Why do I have Panic Attacks?

Causes of Panic Attacks and How to Deal with them

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Panic attacks are sudden episodes of extreme fear. Many people experience them at least once. Here’s what you should know about panic attacks and their causes.

Sophia is a nurse in the ICU ward tending to critically ill patients infected with COVID19. The long hours, stress, lack of resources and help has been weighing heavily on her physically and emotionally, but it’s her job and moral obligation to tend to those in need, especially during a pandemic. Sophia isn’t a stranger to long hours and hard work, but the added challenges of the pandemic have been making things more difficult to cope.

One morning, as Sophia was getting ready for work, she suddenly felt her heart dancing in her chest. She started breaking out in a cold sweat, and she felt it hard to breath. She began to feel dizzy and nauseous, and then her vision started to fade as though it was “whiting out” like a camera lens. Her husband saw her struggling with her keys, and he called 911 after leading her to a chair to sit down. After a few minutes the symptoms subsided.

The doctor couldn’t find anything physically wrong with Sophia, and concluded that she experienced a panic attack, possibly due to the built-up stress she was holding in. The added stress of the pandemic pushed Sophia’s nervous system to overreact causing a panic attack. Turns out this was the first of many panic attacks Sophia would experience in her lifetime, and she’s not alone.

Panic attacks are a common mental health issue. Many people experience them at least once in their life. However, for some people, the problem can repeat and turn into a panic disorder. Here’s what you should know about panic attacks and their causes.

What Are Panic Attacks?

Panic attacks are sudden episodes of extreme fear. They appear as an array of physical and emotional reactions that don’t have a clear cause, although they are often triggered by mental conditions or stressful and traumatic events. The symptoms of a panic attack can vary from mild to severe, and they are different for everyone. Mild attacks usually don’t require a hospital visit, as the person can cope with the symptoms alone or with the help of a loved one.

There are cases where people experience severe panic attacks and end up in a hospital. This might be because the panic attack happens for the first time. Although these attacks are in no way life-threatening, the person experiencing them may feel that they are. People often think they’re going crazy or having a heart attack. These attacks are involuntary and you can suddenly just get them without any warning whatsoever. This can lead to feelings of shame or discomfort for the person experiencing it.

A lot of people experience a panic attack at least once in their lives. On average, it lasts for about 5-20 minutes. The majority of people who experience an attack will not have another panic attack in their life; but some people will experience these episodes more than once.

Panic attacks are a significant health concern to many people. They are scary and, for many, have led to the development of other mental health issues such as anxiety or depression.

Panic Attack Symptoms

The symptoms of panic attacks start abruptly. They begin without warning and can happen at any time of the day, no matter where you are and what you’re doing. You will, however, be more prone to a panic attack if you’re under a lot of stress as in Sophia’s case.

A panic attack usually starts with mild symptoms and usually worsens within minutes. They stay at their peak for as long as the panic attack lasts. Additionally, you may feel tired or fatigued once the panic attack stops.

The symptoms of panic attacks can be both mental and physical, often appearing together. That happens because physical symptoms worsen mental ones and vice versa. A racing heartbeat will cause fear, which will, in turn, lead to trembling, causing more anxiety, and so on.

Here are the most common symptoms of panic attacks:

Physical Symptoms

Although symptoms of a panic attack are different for everyone, there are common physical symptoms that are seen.

A panic attack usually starts with a racing heartbeat and shallow breathing.

Other symptoms include:

  • sweating
  • chills or hot flashes.
  • chest pain
  • dizziness and feeling lightheaded
  • limb numbness or tingling sensations in your arms and legs
  • ringing in your ears, inability to hear clearly
  • stomach problems, such as nausea or diarrhea
  • a choking feeling, where you may not be able to breathe in fully

Emotional Symptoms

Emotional symptoms usually happen in response to physical ones. Most people experience intense fear before a panic attack, followed by fears associated with their physical symptoms such as fear of a serious illness, fear of going insane, or even fear of death.

Panic attacks are quite terrifying. People who experience them once fear that they will happen again, which often leads them to experience and develop other mental health disorders such as phobias including general anxiety disorder, social anxiety and agoraphobia.

What Causes Panic Attacks?

The physical symptoms of a panic attack are due to the human body’s nervous system, specifically the sympathetic nervous system. This is the body’s “fight or flight” system that’s meant to protect us from emergency situations. It’s helpful when you’re trying to run from a charging grizzly bear, but not so helpful when your perceived threat is an unreasonable boss you see every day. The human body can only sustain the stress response from these “emergencies” for a short time; however, most of us are in this constant mode of stress, making us susceptible to common mental health disorders such as anxiety and panic attacks.

When the body’s sympathetic nervous system turns on, the hormone adrenaline increases in your blood, causing you to be on high alert, and increasing your heart rate and blood flow to your muscles in preparation for “fight or flight”. You start to breath faster and shallower to take in more oxygen, your blood sugar spikes for energy, and your senses become sharper. This same physiological response, starting with the spike in adrenaline, has been associated with panic attack symptoms.

A unique study found surprising results that may actually predict when a panic attack may occur. This study found significant physiological instability one hour before someone experienced an attack, usually with the person who experienced the attack unaware of the preliminary effects, making it appear as though it happened without warning. The physiological points measured were respiration, cardiac activity, and sweating. This study may lead to future understanding and therapies for this difficult disorder.

Although there is no clear cause of panic attacks, both physical and psychological factors have been shown to play a role. Let’s take a look at how genetics, stress, and medical issues aid in panic disorder development:

The Genetics of a Panic Attack

Studies done on twins suggest that genetics are a major factor in panic attack development. If you have a panic disorder, someone in your family has likely also had a panic attack at least once in their life. Still, panic disorder is not a single gene disorder. Multiple genes and environmental factors aid in the development of a panic disorder.

How Stress Influences a Panic Attack

The first panic attack often comes after a lengthy period of stress. As we saw with Sophia, severe stress, such as from work, a  job loss, a death in the family, or a major life change can trigger anxiety leading to an attack. Small stressors can also build up in the body over time, leading to mental problems, such as anxiety and panic attacks.

Medical Conditions and Medications That Can Cause a Panic Attack

Several medical conditions produce panic-like symptoms that can eventually produce an attack. This includes conditions that suggest neurotransmitter imbalances such as depression, anxiety, and other psychological conditions. Some physiological conditions include:

  • Severe chest pain (Angina pectoris). 
  • Arrhythmia or tachycardia
  • Coronary artery disease
  • Heart failure
  • Pulmonary embolism
  • Stroke
  • Hypertension
  • Asthma
  • Hyperthyroidism
  • Low Blood Sugar (Hypoglycemia)
  • Premenstrual syndrome
  • Anemia

Similarly, certain medications and stimulants such as coffee or energy drinks can increase anxiety, and in turn aid in panic attack development. Specifically, withdrawal from medication such as antianxiety medication, or benzodiazepines, can lead to anxiety. A similar situation can happen after a night of binge drinking or as a result of insomnia.

The Prevalence of Panic Attacks

Panic attacks affect around 2-3% of Americans, with the first attack usually happening in early adulthood. Similar to many other anxiety disorders, statistics from 2001 – 2003 have shown that panic attacks are more common in women, and among adults about 44% reporting severe impairment from the attacks, and 25-30% mild to moderate symptoms. Statistics from 2020 reported higher cases of anxiety, up to 62% among adults in the United States, with 6 million Americans diagnosed with a panic disorder. Overall, statistics and our own everyday experience show that stress and anxiety are on the rise, putting more people at higher risk for experiencing a panic attack at some point in their lives.

What to do when you have a Panic Attack

Once you have experienced a panic attack, you are in a better position to know and recognize when it’s about to happen. The best ways to stop a panic attack from developing and intensifying is to:

  • Recognize the signs- the sooner you recognize you’re having an attack, the better position you’ll be to tackle it. Understand that it’s temporary and it will pass to minimize any accompanying fears.
  • Practice deep breathing – Hyperventilating can increase fear and intensify the attack. By practicing deep breathing you gain control of your breaths and decrease the chances of other physical symptoms happening or worsening.
  • Be mindful – practice mindfulness and/or focus on an object. This will help shift your focus away from the fears that are feeding the attack.
  • Close your eyes – If you find that focusing on an object is too difficult, close your eyes to slow and block out any stimuli that can feed any racing thoughts or emotions that may intensify the attack.
  • Relax your muscles- this should be practiced regularly before an attack and during an attack. Tense one muscle at a time, then relax it. This promotes overall body relaxation.

If someone you know is experiencing a panic attack, the best course of action is to stay with the person until he or she rides out the attack. Stay calm, be encouraging and positive, and help them breathe by counting or breathing with them. Remind them that this is a temporary event, be patient, and offer them support for recovery.

Conclusion

If you’ve ever had a panic attack, you know how scary it can feel. You may fear it will happen again or that the symptoms will be too much for you to handle. However, there are treatment options, both natural and prescription, that can help you manage the causes of the attacks. Stress, anxiety, and panic attacks can be successfully managed, and you don’t have to deal with them on your own. It’s important to find a health and wellness professional you trust, and continue working with them until you discover the causes, triggers, and most effective solutions for your panic attacks.