Panic attack is an episode of sudden feeling of intense fear reaching the peak within 10 minutes and lasting for a period of a few hours. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition-Text Revised (DSM-IV-TR) published by the American Psychiatric Association lists the following thirteen mental and physical symptoms of panic attacks:
- Feeling heartbeats in accelerated rate (palpitation)
- Trembling or shaking
- Sensations of smothering or shortness of breath
- Feeling of choking
- Pain or discomfort in the chest
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Strange feelings of unreality (de-realization) or curious feeling of being detached from one’s self (depersonalization)
- Fear of losing control or going insane
- Fear of impending death
- Sensations of numbness or tingling (Paresthesias)
- Sensations of chills or hot flushes (also known as hot flashes)
|A Woman in panic|
|Panic attack on seeing a spider|
Even though the DSM-IV-TR lists only 13 symptoms I have seen cases of panic attacks with the history of sudden feelings of neck soreness, hearing whistles in the ear (tinnitus), headache, and uncontrollable screaming or crying
Triggers of panic attacks
Many situations can trigger episodes of abrupt fear. A healthy normal person might experience a panic attack when confronted with sudden extreme danger. When an individual with phobia of spiders sees a spider in the room he/she might experience panic attack. Many, who experience a panic attack, mostly for the first time, fear they are having a heart attack or a nervous breakdown.
Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person's life and may take days to recover from. If an individual experiences panic attacks spontaneously, at frequent intervals without any trigger or when not confronted with sudden extreme danger, the condition is called panic disorder.
Sufferers of panic disorder often report a fear or sense of dying, "going crazy," or experiencing a heart attack or "flashing vision," feeling faint or nauseated, a numb sensation throughout the body, heavy breathing, or losing control of themselves. These feelings may provoke a strong urge to escape or flee the place where the attack began. This feeling is caused by the “flight response”. The natural instinct of every animal dictates to flee from the scene of danger and this response is triggered by the stress hormones produced by the adrenal glands.
Often, the onset of shortness of breath and chest pain is the predominant symptoms; the sufferer incorrectly appraises this as a sign or symptom of a heart attack. This can result in the person’s experiencing a panic attack seeking treatment in an emergency room.
Difference between panic attack and generalized anxiety
Panic attacks are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature. They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not usually indicative of a mental disorder.
Predisposing factors, causes, and triggers
Panic disorder has been found to run in families, and this may mean that inheritance plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. The onset of panic disorder usually occurs in early adulthood, although it may appear at any age. It occurs more frequently in women and often in people with above average intelligence. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an “overly cautious view of the world expressed by parents and cumulative stress over time have been found to be correlated with panic attacks”. (The Anxiety and Phobia Workbook 4th edition by Edmund J. Bourne)
A common physiological cause of panic attack is lowering of blood glucose level, a condition known as hypoglycemia. This may occur frequently in patients suffering from diabetes mellitus due to excess medication or medication without ample food intake. A condition called hyperthyroidism also causes frequent panic attacks. Consumption of some stimulant drugs such as Ritalin (methylphenidate) may cause panic like symptoms. Some antidepressant drugs also cause panic attacks as side effect. I have seen many alcohol addicts who experience panic attacks on dry days.
Some psychological disorders such as obsessive compulsive disorder, post traumatic stress disorder, and phobias frequently cause panic attacks. Many physical illnesses such as Wilson’s disease, prolapse of the mitral valve of the heart, pheochromacytoma and inner ear disturbance known as labyrinthitis are associated with panic attacks.
Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change, and stimulants like caffeine or nicotine can act as triggers for a panic attack.
According to American self-help author and psychologist Edmund J.Bourne lack of assertiveness is a contributing factor in the continuance of the panic disorder. A growing body of evidence supports the idea that those that suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also characteristically un-assertive. This un-assertive way of communicating seems to contribute to panic attacks.
How to get rid of panic attacks?
The American Psychological Association says: “most specialists agree that a combination of cognitive and behavioral therapies is the best treatment for panic disorder. Medication might also be appropriate in some cases". The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they are 'going crazy' or that the panic might induce a heart attack. Cognitive restructuring helps people replace those thoughts with more realistic, positive ways of viewing the attacks.
An easy way to control panic attacks
Force yourself to breathe slowly while counting to 20. Try to breathe in and out with every two seconds while counting to twenty. These slow, even and deep breaths will most likely distract us while making the panic attack run its course and totally bringing the stress down in those vital first 20 seconds. Concentrating on breathing slowly, making sure that you don’t rush yourself with the counting, taking all the time to concentrate, will most definitely work in slowing our heartbeat down thus alleviating the stress caused by all the adrenaline forcing us to react. This works mostly because you are able to create a distraction that will force your body not to react too rapidly to the attack, your brain will force itself to concentrate on other things other than the anxiety that forces you to react to the stress the panic is creating. When you count and breathe slowly, you concentrate on regaining control to your reactions, rather than letting the panic attack have control over you.
This technique can be most helpful in our everyday lives, once mastered, as it can greatly help you control your reactions in panic inducing situations, thus making it a tool to control your physical reactions in preventing the stress to overwhelm you.