What IS a Panic Attack? A panic attack is a sudden increase in intense fear that peaks within minutes. By definition you must experience at least four symptoms. While most of these symptoms are physical, symptoms may also include fear of dying, fear of going crazy, or fear of embarrassment. Although a panic attack may seem like it lasts for several hours, the peak of a panic attack subsides within twenty minutes.
Diagnosis Doc? Panic attacks may be an indication of Panic Disorder in which one suffers recurrent panic attacks. There is also a persistent fear of having more attacks, worry that the panic attack is really something more serious (like a brain tumor or a heart attack), or behavior is changed to avoid the attacks (e.g., avoiding public places while alone). Panic Disorder with Agoraphobia is when an individual is fearful of having a panic attack outside of the home where escape would be difficult or where help is not available. The grocery store, driving, and being in a crowd are some examples. People may also have panic attacks in response to a phobia. So for instance, if you have social phobia or a specific phobia (e.g., fear of dogs, heights, spiders) you might have panic attacks exclusively in these situations.
What Causes Them? While it may feel as though a panic attack comes out of the blue, there is always some trigger. I believe that the first panic attack is the perfect storm of multiple triggers. These triggers can be internal triggers (physical sensations or thoughts) or external triggers (an actual or perceived threat in your environment). Examples of external triggers include: an argument, a loud noise, hearing bad news, or exposure to a phobic situation. Internal triggers are thoughts (i.e., worry) or changes in how you feel physically. The physical sensations can be caused by a variety of factors including artificial lighting (especially fluorescent lights), lack of sleep, dehydration, low blood sugar, side-effects to a medication, and even normal physiological fluctuations in your body.
The initial trigger is followed by a rapid spiral of thoughts, physical sensations, fear, and, sometimes, behaviors attempting to reduce the anxiety (e.g., escaping the situation, checking one’s pulse). Soon the sufferer of panic becomes overly sensitized and develops a fear of fear. The avoidance and checking behaviors usually strengthen the fear, causing the panic attacks to become more severe and occur more frequently. While there is some evidence of a genetic pre-disposition to having panic, there is more evidence that it is mostly learned. Tune in later this week for information about overcoming panic attacks.