Panic Disorder: What is Happening?

Do you ever experience an intense wave of fear and panic that washes over you? It appears to come from out of nowhere causing you to feel out of control with overwhelming anxiety and feeling as if you may die. If you’ve experienced more than one of these, you may come to fear it happening again which leads you to limit your life as a way to prepare for the unexpected. You begin to avoid places like the grocery store or driving because “Oh my goodness! I would never want to have that experience when I’m doing that! I think I better stay home! Yes, that feels much better!” But then you fear it happening when you’re alone and it begins to cripple you with anxiety as your life becomes smaller and smaller.

What is Panic Disorder

What you may be experiencing is something known as panic disorder (PD) which is something that is diagnosed by a physician or a mental health professional. Panic disorder comes from a fear of repeated panic attacks that interfere with daily functioning. Panic attacks in and of themselves are not diagnosable as a mental health disorder even though one can feel intense physical and emotional symptoms accompanied by fear. Panic attacks can include a pounding heart, sensations of shortness of breath, shaking, sweating, feelings of choking, chest discomfort, nausea, dizziness, hot/cold sensations, numbness/tingling, feeling as if the world is not real or feeling detached from oneself, feeling as if you are losing control, and fear of dying (APA, 2022). The attack can last anywhere from a few minutes to over an hour in some cases. Although very scary to experience, these attacks are not life-threatening. They may feel like it, but there is no research to support that a panic attack leads directly to death.

Prevalence

In the United States, panic disorder is prevalent in about 2-3% of teens and adults (APA, 2022). Women experience panic disorder twice as often as men and it tends to peak in adulthood with the average age of onset around 35 (APA, 2022). Many report relationship stressors, disease, or a death in the family before the first panic attack. Others may have a trauma history and/or stressful life adversities. Intrusive parenting with low emotional care can also be a risk factor (APA, 2022). And yes, there is an increased genetic risk if your parent struggled with anxiety, depression, and/or bipolar disorder. Smoking is also a risk for panic attacks (APA, 2022).

There is Hope

The good news is that help is available! You can change the way you feel. There are some things that you can be in control of when you fear that your life feels out of control.

When you experience a panic attack, your brain has a misfired cue that sends your brain into a fight-or-flight state – meaning that your brain, for whatever reason, misinterpreted external and/or internal cues of danger. When your brain detects danger, your thinking brain goes offline, and your limbic brain (the fear center) begins driving the bus in an attempt to keep you safe. I know, it certainly doesn’t feel like your body is trying to keep you safe. In a panic attack, your body can feel like the enemy. The truth is your body is doing exactly what it was created to do when it senses danger; but sometimes, your body senses danger when there is none. (You can learn more here.) So, what can you do?

What to Do in a Panic Attack

First, knowing the symptoms listed above, can help you to understand what is happening in your body rather than attributing the physical sensations to something else which can help to lessen the intensity of the panic attack. Remind yourself, “This is a panic attack. It feels awful, but it is not dangerous.” (A great book on the subject is DARE by Barry McDonagh.)

Second, try to do some deep belly breathing to stimulate the vagus nerve and activate the calming part of your nervous system. You can try breathing in through your nose for a count of 4 and exhaling through pursed lips to a count of 8. You can also try “box breathing”, which is breathing in for a count of 4, holding the breath for a count of 4, exhaling for a count of 4, and holding for a count of 4. Repeating the deep breathing for 3 – 5 minutes can be helpful. (Here’s a video of box breathing.) If focusing on your breath makes you feel anxious, try taking in a regular breath, hold it for 2 counts and blow it out of your mouth with pursed lips for a count of 4.

Third, ride the wave (Learn more here). Feelings of panic will subside. No, it doesn’t feel good, but the feelings will go away on their own as long as you don’t keep it going with fearful thoughts. Don’t fight the feelings. Allow them to come and then to go. Whatever you do, do not leave the feared situation as this will reinforce to your brain that it really is something dangerous. When you leave or avoid things, it strengthens the neural network that tells your brain the situation is dangerous when, in fact, it is not.

Fourth, enlist the help of a trusted confidant who can remind you that feelings are not dangerous and who can be there to support you through it. We were not made to do this life alone. We all need the support of others – especially when fear is present. It doesn’t mean that you need someone with you all of the time because a part of being an adult is that we are sometimes alone. However, we do need to be in close relationship with healthy people who can walk through difficult times with us without judging or shaming us. This isn’t everyone in your circle, just one or two close friends with whom you feel safe enough to invite into your story. (You can see here why this is so important.)

Stopping panic attacks, and the anxiety that fills the space in between, is not a quick fix; but with time and repetition of skills, you can begin to take your life back. Therapy, medication, lifestyle changes, and/or a combination of these things can lead to less panic attacks which can lead to you taking more control of your life – one where you can thrive and not just survive.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

U.S. Department of Health and Human Services. (n.d.). Panic disorder: What you need to know. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

Villines, Z. (n.d.). Anxiety attack: Symptoms, causes, and complications. Medical News Today. https://www.medicalnewstoday.com/articles/307863#treatment