What Is Panic Attack?

Overview

A panic attack is a sudden episode of intense anxiety that may trigger severe physical reactions such as shaking, nausea, rapid and irregular heartbeats, breathlessness and feeling disorientated. These symptoms are not dangerous but can be very frightening and people often feel like they are dying or having a heart attack. A panic attack can last between 5 and 20 minutes but some can last up to an hour.¹

For most people, having a few panic attacks in their lifetime is normal but frequent and unexpected panic attacks can be a symptom of panic disorder. Other possible causes of panic attacks include genetics, major stress, a fight-or-flight response or even other health conditions. Management and treatment of panic attacks can be through breathing exercises, cognitive behavioural therapy (CBT), medicine or referral to a mental health specialist such as a psychiatrist or a clinical psychologist.¹

This article will explore the symptoms and possible causes of panic attacks as well as the management, treatment and prevention of panic attacks.

Causes of panic attacks

As with many mental health conditions, there is no clear cause of panic attacks but there are possible factors that can influence the occurrence and frequency of them.

Evolutionary response to fear fight or flight

Evidence suggests that a panic attack is part of your body’s natural response to danger. Scientists studied the brains of individuals undergoing a virtual predator paradigm and found brain activation in the prefrontal cortex. This brain area is associated with complex risk assessment and approach behaviour. As the distance between the individual and the virtual threat decreased, brain activity shifted to the brainstem which is a part of the brain that is associated with faster and more primitive responses such as a fight-or-flight response. The scientists found that the emotions that were associated with this virtual threat included anxiety and fear. These are symptoms of a panic attack.²

Panic disorder

Frequent panic attacks are often a symptom of panic disorder. This is an anxiety disorder where you experience regular and sudden attacks of panic or intense fear, often for no apparent reason. Panic disorder symptoms usually start in late teens or early adulthood and usually affect more women than men.¹

One of the major symptoms of panic disorder is anxiety which is a feeling of unease and  can range from mild to severe. The most severe form of anxiety is panic. This can lead to you avoiding certain situations in case you trigger another panic attack. This can add to your fear and panic and create a cycle of living ‘in fear of fear’.¹

If left untreated, panic disorder can affect almost every part of your life and therefore, ruin the quality of your life. Living in a constant state of intense fear can lead to the development of a specific phobia such as fear of driving or leaving your house. It can also lead to the avoidance of social situations, increased risk of suicide or suicidal thoughts, alcohol and drug problems and other psychiatric disorders such as depression and anxiety disorders.³

Genetics

There is a range of data that suggests that genetics plays a role in the pathophysiology of panic disorder which ultimately causes panic attacks. Family studies have revealed that the risk for panic disorder significantly increases in first-degree relatives. Research also shows that the risk for panic disorder is higher for monozygotic twins ( identical twins) compared to dizygotic twins (non-identical twins) which suggests that panic disorder is genetically driven and not shared by environmental factors.²

Major stress

• A major stress event or life-changing event can trigger panic attacks such as³
• A major death or serious illness of a loved one
• Life-changing events: moving to a new country, graduating, starting a new job, divorce, becoming a parent
• A traumatic event: a serious accident or abuse/assault

Other possible health problems

Panic attack symptoms often overlap with other health problems so you may not always be experiencing a panic attack. For example, a rapid heartbeat is often a sign of very low blood pressure. It is important you seek medical attention to rule out any other possible health problems.¹

Signs and symptoms of panic attacks

People often confuse panic attacks and anxiety attacks. Although they are similar, anxiety attacks are usually less intense and are in response to a perceived threat. During a panic attack, you are overwhelmed with a rush of intense physical and mental symptoms. These can be very frightening and can come on very quickly, often for no apparent reason. Similar to anxiety attacks, panic attack symptoms includ: ⁴

• Shaking or trembling
• A rapid, pounding heartbeat
• Sweating
• Shortness of breath or a feeling of tightness in your throat
• Chills or hot flashes
• Chest pain
• Feeling faint, dizzy or lightheaded
• A feeling of impending doom or danger

Management and treatment for panic attacks

Management and treatment of panic attacks aim to ease your symptoms and reduce the number of panic attacks you have.

What to do if you have a panic attack

• Do not fight it
• If possible, stay where you are
• Focus on your breathing – breathe slowly and deeply
• Focus on your senses – the taste of something sweet or touch something soft
• Try grounding techniques
• Stamp on the same spot – it can help control your breathing
• Focus on peaceful and relaxing images
• Remind yourself that the attack is not life-threatening and it will pass¹

Breathing exercises

If you have a panic attack, breathing techniques can ease your other symptoms and help you control your breathing. This can help you feel better in a few minutes but you may feel tired afterwards.

• Breathe in slowly and deeply through your nose
• Breathe in slowly and deeply through your mouth
• If helpful, count slowly from 1 to 5 each time you breathe in and out
• Close your eyes and stay focused on your breathing⁴

Talking therapy

Talking therapies such as cognitive behavioural therapy (CBT) are another option for treatment. A therapist can discuss your symptoms and how you react and feel when you have a panic attack. They can then teach you ways to change your behaviour and negative thoughts so you stay calm during an attack.¹

Medicine

If you have frequent panic attacks and severe symptoms, your doctor may prescribe you:¹

• Selective serotonin reuptake inhibitor (SSRI) – a type of antidepressant
• Imipramine or clomipramine – these are tricyclic antidepressants given If SSRI is not suitable
• Pregabalin – an anti-epilepsy medicine also useful for treating anxiety
• Clonazepam – for severe anxiety

Support group

Panic attacks can have a big impact on your life and so it may help to talk to other people with the same condition or to connect with a charity. A panic support group can help you get useful advice on how to manage your attacks. Also, your GP can help you get in touch with support groups in your area.¹

Here are a few useful links for support:

• Anxiety UK
• Mind
• Triumph Over Phobia
• No Panic

Referral to a psychiatrist or clinical psychologist

If your panic attack symptoms are not improving after medicine, CBT and connecting with a support group, your doctor may refer you to a mental health specialist such as psychiatrist or clinical psychologist. They will then carry out an assessment to identify your panic attack symptoms and create a treatment plan which will help you manage your symptoms.¹

Can panic attacks be prevented

There is no sure way to prevent panic attacks but there are a few recommendations to help you:^1,4

• Read a self-help book for anxiety based on cognitive behavioural therapy (CBT)
• Practice breathing techniques every day to help you ease your symptoms and relieve a possible panic attack
• Create a regular exercise routine, especially aerobic exercise, to manage stress, reduce tension, lift mood and boost confidence
• Eat regular meals every day to stabilise your blood sugar levels
• Avoid sugary foods and drinks
• Avoid caffeine, alcohol and smoking as they can make panic attacks worse
• Try complementary therapies – massage, aromatherapy, yoga and pilates can help you relax
• Get enough sleep – insufficient sleep can worsen anxiety and other health problems

When should I call a doctor

You should contact your GP if you have been experiencing severe panic attacks or symptoms of panic disorder. Although panic attacks are not dangerous, they can be hard to manage on your own and may get worse without treatment. You may be diagnosed with panic disorder if you have frequent and unexpected panic attacks and at least a month of constant worry and fear about having further attacks.

In addition, your GP can identify your symptoms and rule out other possible health conditions which is why it is important to seek medical care in case if you are not sure what is causing your symptoms.¹

Summary

In summary, a panic attack is a sudden episode of intense fear and anxiety that can last anywhere from 5 minutes up to an hour. A panic attack can often feel as if you are dying or having a heart attack and can trigger physical symptoms such as a pounding heart, shaking, breathlessness, sweating and a dry mouth. Panic attack symptoms are not dangerous but recurrent panic attacks are a symptom of panic disorder. Panic disorder causes intense anxiety attacks for no apparent reason and can lead to phobias, social anxiety, anxiety disorder, depression and alcohol and drug problems. However, panic disorder and panic attacks are treatable and a doctor may recommend medication, cognitive behavioural therapy (CBT), breathing techniques, a support group or referral to a mental health specialist.