria.com/criteria/panic_disorder.htm
  • "Emotion-Regulating Protein Lacking in Panic Disorder." National Institute of Mental Health. (Feb. 21, 2008)
    http://www.nimh.nih.gov/science-news/2004/emotion-regulating
    -protein-lacking-in-panic-disorder.shtml
  • "Heart Attack, Stroke and Cardiac Arrest Warning Signs." American Heart Association. (Feb. 21, 2008)http://www.americanheart.org/presenter.jhtml?identifier=3053
  • "Heart Disease." Center for Disease Control and Prevention. (Feb. 21, 2008)
    http://www.cdc.gov/heartdisease/
  • "Let's Talk Facts About Panic Disorder." American Psychiatric Association. (Feb. 21, 2008)
    http://healthyminds.org/factsheets/LTF-Panic.pdf
  • "Panic Attacks, Panic Disorder and Agoraphobia: Symptoms, Causes, and Treatment." HelpGuide.org. (Feb. 21, 2008) http://www.helpguide.org/mental/panic_disorder_anxiety_
    attack_symptom_treatment.htm
Article by: Jane McGrath, originally posted on Discovery Health 2011


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2 comments :

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  2. As a fellow sufferer of panic attacks I know how dibilitating they can become. I got to the point where I was afraid of driving. It was terrible. I finally went to the doctor and have been taking Lexapro for the last year. They have greatly subsided. It wasn't until I started acupuncture that I have finally found the complete calm of a "normal" existance - free from panic attacks. It worked for me, maybe it will work for you or some of your readers. Thank you for this great and informative post. Most people don't/can't understand how much they affect your life.
    ~Carrie-Anne

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