Panic Attack/Panic Disorder – Defined
According to the National Center Biotechnology Information (NCBI) “panic disorder is characterized by recurrent, unexpected panic attack(s).”
Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of intense fear or discomfort reaching a peak within minutes.”
From personal experience, the author has found panic attacks can reach their peak in a matter of seconds.
Panic Attacks vs Panic Disorder – The Short It
Think of panic attacks as sudden intense moments of fear when there is no rational reason to be fearful. Having a Panic Disorder is when you experience recurrent panic attacks.
Symptoms – Understanding Panic Attacks
Symptoms may consist of physical and/or psychological symptoms:
Physical symptoms may include:
- Dizziness
- Muscle Tightness
- Labored Breathing
- Numbness
- Chills
- Sweating
- Trembling
Psychological Symptoms may include:
- Heightened Anxiety
- Irrational fear or a sense of unwarranted danger about a given situation
- Flashes of panic that occur for a short period of time
- Avoidence of places and/or situations that brought on a panic attack in the past
- Thoughts of losing control and/or passing out
- Feeling unable to breathe or breathing too fast
Panic Attack Triggers
The triggers of Panic Attacks are unique to everyone. A key point to remember is that you are in no real danger. The danger you perceive is in your mind. With that said, is it easy to change your mind’s belief system and simply move on? Be panic and anxiety free? Heck no. That’s what makes the world interesting.
The following items can be triggers:
- Nothing – You could be watching tv or talking with a loved one. At a restaurant or in a store. Suddenly, your mind drifts to the ‘panic place’ and you panic. Just thinking about panic brings on an attack.
- Genetics – A link between family members who had mental illness passed down
- Overthinking – Making a situation more harmful than it is
- Low resistance – When you are fighting an illness like a cold, etc.
- Major Stress at the workplace and/or at home
- Taking on too much responsibility
- Situations/Locations where you have had panic attacks in the past
Relationship between Anxiety and Panic Attacks w/ example
Anxiety is often a precursor to panic attacks. The following real-world example puts this into perspective.
Let’s say you get panic attacks at red lights. You are driving and coming up to a red-light. Suddenly, you start feeling something in the pit of your stomach. Then notice your core is starting to tighten up. Then your shoulders. Your level of anxiety is off the charts. You know it’s coming. It’s happened before. You’re at the red light. This is the beginning of your panic attack. The sudden onset of fear. Acute anxiety and fear.
You are stuck between two cars and are trapped. There is no escape. No way out until the light turns green. You’re stuck in a fight or flight situation.
The light-headedness is starting. You know the panic attack is coming on and you have no control. You feel dizzy and then the thoughts of passing out enter your mind. Passing out while trapped at the light. There’s no where to escape as your fight or flight emotions are at 100%. Then bam!
A flash of panic hits you. Struggling to not pass out, your arms are like lead weights. You feel yourself starting to get dizzy and fear passing out. You’re struggling to maintain consciousness. Are these fears valid? From the standpoint they have happened before. Yes. From the standpoint there is real danger that is enveloping you. No.
You glance up occasionally to see if the light has changed. Where is the green light? All your senses are being bombarded with everything around you. Too much input. You can’t process everything. There’s too much. You are trying anything you can to take your mind off the panic. To not pass out.
You struggle to keep your thoughts away from the red light. You keep your mind focused elsewhere. Anywhere. You must have control.
When will the light change? The lightheadedness and dizziness are growing. You are struggling. You focus on the steering wheel. Gripping it tight then releasing. Trying to keep your mind from panic. You’re afraid to look around as your senses take everything in, which just adds to the panic. You cannot process the information overload that has taken over. You continue this until the light changes.
After what seems like hours, the light changes. You feel the panic subside and your mind is focused on the green light. The cars start moving. You’re feeling a heavy weight being lifted. You can now escape. You are moving. You are free. That is until you come to the next red light and the process repeats.
The actual thoughts that you feel overpowering you are waiting to come back another day. Another time. You know there is no need to fear being at a red light. The light will turn green at some point. However, in your mind, on any given day while driving this remains in the back of your mind. The irrational fear waiting to be unleashed.
Fighting the Panic Attack
The following are some ways to defeat/lessen the impact of panic attacks while in a car. We will keep with our example of the red-light.
- Grip the steering wheel tightly and then release your grip, tighten and release, repeat…
- Mammalian Dive Reflex – place a frozen water bottle under your eye whenever an attack is building or has manifested. This will of course require some pre-work before getting in your car. A detailed explanation of the mammalian dive reflex can be found here.
- Hot or sour candies – take one as you’re approaching the stressful situation. This will help take your mind off the panic sensations.
- Gummy worms or other candy – take one as you’re approaching a stressful situation and focus on the chewing, texture and taste. This will help take your mind off the panic sensations.
- Stare at the dashboard focusing your eyes on a point. Glancing up occasionally to see if the light has changed. This can be done in conjunction with steering wheel grip tightening and release
- 333 Rule – According to a healthline.com article written by Jaime R. Herndon, MS, MPH, MFA, the 333 Rule is a grounding technique where you focus on 3 things: “3 objects, 3 sounds and moving 3 body parts.”
- Box breathing – used by US Navy Seals to reduce stress and bring them into focus. Picture a box and the 4 sides. For each side perform the step outlined below.
- Step 1: Breathe in, counting to 4 slowly.
- Step 2: Hold your breath for 4 seconds.
- Step 3: Slowly exhale through your mouth for 4 seconds.
- Step 4: Hold your breath for 4 seconds.
- REPEAT
- Deep Breathing
- Avoiding stimulants such as coffee and nicotine
- Exercise
- Talk therapy
- Tapping
- Meditation
The purpose of these techniques is to take your mind off the panic w/ the exception of stimulant reduction and exercise. They will help with having a clearer mind in general. Talk therapy may help as well.
The best thing you can do is Exposure therapy. It is also the most painful. Your experiences have programmed your panic response to these situations and unlearning this programming takes hard work. Hard, uncomfortable, work. There are no shortcuts. However, by teaching/showing yourself that you can survive and not pass out you are building your confidence. This confidence can be a life changer. It can be a means to kick medications. Only on doctor’s orders. Don’t do this on your own. Bad things happen when you stop taking meds cold turkey.
Potential Impact of Panic in Your Daily Life
- Difficulty at Work
- Relationships may be taxed
- Quality of life
- Socialization with others
- You may not be able to drive
- Stigma of meds, talk therapy and the feeling you are weak for having the attacks
- Avoiding Triggers
How is Panic Disorder diagnosed?
Diagnosis will come via your PCP or mental health professional such as a psychiatrist or psychologist. Tests may be run to rule out other illnesses; such as heart issues, thyroid issues, etc…
Per the Mayo Clinic ‘For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association is utilized.’ The following NBCI table shows the criteria that is involved in diagnosing a panic disorder https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/
Treatment
Below is a list of some of the treatment/coping mechanisms for anxiety and panic attacks:
- Medications…DO NOT SELF MEDICATE…There are many meds that can help with anxiety and panic attacks. For example, Benzodiazepines such as Xanax. On a POSITIVE note, THEY WORK. The downside is THEY ARE ADDICTIVE. Keep in mind that medications just mask an underlying problem. It doesn’t get to the underlying issue. It’s still there and therapy may help.
- Therapy – It’s important to find a therapist that you can work with. Don’t settle for person X if you need person Y’s approach. This can be hard since the metal health providers are in high demand these days. Try not to settle. Both you and your therapist must be on the same page to effectively work through your challenges.
- Yoga
- Physical Exercise
- Relaxation techniques such as hypnosis and meditation
- Stress Management
- Support Groups as well as family and friends you can confide in
- See ‘Fighting the Panic Attack’ for additional treatment/coping mechanisms
Summary
Panic Attacks can have a major impact on your life. Left untreated, you may find yourself withdrawing from society and living an isolated life. You may find yourself avoiding situations/places that you once enjoyed. For example, if you have panic attacks in a classroom setting you will have difficulty taking in information or even going to classes. The fear of panic is just too great.
Another example is if you have panic attacks while on the highway. If this happens, you may find yourself seeking alternate routes to a destination that involve highway avoidance.
The key is to seek help. Don’t try and go through this on your own. Seek the help of a professional. People are there to help you. Whether it be your PCP or someone in the mental health community.
DISCLAIMER: The information provided above is for informational purposes ONLY and should NOT be taken as medical advice.