Andrew Martin Counselling in Muswell Hill and Crouch End, North London

Panic Attacks. Panic Article 1

Understanding Panic Attacks and Panic Disorder

What is a panic attack?
A panic attack is the name given to a frightening set of symptoms characterised by strong emotional feelings, physical sensations, and unpleasant thoughts.

The emotions are of strong fear, anxiety, or terror. These emotions are accompanied by physical sensations, such as increased heart rate, palpitations, chest pains, difficulty breathing, numbness, dizziness, dissociation, abdominal cramps, and dry mouth.

The unpleasant thoughts that can come during a panic attack include, “I’m going to pass out; my heart is going to explode; I’m going to have a heart attack or stroke; I’m going to suffocate; I’m going to soil myself in public; I’m going to be humiliated; I’m going mad; I’m going to die.”

Usually an attack will peak after 10 -15 minutes, with the worst of the symptoms calming down after that.

As with all anxiety issues, avoidance and safety behaviours are likely to surface. Sufferers will want to avoid the situations that might bring on the panic or where they would not want to have a panic attack, for example on public transport or in a place they fear they cannot escape from.

Many people will experience a panic attack in their lives, so having a panic attack does not mean you have panic disorder. Panic attacks are often seen in other kinds of anxiety disorder such as OCD, PTSD, or social phobia.

What is panic disorder?
To be diagnosed with panic disorder you have to have experienced at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealisation) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes

Moreover, when people are suffering from panic disorder the attacks appear to come out of the blue, with no obvious trigger. The panic attacks have to be persistent, and the sufferer must have experienced fear of having another panic attack for at least one month.

The best way to define panic disorder, as distinguished from just a panic attack, is that it is strongly linked to the fear of having a panic attack. I like to think of it as a fear of fear.

Misinterpretation of normal symptoms:
If you remember the kinds of thoughts panic sufferers are likely to have, you can see one of the reasons that panic attacks turn into a full disorder.

Such thoughts are due to a misunderstanding or a misinterpretation of the unpleasant physical symptoms that are common when an attack occurs.

For instance, it is common to feel palpitations, a racing heart or chest pains when having a panic attack. This can be misunderstood by the sufferer as very convincing evidence that they are having a heart attack and are going to die. In fact, it is quite common for people to call an ambulance when they have a panic attack for the first time.

One thing that happens when someone is suffering from this “fear of fear” is that they start to focus more on physical sensations as a misguided way of protecting themselves.

For example, as a way of not allowing a heart attack to happen they are very aware of their heart rate. When their heart rate naturally goes up, after walking up a hill or perhaps while experiencing some mild anxiety about a required activity, they will notice the heart increase. This is likely to make them afraid: “Perhaps I am going to have a panic attack. Yes, my heart rate is definitely increasing.”

So a perfectly natural variation in heart rate, which most people would never notice or care about, leads to some quite frightening thoughts about an imminent panic attack. Unfortunately, this can become a vicious cycle in which the physical symptoms increase, the anxiety increases in its turn, and the physical sensations increase even further. The outcome for someone with panic disorder is that they then have a full-blown panic attack.

Strategies for treatment:
One key element of dealing with panic attacks is simply to look at the lifestyle factors that aggravate panic. This can be as simple as making changes to how you exercise, sleep, and relax, your alcohol consumption, recreational drug use, and nutrition.

There are two further key strategies for treating panic disorder which draw heavily on the concepts of behavioural and cognitive psychology. The first deals with reducing the symptoms and severity of a panic attack once it has started. This can be done with techniques based on relaxation, breathing, external focus and distraction. They are simple enough to learn, and with practice you can develop a tool that is truly useful when you think a panic attack is around the corner.

This is an important part of the treatment. However, the real meat of the treatment is based on how to reduce the likelihood of a panic attack happening in the first place.

This can be done by looking in more detail at the vicious cycle of how physical sensations, emotions, catastrophic thoughts, avoidance and safety-seeking behaviours all work together to dig you further into your panic disorder.

As with most anxiety treatments, it is challenging work, but I believe well worth your while. In future articles I will look in more detail at how to beat your panic disorder.


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