What is Panic Attack?
It is a type of anxiety disorder where the symptoms of anxiety appear as episodes. According to DSM IV (Diagnostic and statistical manual; an American classification system of diseases 4th version), the panic attack is a state when a person faces a sudden fear of something and discomfort. It reaches its peak only within a few moments of onset. Hence this comes along with a great fear of helplessness.
This may lead to a constant fear of getting the symptoms again. While having a panic attack, the fear overwhelms the patient so much that he finds himself helpless. The overwhelming fear can be about heart attack, breathlessness or choking, losing control, or death.
The episode has a lifespan of a minimum of 10 minutes to hours. But it has lasting effects of getting it again or feeling the fear of getting it again. This fear of symptoms doesn’t let the person relax even after the episode. Moreover, he also remains preoccupied of having another attack.
Below is overview in video from psychiatric doctor in Lahore
Core psychological sign of Anxiety Attack
As described above key feature of a panic attack is an overwhelming fear that can be related to heart attack, choking or breathlessness, and death. As a result patient frequent monitors his bodily symptoms. Checking the pulse repeatedly or frequently investigating for blood cholesterol levels are common behaviors.
Panic Attack Causes Affects Six Major Physical Areas
- Cardiovascular; Increased heart rate and chest pain
Symptoms related to the cardiovascular system are frequent in a panic disorder. These are increased heart rate, chest pain, pain in the left arm. Some patients describe as racing or pounding heart. When the patients go to the cardiac evaluation, no abnormality is found related to his cardiac status.
- Respiratory system; breathlessness, choking, lump in throat
During a panic attack, the respiratory system is also involved. Patients may feel difficulty in breathing, choking of respiration, chest pain or chest compression. When they go for medical evaluation, no abnormality appears in the respiratory system. The patient puts extra effort to breathe with the fear that his breathing will stop. This results in hyperventilation.
- GIT Disturbances
Symptoms of gastrointestinal tract include abdominal pain, bloating (feeling of gas in the abdomen), diarrhea, pain in epigastrium, pain in the right lower abdomen (area for appendicular pain).
- Symptoms of Autonomic Nervous System
These include tremors of hand and feel, cold extremities, excessive sweating especially on palm and sole. A patient may experience fluctuations in blood pressure. Most of these panic attack symptoms are temporary and usually disappear after this episode.
- Panic Attack and Central Nervous System
Dizziness and feelings of fainting are commonly anxiety attack symptoms. In addition, a patient may experience unsteadiness, loss of control. Depersonalization and De-realization can also appear in a panic attack.
- Genitourinary System
Frequent micturition, burning sensation during micturition is also common in a panic attack and other anxiety attack.
Two Major Problems of Panic attack
Role of Vicious Circle
A key maintaining factor for a panic attack is, some symptoms trigger other symptoms and these trigger previous symptoms. For example fear causes the heart to beat faster and this fastened heart results in increased fear of heart attack. This increased fear further enhances heart rate and so on
Role of Hyperventilation
When the patient breaths excessively during a panic attack, it results in increased oxygen intake into the body and more carbon dioxide released from the body. This causes changes in acid-base balance in blood temporarily.
The patient starts experiencing symptoms of hyperventilation such as dizziness, numbness, and discomfort in chest, faintness, and difficulty in breathing. These symptoms further increase the fear that breathing will stop, he puts more effort to breathe and more symptoms of hyperventilation will appear and so on.
Why it is easy to cope with physical symptoms of panic attack?
- Wide range of physical symptoms doesn’t mean a wide range of physical disorders As mentioned above there is a huge number of physical symptoms that can appear in a panic attack. But these symptoms are not caused by organic pathology in those organs. For example when a patient with pain in chest and palpitation go for medical evaluation, usually no cardiac abnormality is found. The same is for other organs and symptoms.
- Physical Symptoms are Reversible and other important thing to remember is that anxiety physical symptoms are not life-threatening. Usually, there is no risk if anxiety symptoms appear. They disappear when a panic attack or anxiety treatment is treated properly.
Seven mistakes people do in panic attack
Safety Seeking Behaviors in Panic Attack
These are behaviors that a patient adopts either to avoid the supposed catastrophic outcome of a panic attack. Patients may adopt these behaviors just for reassurance that they are not having any medical illness. All these behaviors maintain the illness for a longer period and they should be avoided. These are listed below.
- Checking for pulse and blood pressure frequently
- During a panic attack, some patients hold their chest or something nearby firmly so that they can prevent heart attack or choke
- Keeping water always with them with the fear that their mouth will dry
- Trying not to be alone with the fear that a panic attack will occur and someone should be there to help him
- Praying a whole day to prevent the panic attack
- Frequently consulting physicians and frequently going for investigations especially ECG, these patients ask physicians repeatedly to assure them that they are not having any cardiac issue. The effect of reassurance by a physician is only short-lived. After some time they again need reassurance.
- Strict dietary control of body fat and cholesterol even if it is not required.
Causes of panic attack explained in five steps
The exact panic attack cause is yet to be found, but genetics might play a role in panic disorder. It’s not defined yet how much genetics or environment plays a role in it. It has been observed that panic attack and other anxiety disorder are more prevalent in monozygotic twins than in dizygotic twins. In addition, prevalence is also high among family members than in general populations.
- Brain Changes
Some say the part of the brain dealing with stress and fear emotions; the amygdala may be more sensitive than usual. Other brain areas that are involved are the hippocampus, hypothalamus, anterior cingulate gyrus. The abnormal activity of neurotransmitters such as norepinephrine plays a vital role in panic attacks. Decreased functioning of GABA neurotransmitter receptors in the brain is also observed in patients with a panic attack by fMRI studies and PET scans.
- Learned Experiences
These causes of anxiety attacks may be caused by learned experiences. For example, if someone experienced a sudden death of a close relative due to a heart attack, he may develop the fear that he will also die due to a heart attack.
- Cognitive theory and Coping Styles
The research has found that patients who developed panic attacks in the future had certain thinking and coping styles. They used to be overly preoccupied with physical and mental health even before the development of panic attacks.
- Drugs of Abuse
Drugs of abuse can also trigger a panic attack. Common culprit drugs are alcohol, cannabis, Ecstasy, cocaine, and amphetamine.
Mechanism of Developing Physical Symptoms in Panic attack
There is complex interplay among our thought process, mood states, and bodily symptoms. For example, if a person is ill, he will not be happy. Similarly, a person suffering from depression may have poor control of his diabetes and hypertension. In the case of a panic attack, fear and overwhelming are the main factors behind these bodily symptoms.
Fear activates the stress hormones and catecholamine such as norepinephrine and epinephrine. These chemicals increase the heart rate and blood pressure. These chemicals along with serotonin and acetylcholine have their maximum concentration in GIT. Here they produce symptoms of the GIT tract. These symptoms are reversible there is a permanent change in body organ function due to a panic attack.
Can CBT really help in Panic Attack?
As with anxiety disorder treatment of panic attack include self-help techniques, psychotherapies, and medications. For mild cases only self-help techniques are sufficient. For more severe cases, the requirement is for both psychotherapy and medicine.
Cognitive Behavioral Therapy in Panic Attack
A panic attack usually underlying problems in thinking pattern and maladaptive behaviors. Maladaptive behaviors are safety-seeking behaviors. The patients use these behaviors so that they can neutralize the supposed threat, say heart attack. Problems in thinking patterns are there are minor bodily symptoms. The patients unduly attribute them to the worst outcome.
For example, the increased heart will lead to heart attack; dizziness means he is going to be unconscious; if he doesn’t hold his chest tight he will not be able to breathe. The key concept of cognitive-behavioral therapy to address these sorts of issues.
Different techniques are available to change these negative thoughts. Just saying the patient that you are not thinking in the right way is not helpful. Among various techniques, one technique is a behavioral experiment. For further details see Cognitive Behavioral Therapy. We will discuss the behavioral experiment here.
This is a technique of CBT mostly used in a panic attack. The patient performs a maneuver, and the results of this maneuver are likely to change the negative thoughts of a person.
- The problem; if I don’t hold my chest tightly I will suffer from a heart attack
- Task; during panic attack don’t hold your chest
- Result; Panic attack did occur, I didn’t hold my chest, I felt discomfort in my chest, but no heart attack occurred
Results; holding your chest has nothing to do with a heart attack
When Drug treatment is required in Panic Attack?
Drugs are recommended only if anxiety disorder symptoms are severe and if psychotherapy is not working. First-line drugs for are SSRIs. These include Escitalopram, Paroxetine, Sertraline, etc. See Antidepressants. Usually, single medicine is started at a low dose and gradually dose is increased until the response is achieved. It takes two to three weeks to achieve effects. This duration during which the effect of SSRIs will start can be covered by a short course of benzodiazepines.
Self-help in Panic Attack; Try these tips before it is too late
These are breathing retraining and progressive muscle relaxation. When we are calm and comfortable we breathe via the diaphragm. We call this abdominal breathing. When we do exercise or when we are anxious and stressed we start using accessory muscles for breathing. This is thoracic breathing. Breathing retraining technique focuses on to practice abdominal breathing even during the phase of anxiety.
When we stretch our muscles for some time, there will be a phase of relaxation afterward. In progressive muscle relaxation technique muscle groups of the body from head to toe are stretched and then relaxed one by one. For details see Breathing Retraining and Progressive Muscle Relaxation.
Avoid Safety Seeking Behaviors
As discussed above that these behaviors prolong the illness. It is better to stay away from them. The first task is to assess which safety-seeking behavior the patient is using such as checking pulse repeatedly or holding his chest tightly. The patients are to discourage these behaviors. There is a need to stop these repeated investigations. The patients should go for investigations only if the physician advises them.
An important tip
When panic Attack does appear don’t rush for help. But stay there and wait. Symptoms will fade eventually. During a panic attack, the patient tries best to control it by doing different sorts of activities. The best way is to try not to control it rather let the panic attack happen. There will be no harm by panic disorder symptoms. Our efforts to control panic attacks will ultimately prolong the illness.
There are a few things that can increase the chances of a panic attack. These are stimulants, energy drinks, and caffeine. On the other hand, some patients go for strict dietary restrictions to reduce their body fat and cholesterol. Avoid these types of dietary restrictions and take regular meals.
Healthy Life Style
Among a large number of healthy life things, these three core components.
(A) Daily exercise,
(B) Regular meals
(C) Take regular sleep
Some people who used to do exercise regularly stop doing it when the illness starts. This is because when they do exercise, it results in increased heart rate and they fear that it may result in any cardiac issue.
Truth is that this increased heart rate during exercise is a physiological thing as a body needs more blood during exercise. The people who do regular exercise are less likely to have heart disease. This is also evidence that heart rate is not a sign of a heart attack.
Avoid Drugs of Abuse
Drugs of abuse such as alcohol, cannabis, ecstasy, or amphetamine can precipitate a panic attack. So, patients having panic attack should avoid these drugs. Many patients abuse benzodiazepines without medical advice. Ultimately they can be dependent upon benzodiazepines. Use the benzodiazepines with proper consultation.
Keeping in the view of above discussion timely Anxiety attacks treatment can improve the quality of life. When someone feels the anxiety signs should consult to the best psychiatric doctors.
Author: Dr Farast Ali
CEO Psychiatry Clinic