Panic disorder and panic attacks often overlap and can be confused with each other. Experiences commonly described as ‘having a nervous breakdown’ can also be incorrectly labelled as a panic attack or panic disorder. This article will clarify concepts such as panic attacks, panic disorder and agoraphobia.
What is a panic attack?
A panic attack is a state of intense fear, anxiety and distress that starts suddenly, rapidly intensifies and has a beginning and an end. Symptoms often intensify and reach their peak within about 10 minutes, then usually gradually subside.
What symptoms occur during a panic attack?
- Palpitations, sweating, trembling,
- Shortness of breath or a feeling of not getting enough air, a feeling of choking,
- Chest pain or discomfort,
- Nausea, abdominal pain,
- Dizziness, light-headedness, feeling faint,
- A feeling of detachment from your surroundings or yourself,
- Fear of losing control, going mad or dying,
- Numbness, tingling
- Feeling cold, chills, hot flushes, dry mouth
An episode in which 4 or more of these symptoms occur within minutes is called a panic attack.
Are panic attacks and panic disorder the same thing?
Having a panic attack does not mean you have a mental illness. Panic disorder, however, is a mental illness. If you have recurring panic attacks and worry between attacks about having another one, and the attacks significantly affect your life, functioning and lifestyle, this is called panic disorder. Anyone can experience panic attacks in response to certain stressors or on rare occasions during their life. This does not mean that the person has a mental illness.
In other words, panic attacks can happen to anyone.
During panic attacks, people often have thoughts such as ‘I’m going to die’, ‘I’m going to go mad’, ‘I’m losing my mind’ or ‘I’m having a heart attack’. They interpret the physical and psychological symptoms they experience during the attack in catastrophic terms. During an attack, the body interprets a passing thought or a physical symptom as something catastrophic, a sign of danger.
Because the person feels as though they are choking, they begin breathing faster and more deeply to relieve this feeling of air hunger. The belief at that moment that there is danger, and the fear and anxiety this creates, activate the body’s sympathetic nervous system (the system that rapidly activates to protect the body in situations evolution has taught it to recognise as dangerous).
One of the flight-fight-freeze responses is triggered. Blood flow to the skeletal muscles increases. Blood flow to the extremities decreases, the hands and feet become cold, the skin turns pale, and sweating and trembling occur. To counter this stimulating effect of the sympathetic system, the parasympathetic system activates within minutes, working to slow the body down and restore balance.
An attack usually lasts no more than 20-30 minutes and ends on its own.
What not to do during a panic attack
In an attempt to escape this distressing state, people often try to breathe faster and more deeply, further reinforcing this vicious cycle. Although responses such as going to the emergency department, leaving the situation, avoiding places where a panic attack might occur, drinking alcohol or taking sedatives may bring immediate relief, they make panic disorder more persistent in the long term.
Remember that even if nothing is done, a panic attack will naturally end on its own as the body’s mechanisms for restoring its internal balance take effect.
No panic attack lasts forever.
When should you see a psychiatrist?
If panic attacks recur, you experience fear and anxiety about having another attack between episodes (anticipatory anxiety), you avoid certain places or situations because of a phobia of panic attacks, and your daily life and quality of life are affected, you should see a psychiatrist.
What can you do during an attack?
The most appropriate approach is to continue whatever you are doing at that moment. Many actions intended to stop or suppress an attack will maintain the attacks in the long term.
Panic disorder is a treatable illness. With Cognitive Behavioural Therapy and medication, treatment is successful in around 80% of cases. Unfortunately, when medication is used alone, the risk of relapse after stopping it is high. For more lasting treatment, changes in thinking, good psychoeducation and a behavioural approach therefore substantially reduce the risk of relapse.
