Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms. The onset of these episodes is typically abrupt, and may have no obvious trigger. Although these episodes may appear random, they are considered to be a subset of an evolutionary response commonly referred to as fight or flight that occur out of context, flooding the body with hormones (particularly adrenalin) that aid in defending itself from harm.
According to the American Psychological Association the symptoms of a panic attack commonly last approximately ten minutes. However, panic attacks can be as short as 1-5 minutes, while more severe panic attacks may form a cyclic series of episodes, lasting for an extended period, sometimes hours. Often those afflicted will experience significant anticipatory anxiety in between attacks and in situations where attacks have previously occurred.
Panic attacks also affect people differently. Experienced sufferers may be able to completely 'ride out' a panic attack with little to no obvious symptoms. Others, notably first time sufferers, may even call for emergency services; many who experience a panic attack for the first time fear they are having a heart attack or a nervous breakdown.
Many who suffer from panic attacks state they are the most frightening experiences of their lives. Sufferers of panic attacks report a fear or sense of dying, "going crazy", and/ or experiencing a heart attack, feeling faint, nauseous, or losing control of themselves. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the sympathetic "fight or flight" response).
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms may include: trembling, shortness of breath, heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking, smothering, derealisation, or the feeling that nothing is real. These physical symptoms are interpreted with alarm in people prone to panic attacks, this results in increased anxiety, and forms a positive feedback loop.
Triggers and Causes
While the various symptoms of a panic attack may feel that the body is failing, it is in fact protecting itself from harm. The various symptoms of a panic attack can be understood as follows. First, there is frequently (but not always) the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline which brings about the so-called fight-or-flight response wherein the person's body prepares for strenuous physical activity. This leads to an increased heart rate , rapid breathing (hyperventilation) which may be perceived as shortness of breath , and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood, which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and light-headedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and light-headedness.
Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty travelling from this "safe place". The word "agoraphobia" is an English adoption of the Greek words agora and phobos literally translated as "a fear of the marketplace". This translation is the reason for the common misconception that agoraphobia is a fear of open spaces, and is not clinically accurate.
People who have had a panic attack in certain situations — for example, while driving, shopping in a crowded store, going to a party, experimenting with psychedelic drugs, etc. — may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place. Agoraphobia of this degree is extremely rare. It should be noted that upwards of 90% of agoraphobics achieve a full recovery. Agoraphobia is actually not a fear of certain places but a fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing.
The thinking behind agoraphobia usually follows the line that were a panic attack to occur, who would look after the person, how would he or she get the assistance and reassurance they needed? The vulnerability grows from the feeling that once victims of agoraphobia are caught in the anxiety, they are suddenly unable to look after themselves and are therefore at the mercy of the place they find themselves in and the strangers around them. In its extreme form, agoraphobia and panic attacks can lead to a situation where people become housebound for numerous years.
It is important to note that agoraphobia is by no means a hopeless situation. Sufferers often do not realise that they have experienced these same situations before and nothing terrible occurred. Successful treatment is possible with the right combination of therapy and medication.
Agoraphobia is often described as a fear of having 'no place to run or hide' if one does have a panic attack. Common examples include: driving, airplanes, malls, moving out of the house, etc.
People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have Panic Disorder. Panic Disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.
People with Panic disorder often can be successfully treated with therapy, particularly Cognitive Behavioural Therapy and/or anti-anxiety medication or antidepressants.
Paper bag rebreathing
Some panic attack sufferers and even some doctors recommend breathing into a paper bag as an effective short-term treatment of an acute panic attack. However, this can prove to be fatal in some cases and it is strongly advised against to engage in such a practice, by well-respected medical studies dating back to 1989 and 1994