PANIC ATTACKS
Dee Chadwick
09 May 2021
Having known panic, and attacks of anxiety, I look at how these differ from an actual panic attack. The three, although exhibiting many similar symptoms are different. The majority of us will experience periods of anxiety or panic as normal responses to situations we may be in, or are facing. However, a panic attack can (mostly) seem to come out of nowhere and for no obvious reason.

LET’s BEGIN WITH ANXIETY

Anxiety is featured in several common psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - diagnostic tool published by the American Psychiatric Association. It can gradually build up, as in the approach to a situation that you believe is going to be stressful. People who experience anxiety are at an increased risk of experiencing panic attacks. However, having anxiety does not mean you will experience a panic attack.

Anxiety attacks, as such, are not recognised in the DSM-5, with the symptoms being somewhat open to interpretation from person to person, though they generally include fear, distress and worry.

WHAT IS PANIC?

Wikipedia describes panic as a sudden sensation of fear, which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reaction. Panic may occur singularly in individuals or manifest suddenly in large groups as mass panic’... sadly this often leads to a human stampede with one focus in mind - the search for escape or a physical escape exit. Such events tend to hit world-wide news as did the recent happening at a religious celebration in Israel. One can only imagine the fear, alarm, helplessness at feeling trapped at such happenings; surrounded by others with each person fighting for their own survival with some also endeavouring to protect their nearest and dearest.

On a more personal scale, those same feelings erupt if we cannot find our offspring, or if we are woken by a loud bang. Our body is triggered by that emotional response giving physiological reactions in preparation for dealing with the danger, the threat. When the child is found – for me, it was my young son was hiding in a waterside camp site thinking our frantic shouting of his name was a game. Then there was that sound which, upon investigation was found to be the cat having knocked over a vase. Both were followed with feelings of relief wash over, taking over from the panic...that phew feeling. 

THEN WE HAVE PANIC ATTACKS

They are in fact quite common, with a reported 20,000 a year in the UK. Yes, they are scary when you have an attack; an attack that can last from five to thirty minutes. But they and their symptoms, are not of themselves dangerous. The only time that they can be is if the flight mode doesn’t take note of safety issues such as that much desired escape route being across a busy road.

What of those symptoms? They can include an increased heartbeat rate; chest pain; breathing difficulties; dizziness; shaking or trembling; headache; feelings of terror or dread for no specific reason.

DSM-5 recognizes panic attacks, and categorizes them as either unexpected or expected. Probably worrying, stressing and being anxious about a repeat panic attack when faced with a similar situation can lead to it becoming that old self-fulfilling prophesy. For some, they make every effort to avoid such situations, though this is not always a possibility. As I said, anxiety can lead to a panic attack especially if you focus on those negative feelings. They can also be triggered by phobias such as agoraphobia, claustrophobia; social situations; reminders of past traumatic happenings; chronic illnesses; withdrawal from alcohol or drug addiction. People have also reported being woken by a panic attack.

An article in the Swaddle explains the difference between those panicky feelings and a panic attack, saying that ‘knowing the difference between feeling panicky and having a panic attack can make us better prepared to help ourselves or loved ones through any struggles against overwhelming alarm.’

Though for some there are warning signs of a panic attack, for most that feeling seemingly comes out of nowhere to well and truly bite them on the backside. The flight, fight, freeze response takes over, no matter where we are. For me, my first experience of what I recognised as a panic attack was in my local supermarket. A place with which I am very  familiar. OK, I was struggling with depression and anxiety at the time but the panic attack just zoomed in on me, leading me to simply drop my basket as the dominating thought and feeling was that I had to flee the place, the people, the sights, the sounds as quickly as I could. I had no idea what was going on in my mind, and the frightening physical symptoms of my heart racing, and the tightness in my chest making it seem hard to breathe combined to produce that overwhelming feeling of panic. Luckily, there was no security guy in pursuit assuming that I had stolen something. My handbag was over my shoulder, so my purse and car keys were with me. This was certainly by accident rather than by design. I reached my car and clambered in. I attempted to drop my shoulders, relax my stomach muscles and keep repeating – ‘You are safe’ on a loop for several minutes. The symptoms gradually settled and I put on some relaxing music within the cocoon of my car. I guess I could have made a second attempt at my shopping applying the ‘getting back onto a horse I had just fallen off scenario’. However, on the grounds that I may have been recognised and/or the same thing may happen again, I decided not to. Instead, I carefully drove home when I felt it was safe for me to do so.

As with mine, unexpected panic attacks though they can happen against a backdrop of general anxiety seemingly have no obvious trigger. The expected ones have a trigger, a cue. This may be a phobia or specific stressors. Whilst they may happen to anybody, having more than one can be a sign that there is a panic disorder and professional help should be sought.

There is a very useful series of e-books - CBT4Panic which help with understanding of panic and panic attacks, then move on to offering strategies to help. Based on CBT (Cognitive Behavioural Therapy), they are well worth clicking through to check them out. It is good for anyone who panics or who has had a panic attack to see in black and white that the symptoms are harmless but that you then need to stop focusing on them, no matter how intense they may feel. I quote ‘the answer is simple (not easy). When you lose your fear of panic – it will stop happening.’

When a panic attack happens, the feelings that hit you are very intense and that fear can be overwhelming. I remember the look in a client’s eyes as he described the feeling that swept over him – in a supermarket like myself. He said that he honestly thought that he was going to die and why were the rest of the shoppers just going about their mundane task of shopping? Sadly, most people are so engrossed in themselves and their lives that they don’t give even passing consideration to others. I will never forget tripping over a paving stone in Manchester and ending up on my hands and knees. Passersby did just that and passed me by, one even saying ‘excuse me’ as if I should move out of his way. Obviously he was an important person – in his mind at least. No Samaritans in that little bit of Manchester that day. Maybe they thought I was affected by drink or drugs? Was this their reason for not offering a helping hand? I just knew that I could not have passed by anyone else in a similar situation. Whatever, it made a huge impact on me and made me feel very alone in a city full of people.

PANIC ATTACK or ANXIETY ATTACK?

Healthline.com in their explanation of these being different conditions offers a table of symptoms – both emotional and physical. Whilst there are many parallels, the more extreme symptoms of fear of dying or losing control as well as a feeling of detachment either from yourself or the world around you are present only in panic attacks. Anxiety can range from mild through to severe, and can be with you whilst you are still going about your day with the onset often by way of a gradual build up. This is rarely the case with panic attacks as that flight, fight, freeze response becomes abruptly activated.

HOW TO HELP OURSELVES

As I said, if anxiety and/or panic are adversely affecting your life, professional help should be sought. But there are things that you can do on a self-help basis.

Rather than focusing in on specific symptoms thereby convincing yourself that you are seriously ill with a heart attack or stroke, if not about to die, acknowledge how you feel. Affirm that it is uncomfortable, but that it will pass and that the adrenaline driving those feelings is not going to kill you. Focus on relaxing your shoulders, neck, stomach muscles and spread this throughout your body. This is much easier if you include mindfulness and/or relaxation techniques as a regular part of your routine. So that when needed in times of stress, you can readily apply them. Include these as part of a whole body programme which includes exercise and a healthy eating regime. This is obviously working on the theory that prevention is better than cure and will help fend off so much more than panic attacks!

JUST A REMINDER

Although any specific cause of panic attacks remains unknown, we do know that anxiety and other specific factors, as mentioned, can play a role. They can also be a part of other disorders including OCD, PTSD, Social anxiety - another reason to check with your doctor.

As I said before, I find the e-books CBT4Panic informative and a useful support tool. Do check them out. As they say - ‘the answer is simple (not easy). When you lose your fear of panic – it will stop happening.’Make the reading and use of these a part of  those lifestyle changes and you really will reap the rewards in so many ways. If I can help in any way, please do get in touch via my web site. If not local to me, I do offer support either by phone or by Skype. Also, there are some guided relaxation recordings that can be downloaded to help with relaxation...and everyone benefits from including more relaxation in their life!

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