What is a Panic Attack?

A panic attack is a general term used to describe a sudden and extreme case of fear in which normally-moderate physical and psychological reactions occur at extreme levels.

This extreme reaction leads to a loss of rationality -- a panic -- which is out of all proportion to the real level of threat that you are experiencing.

It is likely that the majority of people will experience such an attack at some stage in their lives, usually at a time of extreme worry or stress. As many as one in 10 people may experience them occasionally.

Panic attacks can occur suddenly and in some cases without an apparent cause. In reality, they are more likely to occur when someone is experiencing a prolonged period of stress or worry, when they may be hypersensitive to further stress. This means that the event that causes the panic can be extremely minor. Onlookers who don't understand this and indeed the person experiencing the attack, can therefore believe that the victim is being silly or over-dramatic. Blame and shame can be a part of the panic attack syndrome.

In a minority of cases, probably less than four in every 100 people, attacks may occur regularly and without there seeming to be any reason. If this becomes a pattern sustained over a period of several weeks, it may be classified by a doctor or psychiatrist as "panic disorder". This is often associated with an imbalance in brain chemicals (neurotransmitters) although it is not clear whether this is genetic or arises from frequent and sustained bouts of anxiety which then creates a hypersensitivity to stress. In reality, it is probably a mixture of the two. Panic disorder usually responds well to treatment with antidepressants, particularly those that increase the level of serotonin in the brain, suggesting that neurochemical imbalance may indeed be implicated as a cause. Psychotherapy, particularly cognitive behavioural therapy (CBT), can also be extremely helpful and a combination of CBT and medication has been found to be more effective still. If you go through CBT you are also less likely to suffer attacks in the future. Back to top of page

What Happens in a Panic Attack?

A panic attack is a more extreme version of the perfectly normal "fight or flight response". For more details of this see the page “What Happens When I get Anxious?” but in summary this is the adrenaline-based response which prepares our bodies to fight or run away from physical danger.

A panic attack is a general term used to describe a sudden and extreme case of fear in which normally-moderate physical and psychological reactions occur at extreme levels.

When we perceive that there is a threat to our existence our bodies respond by producing the hormone adrenaline. This prepares us to either fight or flee from the danger by triggering a number of physical changes designed to increase our chances of survival.

These physical responses to stress or fear can accumulate to the point where you lose all rationality and enter a panic state.

Reactions in this state are so severe that they are often mistaken for a heart attack, with severe breathlessness, chest pain and even pain in the arms. There can be loss of sensation, dizziness, tingling in the face and visual disturbances producing some loss of vision - all of which only adds to the fear and may extend the duration of the symptoms.

Some people also report feeling as if they are "outside their bodies" or they experience sensations of unreality, adding still further to disorientation and increasing the fear – “am I going mad?!”

Once you have experienced a panic attack you may start to fear having further attacks. This kind of thinking -- so-called “anticipatory anxiety” -- only makes further attacks more likely by increasing your overall level of stress. In short, you start to become anxious about being anxious!

If you experience a panic attack in a particular situation, in a crowd for example, you may falsely associate the panic with that situation, whereas the situation may actually just be incidental. If you start avoiding situations for fear of a panic attack, your world can "shrink". In extreme cases, this can lead to agoraphobia, a fear of the outdoors or open spaces.

Similarly, if you experience a panic attack whilst in bed you can start to avoid sleeping, staying up later and later and achieving less than restful sleep when you do eventually nod off. Again, lack of sleep will make further attacks more likely because you will be less rested and more anxious. If you turn to alcohol, cannabis or prescription/"over the counter" medication to help you sleep this may at first appear to help. But sleep achieved because of alcohol and other drugs, is not proper, restful, sleep. Moreover, over time you will haveto have to increase the quantity of alcohol or drugs you consume and this can lead to problems with dependency, not to mention issues in relationships and with work or learning. Back to top of page

Next Page: How to manage your stress in order to prevent panic attacks