Panic Attack: A Complete Guide To This Distress

You feel a knot rise in your throat. Your heart is a subwoofer in your chest. The room becomes smaller. Convinced you’re running out of air; you start sweating profusely and in the next moment you are hyperventilating. You cannot seem to place this onset of extreme, irrational fear. This describes exactly what occurs during a panic attack. For those experiencing it, the signs and symptoms of the panic attack are just as frightening as the abrupt “threat” without any true danger.

What is a Panic Attack?

A panic attack is described as an abrupt onset of intense fear marked by physical and psychological distress without the presence of danger. It always involves a sensation of “unreality”—or depersonalization making the world appear unreal. The suddenness of a panic attack occurs ‘out of the blue’ at random. As the fear arises, symptoms of severe anxiety peak within ten minutes before lessening in intensity.

Approximately 5 percent of the population will experience a panic attack throughout their lives. Women under the age of 24 are more likely to have a panic attack than males or older adults. While most have one or two attacks, others have repeating episodes that are indicative of a panic disorder.

Symptoms of a Panic Attack

Those suffering a panic attack have at least four of the following symptoms.

• Sense of impending doom—the feeling that something terrible is about to occur or that death is imminent.
• Shortness of breath
• Fast heart rate—heart rate increases and may include palpitations or a sensation of pounding in the chest.
• Shaking or trembling
• Dizziness—the dizziness can be accompanied by lightheadedness or fainting.
• Chest pain
• Fear of dying
• Nausea
• Sensations of choking—a lump in throat, smothering, or the sensation of not receiving enough oxygen.
• Sweating
• Chills or hot flashes
• Fear of losing control
• Numbness and tingling
• Abdominal pain
• Headache
• Depersonalization—detachment from self, feeling disconnected to your body and environment as if the world is not real.

The Difference Between a Panic Attack and an Anxiety Attack

The terms panic attack and anxiety attack are frequently used interchangeably by the general population. Despite the similarities, and anxiety being characteristic of a panic attack, they are two separate conditions.

The central differences are the length and severity of the attacks. As previously mentioned, a panic attack is more severe. They occur suddenly, and peak within ten minutes. A panic attack occurs in a calm state and lead to a detachment from reality.

Anxiety attacks, however, develop after periods of worry. Symptoms build up over time with an identifiable trigger. Although the manifestations like chest pain, dizziness, fear, fatigue, high heart rate, and restlessness also become pronounced in an anxiety attack, anxiety attacks can last for hours and they do not escalate to the same severity as they would in a panic attack.

Causes of a Panic Attack

The causes of a panic attack are not entirely understood, but there are multiple factors that increase one’s potential for developing a panic attack or a panic disorder.

• Genetics—The chances of developing a panic disorder or a panic attack are increased by having a family member with a panic disorder.  
• Stressful events—Panic attacks often emerge after a major life event. Examples are moving, the loss of a loved one, divorce, or trauma and abuse.
• Mental disorders—The symptoms of common mental disorders actually include panic attacks. Someone with a diagnosis of generalized anxiety disorder, obsessive-compulsive disorder, depression, or post-traumatic stress disorder is more likely to suffer from panic attacks than those without a pre-existing mental disorder.
• Substance abuse—Studies show that drug and excessive alcohol consumption result in alterations in brain chemistry, which can cause a panic attack. Avoiding drugs and limiting alcohol is advised.
• Personality—Personality types that are sensitive to stress are prone to panic attacks.

Diagnosing a Panic Attack

The symptoms of a panic attack mimic those of physical health conditions. The increased heart rate and chest pain might be mistaken for a heart attack, shortness of breath as a breathing disorder, and the other miscellaneous maladies as an acute episode of some dangerous medical problem People often seek medical attention immediately in the midst of a panic attack believing they have a life-threatening condition, only to have test results come back inconclusive. It is always best to rule out medical disorders before assuming panic attack.

If medical tests and physical exam are negative, and the patient has at least four of the above symptoms, a physician can diagnose a panic attack through a psychological evaluation. The evaluation assesses family history, life stressors, and fears that could be at the root of the panic attacks.

Panic Attack Treatment

The good news is that panic attacks are very much treatable. Treatment is focused on the cause of the panic attack, which is occasionally tricky because the symptoms do not have an obvious trigger. It takes some digging to clearly associate panic attacks with an underlying stressor. Three main treatments are helpful for that process, as well as managing daily symptoms when an attack comes on.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is the preferred treatment for panic attacks. Cognitive behavioral therapy is a form of talk therapy which explores how thoughts, feelings, and beliefs influence behavior. Those with panic attacks may not be comfortable addressing their fears with a therapist. In those cases, antidepressant medications can be used in combination with therapy to reduce that hesitancy.

The therapist and client work together to pinpoint false assumptions contributing to their condition. CBT therapy sessions challenge the client to cope with their panic through the awareness that their symptoms are not harmful. A way the therapist accomplishes this is by inducing the physical sensations experienced during panic attacks through other activities such as jogging to get the client’s heart rate up, spinning to make them dizzy, or breathing through a straw to stimulate shortness of breath.

Deep Breathing Techniques

Rather than waiting for panic attack symptoms to dissipate, relaxation techniques which entail deep breathing are of benefit to the physical symptoms. Many therapists teach clients deep breathing, as the ability to relax gives them more control of the situation at a time they feel the most out of control.

Deep breathing requires taking full, deep belly breaths through the nose while exhaling out of the mouth. Imagining calming imagery during deep breathing reduces stress. In turn, it aids the body in finding its equilibrium when stuck in a fight-or-flight response of panic.

Medication

If non-medication treatment options are unsuccessful at deceasing the frequency and intensity of panic attacks, physicians prescribe medications to better manage symptoms.

Antidepressants

Antidepressants are medications that balance the neurotransmitters in the brain to stabilize mood and increase feelings of happiness. There are four classes of antidepressants typically prescribed to treat panic attacks. Each type influences a different neurotransmitter.

• Selective Serotonin Reuptake Inhibitors (SSRIs)—SSRIs block the reuptake of serotonin to increase its availability in the brain.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)—SNRIs balance serotonin and norepinephrine by blocking the reuptake of both neurotransmitters.
• Tricyclic Antidepressants (TCAs)—TCAs increase levels of serotonin and norepinephrine while also blocking acetylcholine. They are not prescribed as frequently as SSRIs or SNRIs because of drowsiness, urine retention, and other unfavorable side effects.
• Monoamine Oxidase Inhibitors (MAOIs)—MAOIs inhibit an enzyme called monoamine oxidase to increase levels of serotonin, norepinephrine, and dopamine. Although MAOIs balance three neurotransmitters ideal for panic attacks, physicians are cautious to prescribe MAOIs due to potentially fatal interactions with food and drugs.

Antidepressants are relatively safe but must be taken daily regardless of anxiety level on that particular day. They are best suited for those with frequent panic attacks.

Benzodiazepines

Benzodiazepines are a class of psychoactive medications that act as tranquilizers. They work by binding to GABA receptors in the nervous system to increase the effectiveness of the neurotransmitter. Benzodiazepines are fast acting, heavily sedating, and have a large side effect profile. Because of this, doctors prescribe benzodiazepines to treat panic attacks as they happen and not as a long-term preventative.  

Beta Blockers

Beta blockers are a type of cardiac medication that blocks the effects of adrenaline to reduce heart rate and blood pressure. They do not treat panic attacks directly; however, adrenaline is raging during a panic attack and beta blockers improve cardiac symptoms that cause additional anxiety.

Learning To Be Open About Panic Attacks

People with panic attacks regularly try to hide their conditions from friends, family, and even medical professionals. They worry they will be seen as “crazy” or like a “hypochondriac” faking symptom for attention. As a result, they isolate themselves from others and do not continue with their daily routines. Yet, panic attacks are no reason for shame. You will find that friends and family are usually supportive. That support is paramount to living a productive life despite panic attacks. Hiding the condition only prevents you from receiving necessary treatment. If you are overwhelmed, start by revealing as minimal information as possible. Explain what happens during an attack, what your triggers are, and just enough details for friends and family to help you through an attack.

References

Hofmann, S.G., Hay, A., & Barthel, A. (N.d). Panic Attacks and Panic Disorder: Symptoms, treatment, Causes, and Coping Strategies. Retrieved from https://www.anxiety.org/panic-disorder-panic-attacks

Miller, C. (N.d). Panic Attacks and How to Treat Them. Retrieved from https://childmind.org/article/panic-attacks-best-treatments/

Susman, J., & Klee, B. (2005). The Role of High-Potency Benzodiazepines in the Treatment of Panic Disorder. Primary care companion to the Journal of clinical psychiatry, 7(1), 5–11.

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.