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PANIC ATTACKS (OR ACUTE ANXIETY)

This is about panic attacks and agoraphobia. First, it will explain the kind of sensations which commonly occur during a panic and then how you can begin to control a panic.

What are panic attacks?

A panic attack is a sudden increase in anxiety and fear which gives rise to a number of physical sensations. Such attacks are very common - about 10% of people experience them at some time during their life. If you are wondering whether what you experience are what we call panic attacks, answer the following questions:

During an attack:

Do you suddenly feel your heart racing or pounding? YES/NO
Do you feel shaky or sweaty even though you have not been exerting yourself? YES/NO
Do you feel as if you were choking or suffocating? YES/NO
Do you breathe faster? YES/NO
Do you have a feeling of tightness in your chest? YES/NO
Do you feel dizzy, faint or weak in your legs? YES/NO
Can you feel butterflies in your stomach? YES/NO
Do you feel as if you are having a heart attack or dying? YES/NO
Do you feel as if you are going to faint or collapse? YES/NO
Do you feel as if you may lose control or go crazy? YES/NO
Do you feel as if you are going to vomit or urinate in public? YES/NO

If you answered "yes" to at least four of these questions then you are probably experiencing panic attacks. The sensations vary from person to person and attack to attack, both in nature and intensity.

What causes a panic attack?

A panic attack is triggered when a person believes that there is some danger, when in fact there is no real threat at all.

People who suffer from panic attacks tend to be so afraid of situations in which they may panic that they often learn to avoid them - in other words, develop a phobia.

Sufferers often fear that during an attack they may have a heart attack or die, or may faint, lose control, go mad, or be sick in public. We will deal with each of these common fears in turn before a description of what to do when a panic occurs. See :- Panic

Fear of heart attack or death

Many people who suffer from panic attacks think that they may have a heart attack or die during an attack. If this is the case with you, you have probably noticed your heart racing or pounding or have felt a sense of tightness in your chest. These physical sensations can be very frightening but are in fact normal features of anxiety or fear. Thinking that you are having a heart attack feeds a vicious circle because anyone who believed they were having a heart attack would become anxious and get more palpitations.

The palpitations are caused by adrenaline which is released into the bloodstream to prepare your body for a quick response to danger. The sensations are not life-threatening, even though they can feel as if they are.

If you are otherwise in good health, there is no reason why you should be any more prone to heart attack than anyone else in the population. Stress only causes heart attacks if you already suffer from heart disease. You can check whether you have heart disease by asking your doctor.

If you do have heart disease then indeed it might be dangerous to be in any situation that makes your heart suddenly go very fast - like playing squash. For most people, a racing heart is not only quite harmless but can in a way reduce your chances of getting heart disease.

This is because one of the things that protects people from heart disease is taking regular exercise. When you exercise, your heart beats faster and if you exercise regularly the heart muscle grows larger and stronger. A panic attack which causes the heart to race has the same effect on the body as running up a hill - it feels different during a panic attack because your anxiety causes you to misinterpret the normal sensations of pounding heart as being dangerous. Far from having a heart attack you are actually reducing the risk of getting heart disease! The same sensations occur if you are very excited (in a fairground, for example). Perhaps you can think of a time when you used to get similar sensations which you just accepted as part of the excitement?

So you see, being afraid of a heart attack can make a panic attack even worse, and the worse the attack the more afraid you become. You may well forget the reasons why you will not die or have a heart attack so write them down on a card and when you next get an attack read it to remind yourself that the sensations you are experiencing are quite harmless. It will also help if you do regular exercise to get used to the feeling of your heart racing and pounding. Ask your therapist for advice if you are not sure where to begin.

Fear of fainting or collapse

A common thought during a panic attack, especially if you feel dizzy or your legs feel weak, is that you will faint or collapse. These sensations are also a normal feature of anxiety or fear. They occur as a result of adrenaline being released into the bloodstream. You believe that you will faint or collapse only because you have misinterpreted those physical sensations. I will explain why it is impossible for you to faint during a panic attack.

When your heart beats fast during a panic, your blood pressure goes up. Fainting is a reflex reaction that only occurs if the blood pressure to your brain is too low. Very low blood pressure forces you to fall down so as to allow more blood to flow to your brain.

A common cause of fainting is standing for long periods on a hot day or in a stuffy place - a problem which can affect shop assistants or soldiers on parade, for example. Fainting is also a reflex action to the sight of a lot of blood. But people rarely faint in normal conditions if they are in good health.

Remember that in a panic attack your blood pressure is going up which will prevent you fainting. You may feel as if you are going to faint or collapse during a panic attack but it is just impossible. You can check this out by trying to reproduce the symptoms of dizziness you get in a panic attack by spinning round in a large room or open space. Then remain standing with your eyes shut. It may feel as if you are going to collapse but it does not happen because the balance mechanism in your ear prevents you from falling. And even if you did collapse in a panic, how much would it really matter? You are probably afraid of causing a scene, but even if you did faint, and I would dispute that it is possible, you would come round in a few seconds and then you could simply get up and walk off.

In summary, the fear that you will faint or collapse is only a symptom of a panic attack and makes the experience much worse. If you believe that you are about to collapse, you will feel more anxious and frightened and so get more sensations of dizziness. This feeds a vicious circle of further anxiety and creates more physical sensations.

So when you next start to get a panic attack, remind yourself that it is impossible to faint. Write down on a card why you are not going to faint or have a heart attack and read it when you start to get panicky. Remember that the sensations may be unpleasant but you will come to no harm. It will also help if you regularly provoke the symptoms of dizziness to get used to the sensations. You could do this, for example, by spinning yourself around.

Fear of choking or suffocation

The sense of being out of breath is caused by breathing too much (or hyperventilating). Taking in less air will make it go away. We don't know why some people feel breathless when they breathe too much, but it is a well-established fact that this happens. It is impossible to breathe too little. The best way of overcoming this feeling is to retrain yourself to breathe less. This is a skill that your therapist can teach you.

Fear of losing control or going mad

Another thought during a panic attack is that you are losing control or going mad. This can happen where you misinterpret your physical sensations as being a danger to your sanity. Remember you are always in full control of your behaviour. If you were not, you would be unable to decide to run away. You can decide equally well just to wait until the anxiety passes. Panic attacks are not a sign of madness. People who panic are never shut away in mental hospitals. Fear that you are going to lose control is just a symptom of acute anxiety.

Fear of vomiting in public

Another fear is that you are going to be sick during an attack. This is probably because you feel butterflies in your stomach as a symptom of the attack. It is extremely unlikely that you will actually be sick - it is only a thought that goes through your mind. You then become more anxious and get more butterflies in your stomach and so on.

Fear of causing a scene in public

One common fear is that you will cause a scene or a public disturbance. If you can accept the feelings of panic and just get on with something else like reading a magazine until they pass, a person would have to look very closely to notice that you were panicking. If you are not convinced, ask a few friends or relatives if they notice when you are feeling panicky. Do not tell them when you are having a panic - ask them later whether they noticed. If your friend can really detect an attack, try practising what you would say to a stranger who asked if you were all right.

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