Panic attacks

What is a panic attack?

Panic attacks or panic disorder (PD), may be part of a phobia or obsessive compulsive disorder. They may also be associated with a variety of coexisting medical conditions. However, it can be a distinct illness in its own right.

Panic attacks can occur at random and without any advance warning. They are very distressing to the sufferer and can be difficult to cope with. One minute the sufferer can be at ease and the next minute they are in the throes of blind terror. Many sufferers describe such intense feelings that they feared that they were going to die.

A key element in the genesis of a panic attack is the thought: 'what if I lose control here'? It has been described as a first fear followed by a second fear. The first fear is a collection of symptoms of which the person suddenly becomes aware. The symptoms are listed in the succeeding paragraph. The second fear is a reaction to the first fear.

There are several reasons offered for the triggering of the second fear. It may be fear of suffocation or imminent death. The second fear escalates rapidly and feeds back into increasing the level of the initial symptoms. The symptoms increase like a snowball rolling down a hill resulting in the avalanche of full-blown panic

What are the symptoms?

The essential feature of a panic attack is an intense fear or discomfort accompanied by a variety of physical or psychological symptoms. The attack is sudden in onset and usually peaks within ten minutes. Sufferers describe feelings of imminent danger or impending doom and feel an urgent need to escape.

The accompanying symptoms include palpitations, sweating, trembling, discomfort, nausea, dizziness or light-headedness, fear of dying, pins and needles, and hot flushes and chills. The majority of sufferers describe an intense fear of losing control.

Why does it happen?

Panic disorder is a broad umbrella label applied to a wide variety of conditions having very different origins, outcomes and treatment strategies. Distinct causes of PD include:

  • Prolonged stress
  • Obsessive thought patterns.
  • Phobias.
  • Poor breathing habits of physical or psychological origin.
  • Emotional turmoil.
  • Separation anxiety.

Researchers are investigating the possibility that imbalances in the levels of various neurotransmitters in the brain may be the chemical triggers for these attacks. Neurotransmitters are the chemicals involved in the transmission of messages within the nervous system. Research is focussing on the possible role of serotonin and noradrenaline.

There are a number of conditions associated with panic attacks, which may be instrumental in causing the attacks, or they may simply co-exist.

They include the following:

  • Alcohol abuse.
  • Depression.
  • Sexual dysfunction.
  • Oesophageal reflux.
  • Irritable bowel syndrome.
  • Chronic fatigue syndrome.
  • Fibromyalgia.
  • Endocrine disorders, especially of the thyroid gland.
  • Disturbances of circadian rhythm (e.g. shift workers).
  • Allergic reactions.

The hormonal changes associated with the menopause can produce such a degree of symptom overload that some women experience panic attacks for the first time during this phase of change. In some cases it is the panic attack itself that generates the need for a medical consultation.

Researchers are also focussing on the possible role of excessive caffeine consumption in the triggering of panic attacks.

What can I do to help myself?

Most people who experience an attack for the first time are convinced that they are going to die. It is important that people realise that this disorder is not life threatening. This simple realisation can help some people to cope with an attack. If you recognise that an attack is coming on it might be helpful to try the following:

  • Deep breathing exercises can reduce the intensity of symptoms.
  • Try to conjure up relaxing images in your head. This form of distraction can reduce the level of self-consciousness thereby reducing the symptoms.
  • Try to talk yourself down. For example, "I am not dying, this is a panic attack, I have been through this before and everything will be alright".
  • Put on a relaxing music tape.

If the attack is increasing despite using the preceding measures some people find it helpful to put a paper bag over their mouths and rebreathe through the bag for several minutes. This may sound like very strange advice but it has a sound physiological basis. Exhaled air is high in carbon dioxide and rebreathing through the bag increases the level of carbon dioxide in the inhaled air. Carbon dioxide slows the heart rate and relaxes breathing.

How can it be treated?

A variety of treatment options is available. If the panic attacks are due to a co-existing condition then that condition will also require its own specific treatment. For example, if the attacks are due to an underlying disorder of the thyroid gland the latter will need to be treated simultaneously otherwise the panic will not subside.

Each case of panic disorder is unique and will require its own specific treatment. These treatments could include medication, cognitive behavioural therapy, relaxation exercises or hypnosis. Sometimes a combination of these treatments will be used in a given case.

Cognitive therapy is increasing in popularity and appears to be very effective. It involves confronting the sufferer's false and exaggerated beliefs in order to abort the cycle of distress that is triggered by these beliefs.

A number of studies have suggested that antidepressants seem to work well when the symptoms are of a psychological nature and anxiolytics work best if the symptoms are mainly physical. The new generation of antidepressants known as SSRIs appear to be particularly effective.

There is no "one size fits all" treatment for panic attacks. Each case is treated on its own individual merit.

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