What Are Panic Attacks?
Navigating the Storm:
Understanding and Managing Panic Attacks
What are panic attacks?
Your heart pounds, you can't breathe, and you might even feel like you're dying. What’s going on?
Panic attacks are intense episodes of overwhelming fear or discomfort that can strike suddenly, often without warning. They often have both mental and physical symptoms. Typically, something is considered a panic attack (rather than a period of intense worry or fear) if it involves four or more specific symptoms (see below).
People of all ages and all racial, ethnic and socioeconomic backgrounds experience panic attacks, and the exact symptoms can vary depending on each person. They are a recognized mental health condition that reflects the complex interplay between psychological and physiological factors. Even beyond the immediate symptoms, panic attacks can tangibly impact a person's quality of life – affecting their ability to study, work, and engage in social activities. Understanding panic attacks as a genuine health issue is crucial, not only for those experiencing them but also for their peers, families, and educators. This recognition is the first step toward addressing the stigma that often surrounds mental health challenges, especially in environments like college where the pressure to perform and excel is high.
Panic attacks are especially common in college, where students face a unique daily blend of academic pressures, social challenges, and personal or family stressors. Episodes may be triggered by any combination of stress about grades, future career prospects, relationship issues, or significant life changes. Understanding that these triggers are common in the college experience is crucial in addressing and managing them. It's a reminder that panic attacks are not a sign of personal weakness or a failure to handle stress but a real and often unpredictable part of life.
What are some of the symptoms of panic attacks?
Fear of dying or losing control
Derealization or depersonalization (think: feeling detached from your surroundings)
Heart pounding, racing, or skipping a beat
Excessive sweating
Trembling or shaking
Feeling short of breath
Feelings of choking
Chest pain or discomfort
Nausea or stomach pains
Feeling dizzy, unsteady, lightheaded, or faint
Chills or feeling overheated
Numbness or tingling sensations
What Causes Panic Attacks?
Panic attacks are caused by a mix of factors that can make your body react as if it is in a life-threatening situation, even when there's no immediate danger. They can be traced back to our sympathetic nervous system (the body's natural alarm relay) becoming overly sensitive or misfiring. This results in an acute imbalance in the brain's neurotransmitters, such as serotonin and norepinephrine (which regulate mood and help the body respond to stress), leading to an exaggerated “fight-or-flight” response. Environmental factors, such as ongoing stress from work, school, or personal relationships, as well as significant life changes or traumatic events, can also trigger these attacks. Essentially, panic attacks can occur when our body's natural stress response goes into overdrive, influenced by our biology, life experiences, and current stress levels.
What’s the difference between panic attacks and panic disorder?
Panic disorder develops when someone experiences repeated panic attacks and lives in constant fear of having another attack. This fear can be so pervasive that it interferes with daily activities and leads to changes in behavior aimed at avoiding future attacks. Essentially, while a panic attack refers to a single episode, panic disorder is a chronic condition where the fear of future panic attacks leads to significant distress or impairment in daily functioning.
What’s the difference between panic attacks and anxiety?
Panic attacks are intense and acute bursts of fear or discomfort, often peaking within minutes. In contrast, anxiety is more chronic, characterized by persistent worry or tension, often about future events or the unknown. It’s important to note that panic attacks can often co-occur with anxiety or other mental health challenges. For instance, someone with major depressive disorder (MDD) may also experience panic attacks, though not everyone with MDD will have panic attacks.
Are there treatments for panic attacks or panic disorderS?
There are effective treatments for panic attacks, focusing on reducing their frequency and severity, and improving overall quality of life. Treatment usually involves some form of talk therapy (such as Cognitive Behavioral Therapy) which helps individuals understand the triggers of their panic attacks, change unhelpful thought patterns, and develop coping strategies to manage symptoms. In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed. These medications work by balancing the brain's chemical messengers (e.g., serotonin and norepinephrine) that influence mood and stress responses.
Lifestyle modifications and self-care practices, including regular exercise, adequate sleep, and stress management techniques like deep breathing exercises and mindfulness, can also play a significant role in managing panic attacks. For some individuals, combining therapy with medication and lifestyle changes offers the best outcome. It's important to talk with a healthcare provider to tailor a treatment plan that's right for you. Remember, panic attacks are a common and treatable condition, and seeking help is the first step towards recovery!
Here’s what people who live with panic attacks want you to know:
“What works for each person for support is different. Ask them how to best support them!”
- Trisha T. (Georgia Tech)
“[Sometimes] there isn’t a traceable trigger, which can make it really hard to prevent or recover from.”
- Marky K. (University of Virginia)
“I wouldn’t wish a panic attack upon my worst enemy. When I am in the throes of a panic attack, I feel like I have no control over the situation and can’t seem to pull myself out of it. I feel like the world is closing in on me and like I can’t breathe. My heart rate is always beating fast, I’m shaking, and often, crying. In those moments, it can feel like I’m going to feel like that forever. Despite this, I’m here to tell you that it does get better and your weaknesses don’t define you.”
- Prarthna B. (Wake Forest)
“The stigma against mental health is still very present in our modern world. I feel like a lot of people look at mental illness as something silly and small. I have found with two of my closest friends that by breaking down that wall, no matter how scary it may feel, a huge weight is lifted from your shoulders.”
- Kelly K. (Villanova University)
Coping skills for panic attacks (in the moment):
Controlled Breathing: Practice the 4-7-8 technique. This helps prevent hyperventilation and calms your nervous system by activating the parasympathetic response, which counters the panic-induced fight-or-flight response.
Progressive Muscle Relaxation: This technique reduces physical tension, a common symptom of panic attacks. By tensing and relaxing muscle groups, you can shift your attention away from panic symptoms and encourage bodily relaxation, which is reciprocally linked to mental relaxation.
Mindfulness Meditation: This practice helps ground you in the present moment, letting the overwhelming flood of thoughts and worries pass. It trains your mind to settle simply on the now, which can be particularly helpful in ameliorating the anticipatory anxiety that often accompanies panic attacks.
Grounding Techniques: Engaging your senses brings your focus back to the present, which is especially useful if you’re experiencing derealization or depersonalization during a panic attack. This technique helps in breaking the cycle of escalating panic by anchoring your mind in the current tangible environment.
Health habits to reduce panic attacks:
Structured Exercise Routine: Schedule short, regular exercise sessions between classes or study periods. Even a 10-minute walk can help.
Balanced Diet with Scheduled Meals: Plan your meals to include a variety of nutrients. Avoid skipping meals, which can exacerbate anxiety symptoms. Incorporate foods rich in omega-3 fatty acids, magnesium, and vitamin B, which have shown potential to help manage anxiety.
Sleep Hygiene: Create a bedtime routine. Limit screen time before bed, and try to go to sleep and wake up at the same time every day. Consider using apps that track sleep patterns to help you understand and improve your sleep quality.
Mindfulness Practice: Allocate a few minutes each day for mindfulness or meditation. Many universities offer free classes or resources. Consistent practice, even for short periods, can significantly reduce symptoms of anxiety and panic.
Where to go for help Panic Attacks:
Your primary care physician (these are typically doctors specializing in Family Medicine or Internal Medicine)
A psychiatrist (a doctor specializing in Psychiatry)
A psychologist (a mental health provider with a PhD os PsyD degree), therapist, or counselor (note that these providers cannot prescribe medications but can provide valuable interventions such as therapy)
When should I go to the doctor?
If you experience recurrent panic attacks, especially if they seem to occur without a clear trigger, causing you to live in fear of the next attack, disrupting your daily life or leading you to avoid certain places or situations.
If your panic attacks are accompanied by symptoms that you've never experienced before, such as chest pain, difficulty breathing, or a feeling of detachment from reality, to rule out any other underlying medical conditions.
If the fear of having another panic attack is persistent and is affecting your ability to work, maintain relationships, or take part in social activities.
Immediate medical attention is crucial if you have thoughts of harming yourself or others. Please contact your healthcare provider, dial a crisis hotline, or visit the nearest emergency room if you're in crisis.
How to help a friend having panic attacks:
Identify the Panic Attack: Gently ask if they're experiencing a panic attack or if they need help. This can be as simple as, "Are you okay?" or "It seems like you might be having a panic attack, do you need help?" This approach opens the door for them to share their needs while respecting their space.
Provide Reassurance: Let them know they're not alone and that you're there to support them. Use calming, affirming statements like, "You're safe with me," or "This will pass, and I'm here for you." Avoid minimizing their feelings by steering clear of phrases like "Just relax" or "There's nothing to worry about," which may feel dismissive.
Encourage Grounding Techniques: Help them focus on their surroundings and bring their attention to the present. This can be achieved through grounding exercises, such as the 5-4-3-2-1 method, where they identify five things they can see, four they can touch, three they can hear, two they can smell, and one they can taste. Such techniques can distract from the panic and help regulate their breathing.
Guide Them in Deep Breathing: Deep breathing can significantly reduce the symptoms of a panic attack by slowing down the heart rate and promoting relaxation. Encourage slow, deep breaths, perhaps through a breathing exercise like box breathing—inhaling for four seconds, holding for four seconds, exhaling for four seconds, and holding again for four seconds. If they're struggling, breathe with them slowly to set a pace they can match.
Offer Physical Support (With Consent): Ask if they're comfortable with physical contact, such as a hand on their back or holding hands. Physical support can be incredibly grounding, but it's essential to respect their boundaries and only proceed if they express consent.
Stay With Them: Remain calm and present until the panic attack subsides. Your steady presence can be a powerful source of comfort and reassurance.
Encourage Professional Support: If panic attacks are frequent, suggest seeking professional help from a healthcare provider or therapist. Offer to assist with finding resources or making appointments if they're open to it.
By following these steps, you can provide meaningful support to someone experiencing a panic attack, helping them navigate through the intense moment with compassion and understanding.
Life can be challenging, and students experiencing panic attacks is much more common than you might think. Remember, you’re not alone in this journey. There’s strength in seeking support, and there’s always someone ready to listen and help.
Where can I learn more?
Wondermind, How to Deal If Panic Attacks Are Ruining Your Life
Wondermind, 12 People Break Down Exactly What a Panic Attack Feels Like
American Psychological Association, Panic Disorder: Answers to your most important questions
Anxiety & Depression Association of America, Panic Disorder Resources
Disclaimer: The information above is intended to provide education regarding panic attacks and panic disorder. It is not medical advice and should not be used for medical diagnosis. For questions regarding diagnosis, treatment, and more regarding any mental health conditions, contact a mental health professional.
Published: April 21, 2024.
Written by: Matthew Kang (Medical Student), Edited by: Alexandra Lawlor (Medical Student).
References:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/appi.books.9780890425596
Mayo Foundation for Medical Education and Research. (2018, May 4). Panic attacks and panic disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021
Nall, R. (2019, November 1). Panic attack | definition & patient education. Healthline. https://www.healthline.com/health/panic-attack#What-are-the-symptoms-of-a-panic-attack?
Oerman, A. (2024, January 12). 10 ways to help someone having a panic attack. Wondermind. https://www.wondermind.com/article/how-to-help-someone-having-a-panic-attack/
