Have you ever experienced a “panic attack” – a situation when you have physical sensations of fear, without any reason? If yes, read on to know why this happens.
What exactly is a panic attack?
Before understanding why they happen, here is more information about panic attacks and the disorders associated with them. A panic attack refers to a surge of intense fear or discomfort occurring “out of the blue” that peaks within 10 minutes and subsides typically within 20-30 minutes. This state usually lasts for not more than an hour. Some symptoms you might experience during panic attacks include:
- Sweating
- Racing heart
- Fear of dying
- Trembling or shaking
- Numbness or tingling
- Chills or heat sensations
- Chest pain or discomfort
- Feeling light-headed or dizzy
- Breathlessness or smothering
- Nausea or abdominal distress
- Feeling like you are being choked
- Fear of losing control or going crazy
- Depersonalization or derealization (feelings of detachment)
Now, one question you might have would be about the differences between anxiety attacks and panic attacks. The main differences between anxiety and panic attacks are related to their onset, duration and underlying triggers. In case of anxiety attacks, they occur gradually, last longer and are often based on certain cues. However, panic attacks are abrupt, and intense but brief and “uncued”.In addition, they both are often confused with other cardiac, respiratory or neurological issues, due to the nature of their symptoms. This makes their diagnosis difficult.
Read More: What is the Difference Between Panic & Anxiety?
Disorders associated with panic attacks
1. Panic disorder
According to DSM-5, the individual would be diagnosed with panic disorder if they have experienced recurrent, unexpected attacks and have been persistently concerned about having another attack or are worried about facing its consequences at least for a month. In addition, they should have undergone at least four symptoms of panic attacks. Another significant characteristic for diagnosis is if there is a significant and maladaptive change in behaviour related to panic attacks. This behaviour often involves avoidance of exercises, unfamiliar situations or places, due to the fear of experiencing another attack.
2. Agoraphobia
Agoraphobia is associated with panic attacks wherein the person fears experiencing panic attacks in unfamiliar places or situations which would make escaping difficult or embarrassing. There is a marked fear or anxiety about two (or more) situations such as:
- Being in open spaces
- Being in enclosed spaces
- Being outside the home alone
- Using public transport facilities
- Standing in a queue or being in a crowd
Read More: Understanding Psychology Behind Fear and Phobias
Why do panic attacks happen?
The occurrence of this can be explained using the biopsychosocial model of health. As the term suggests, this model or approach explains disorders and health-related conditions by looking at the underlying biological, psychological, and social causes.
Biological causes
Previous studies show the role of locus coeruleus in the occurrence of panic attacks. However, later research has shown that the amygdala strongly impacts panic attacks. The amygdala is a group of nuclei located in the limbic system in front of the hippocampus. The stimulation of the central nucleus of the amygdala is known to stimulate the locus coeruleus and other autonomic, neuroendocrine, and behavioural responses occurring during panic attacks. Besides, the amygdala is also known to be involved in the “fear network”.
Read More: Ergophobia: Understanding the Fear of Work and Its Implications
This network has connections not only with the lower areas of the brain like the locus coeruleus but also with higher areas in the brain like the prefrontal cortex. According to this consideration, panic attacks occur when the fear network is activated, either through cortical inputs or through inputs from lower brain areas. This theory also states that individuals with abnormally sensitive fear networks are more likely to suffer from panic disorder. This consideration supports the symptoms of panic attacks. For example, individuals with panic disorder show startled responses to certain stimuli like loud noises.
This is associated with the potential sensitivity in the fear networks in their brains. Another part of the brain associated with panic disorder is the hippocampus. The hippocampus plays an important role in the learned conditioning of avoidance behaviours. Certain neurotransmitter systems are also influential in panic attacks namely noradrenergic and serotonergic systems. In addition, the anticipatory anxiety associated with panic attacks is impacted by the neurotransmitter Gamma-Aminobutyric Acid, otherwise known as GABA. All these biological fluctuations manifest as a generalized biological vulnerability, which is often inherited through generations.
Read More: Social Fear: Why Do You Feel Anxious with Others
Psychosocial causes
Panic attacks could be learned. Yes, you read that right. The comprehensive learning theory of panic disorder posits that initial internal bodily sensations related to anxiety or arousal (like heart palpitations) become interoceptive conditioned stimuli associated with higher levels of anxiety or arousal. According to this theory, the panic attacks occurring initially become associated with the initially neutral interoceptive and exteroceptive cues through interoceptive or exteroceptive conditioning. For example, if you have experienced a panic attack previously in a classroom, it is more likely that you would experience another attack in a similar setting.
This is an example of exteroceptive conditioning. One example of interoceptive conditioning would be certain bodily sensations resulting from other seemingly harmless activities, such as exercise, that trigger panic attacks. This type of conditioning is supported by the cognitive theory of panic. This theory proposes that individuals with panic disorder are hypersensitive to their bodily sensations and tend to catastrophize these sensations.
Read More: Childhood Fears and, Their Relation to Mental Health Disorders
In other words, someone with a psychological or cognitive vulnerability might interpret the physical responses to an activity such as exercise, as dangerous and feel a surge of anxiety. This anxiety, in turn, leads to the production of more physical sensations because of the action of the sympathetic nervous system. This can exacerbate the symptoms, and cause panic attacks eventually.
How to deal with panic attacks?
Since panic attacks and the associated disorders are explained using a biopsychosocial approach, the treatment also happens using the same approach. It is still recommended to reach out to a certified mental health professional to receive timely support, guidance and help. To deal with the biological side of panic attacks and panic disorder, drugs affecting the noradrenergic, serotonergic, or GABA-benzodiazepine neurotransmitter systems, or some combination is recommended.
Panic control treatment is another intervention for panic disorder. This intervention focuses on exposing patients with panic disorder to the cluster of interoceptive or bodily sensations that remind them of their panic attacks. The therapist attempts to create “mini” panic attacks by having the patients exercise to elevate their heart rates or by trying out any other methods to produce interoceptive cues of panic attacks.
Read More: Cognitive Behavioural Therapy: Concepts, Types & Techniques
A variety of exercises such as relaxation and breath-retraining have been developed for this purpose. In addition to techniques to deal with bodily sensations, patients also receive cognitive therapy, wherein their basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless situations are identified and modified. In conclusion, panic attacks and the associated disorders can be treated using a biopsychosocial approach. However, it is recommended to reach out to a professional to manoeuvre better through your healing journey.
References +
- Barlow, D. H. & Durand, V. M. (2015). Abnormal psychology, 7th ed. Cengage Learning.
- Butcher, J. N., Hooley, J. M. & Mineka, S. (2014). Abnormal psychology, 6th ed. Pearson.
