Additional Facts on Panic Attacks

Panic attacks:
~ Episodes of intense fear or apprehension of sudden onset.

Panic attacks usually begin abruptly, reach a peak within 10 minutes, and are mainly over within 30 minutes. Panic attacks can be as short as 15 seconds, or can be cyclic, lasting for an extended period, sometimes hours.

The effects of a panic attack vary. Some notably first-time sufferers may call for emergency services. Many who experience a panic attack for the first time, fear they are having a heart attack or a nervous breakdown. Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person’s life.

Sufferers of panic attacks often report:
     • fear or sense of dying
     • “going crazy”
     • experiencing a heart attack
     • “flashing vision”
     • feeling faint or nauseated
     • a numb sensation throughout body
     • heavy breathing (almost always)
     • losing control of themselves

Some suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the sympathetic “fight-or-flight response”) in which the hormone which causes this response is released in significant amounts. This response floods the body with hormones, particularly epinephrine (adrenaline), that aid it in defending against harm.

A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms may include: trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, and derealization.

Often the onset of shortness of breath and chest pain are the predominant symptoms; the sufferer incorrectly appraises this as a sign or symptom of a heart attack. This can result in the person experiencing a panic attack seeking treatment in an emergency room.

Panic attacks are distinguished from other forms of anxiety by their intensity and sudden, episodic nature. They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not usually indicative of a mental disorder.

Triggers And Causes
Long-term, predisposing causes: Heredity. Panic disorder has been found to run in families, and this may mean inheritance plays a strong role in determining who will get it. However, many who have no family history of the disorder develop it. The onset of panic disorder usually occurs in early adulthood, although it may appear at any age. It occurs more frequently in women and often in people with above average intelligence. Various twin studies, where one identical twin has an anxiety disorder, have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis.

Environmental factors, i.e., overly cautious view of the world, expressed by parents and cumulative stress over time have been found to be causes.

Biological Causes
Obsessive compulsive disorder, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson’s disease, mitral valve prolapse, pheochromocytoma, inner ear disturbances (labyrinthitis), Vitamin B deficiency from inadequate diet or caused by periodic depletion due to parasitic infection from tapeworm can be a trigger of anxiety attacks.

Phobias
People often experience panic attacks as a direct result of exposure to a phobic object or situation.

Short-term Triggering Causes
Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change, and as seen below, stimulants such as caffeine or nicotine, can act as triggers.

Maintaining Causes
Avoidance of panic provoking situations or environments, anxious/negative self-talk (“what-if” thinking), mistaken beliefs (“these symptoms are harmful and/or dangerous”), withheld feelings, lack of assertiveness.

Lack Of Assertiveness
A growing body of evidence supports the idea that those who suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also characteristically un-assertive. This un-assertive way of communicating seems to contribute to panic attacks while being frequently present in those that are afflicted with panic attacks.

Medications
Panic attacks may be a listed side effect of medications like Ritalin or fluoroquinolone type antibiotics. These may be a temporary side effect, only occurring when a patient first starts a medication or could continue occurring even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage or type of drug. Nearly the entire SSRI class of antidepressants can cause increased anxiety in the beginning of use. It is not uncommon for inexperienced users to have panic attacks while weaning on or off the medication, especially ones prone to anxiety.

Alcohol, Medications or Drugs
Various substances, both prescribed and unprescribed, can cause panic attacks to develop as part of their withdrawal syndrome or rebound effect. Alcohol withdrawal and benzodiazepine withdrawal are the most well known to cause these effects as a rebound withdrawal symptom of their tranquillizing properties.

Hyperventilation Syndrome
Breathing from the chest may cause over-breathing, exhaling excess carbon dioxide in relation to the amount of oxygen in one’s bloodstream. Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness, which can trigger panic attacks.

Situationally Bound Panic Attacks
Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behavioral predisposition to having panic attacks in certain situations. It is a form of classical conditioning.

Pharmacological Triggers
Certain chemical substances, mainly stimulants, but also certain depressants, can contribute pharmacologically to a constellation of provocations, and thus trigger a panic attack or even a panic disorder, or directly induce one. This includes caffeine, amphetamine, alcohol and many more. Some sufferers of panic attacks also report phobias of specific drugs or chemicals, that thus have a merely psychosomatic effect, thereby functioning as drug-triggers by non-pharmacological means.

The Symptoms
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

     • Clear intense panic
     • Palpitations, or accelerated heart rate
     • Sweating
     • Trembling or shaking
     • Muscle tension
     • Blurry vision
     • Sensations of shortness of breath or smothering
     • Feeling of choking
     • Chest pain or discomfort
     • Nausea or abdominal distress
     • Feeling dizzy, unsteady, light-headed, or faint
     • Derealization (feelings of unreality) or depersonalization (detached)
     • Fear of losing control, going insane
     • Fear of dying
     • Paresthesias (numbness, tingling sensations)
     • Chills or hot flashes
     • Weakness in the knees
     • Confusion
     • Tunnel vision
     • Blank mind
     • Sensing time going by very slowly
     • Feeling the need to escape
     • Feeling warmth inside
     • Head pressure, unlike headache

EDITORIAL NOTE: Please, Do Not self-diagnose; symptoms can fit a wide range of issues. Contact your healthcare practitioner with any concerns or symptoms.

Resources:
Panic attack - Wikipedia, the free encyclopedia, Visit: http://en.wikipedia.org/wiki/Panic_attack .