Did I have a panic attack? What are panic attacks?

First time panic attacks are incredibly scary. They are especially scary because people usually don't know they are experiencing a "panic attack". Panic attacks are commonly misinterpreted as heart attacks, for this reason many first time panic experiences end with a visit to the Emergency Room.Here's a very common first experience with a panic attack:

"I woke up in the middle of the night, it was about 2am. My heart was beating really really fast. I felt like I couldn't get enough air. I sat up in bed and I could hear my heart beating, pounding; it was pulsing in my ear. I finally woke up my partner to tell him something was wrong with me and I didn't know what was happening to me. I was really scared. We both sat up in bed and I described my symptoms- my fast heart rate, difficulty breathing, and chest pressure. And then this fog-like haze started coming over me. I couldn't see straight, it was like misty- hazey- I started blinking to try to see more clearly. I felt almost like I was going to pass out or something. We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got. Finally I jumped up and said, "lets go to the hospital". I was 100% positive: I was either having a heart attack or I was going to have one! We got to the ER around 4am, they hooked me up to all these heart monitors and took my blood. I sat on the table donning a hospital gown, freaking out, waiting for the results. It was humiliating. Finally they came back and told us that all the results were normal. My heart was fine".

The bodily sensations which go along with panic are very real, and misinterpreting these sensations is extremely common. Many people who have a problem with panic, worry that they might be losing their mind and feel frustrated that they cannot just "get a hold" of themselves, or believe they are having a heart attack.

When do people typically have Panic Attacks?

The truth is, sometimes we simply are not cognitively- consciously- aware of how over stimulated and stressed we are. Panic attacks are infamously reported as an experience that seemingly came on "out of the blue". But truly a panic attack is not entirely out of the blue. Panic attacks sometimes occur when a person is experiencing an extreme acute stress (just lost their job, heard they have cancer or learned they're daughter is going to prison). But more often than not, they occur for the first time when a person is under chronic stress for a prolonged period of time with little or no break.Chronic stress includes the big unexpected stressors of life and also the general stress of daily living (relationship, children, financial worries, job stress, lack of exercise and self-care, etc.).

We have an internal stress response system designed to respond to and save us from dangerous situations (for more on the stress response see "The Stress Response"). When we experience fear or anxiety the stress system gets activated. If this stress response system is activated too often for long periods of time, with very little time to recover, the system can actually become more highly sensitized to stress, making panic reactions more likely.

What should I do about Panic Attacks?

The first step is to figure out whether or not you've had a panic attack. Review the list of symptoms below. It's also wise to get a medical evaluation by a physician, just to rule out anything organic (hyperthyroidism for example).

What are the symptoms of a Panic Attack? The DSM-IV TR says, "The essential feature of a Panic Attack is a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by at least 4 of the 13 somatic or cognitive symptoms" 1. palpitations, pounding of the heart or an accelerated heart rate 2. sweating 3. trembling or shaking 4. shortness of breath or sensation of smothering 5. feeling of choking 6. chest pain or discomfort 7. nausea or abdominal stress 8. feeling dizzy, lightheaded, unsteady or faint 9. derealization (feelings of unreality) or depersonalization (being detached from oneself) 10. fear of losing control or feel like you are going crazy 11. fear that you are dying 12. numbness or tingling sensations (paresthesias) 13. chills or hot flashes

Get Help

If you have had a panic attack, talking with a psychologist who understands panic is vital. Untreated panic attacks and chronic mismanaged stress can morph into into panic disorder and sometimes agoraphobia. Panic Disorder is characterized by the "presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack". People who develop panic disorder often begin to avoid situations, people and places where they have had panic attacks in the past.

Please remember that having a panic attack or panic disorder does not make you insane or weak. It just means you're human and you're overstressed. Your body is simply letting you know that you could use some help.

The point of intervention can occur at many places to stop attacks. A pre-emptive strike could mean changing some habits and taking better care of yourself, or looking at some ways to reduce your stress level. Ask for help. Another intervention point occurs at the point in the woman's story where she sat on the bed with her partner talking and worrying about her symptoms: We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got.

Once the fear system (which is mediated by the amygdala) has been activated and we are feeling the bodily sensations associated with panic attacks, we can either keep it going or turn it down with the thoughts that we think. The amygdala is from the oldest - most primitive and unsophisticated part of the brain. However, the higher functioning parts of our brain- those responsible for cognitions have the ability to act upon the amygdala.  In the situation detailed above, the woman did not know she was having a panic attack; she was fully convinced that she was having a heart attack. Her fearful thoughts (I'm going to die", "I'm having a heart attack") about her body's sensations perpetuated the fear response, which serves to perpetuate the fight or flight reaction - increasing the bodily sensations and the panic attack.

The Panic Formula

Panic = Anxiety + the unwillingness to feel anxiety.

Anxiety in and of itself is not the problem. Learning how to mindfully feel anxious feeling states and allow them to pass through is key. "Panic" cannot live where anxiety is faced and released.

If you've experienced panic attacks, have compassion for yourself. Ask for help.

Love and Light,

Dr. Regina