What are panic attacks?
A panic attack is a sudden and overwhelming feeling of fear or anxiety which is often associated with physical symptoms such as shaking, nausea, feeling short of breath and a fast heart rate. The phrase ‘panic disorder’ is used to describe people who regularly suffer from panic attacks.
These panic attacks are very scary for the affected person, and can have a huge impact on daily life, even though they do not generally cause any damage to your health.
Anyone can be affected by panic attacks, although women seem to be more likely to suffer from them than men. Around 0.64% of the Iraqi population reports suffering from panic attacks which works out at around 250,000 people, meaning that this is a common problem amongst Iraqis.2
What are the different types of panic attacks?
Any sort of panic attack can be frightening and disruptive to daily life, but they can be categorised differently depending on their key features.
In general, panic attacks are split into two types: expected and unexpected. They can also be a symptom of another mental health problem, such as dissociative disorders or PTSD (post-traumatic stress disorder).
If they last for a long time, panic attacks may be referred to as being “chronic”, even though the symptoms remain the same.
An expected panic attack is one which happens during or after a specific experience or situation. For example, someone with a phobia of spiders may have a panic attack if they see a spider.
These sorts of panic attacks are also called situational panic attacks and can be triggered by anything that someone may have a fear of. They tend to be predictable and only occur in connection to events that involve the feared object or thing.
An unexpected panic attack is just that - it happens without any warning or obvious trigger. They can occur at any time, and tend not to be associated with feelings of anxiety or fear leading up to them. This can make unexpected panic attacks extremely stressful and frightening, as you never know when they may happen.
Dissociative means to feel disconnected from yourself and your surroundings. Panic attacks can be a symptom of a specific dissociative mental health disorder.
Dissociative symptoms may be referred to as ‘out of body’ experiences by some people. They have similar symptoms to other panic attacks, but also include feeling like you are not yourself, or that you are not present in your surroundings.
A nocturnal panic attack is one that occurs at night time, usually when you are asleep. They are sometimes called ‘night terrors’ and can include all of the same symptoms as any other sort of panic attack.
There is no clear trigger for nocturnal panic attacks, although some sufferers describe having nightmares before the panic attack symptoms begin. They may occur on their own, or in addition to panic attacks during the day.
Who usually gets panic attacks?
Anybody can experience panic attacks, and they can start at any age. However, they are found to be more common in children and teenagers, although the reasons for this are unclear. Panic attacks in children can be very distressing and can interfere with education so it is particularly important that they are spotted early.
Although the exact reasons we get panic attacks are not clear, there are some factors which make people more likely to suffer from panic attacks, including:
What causes panic attacks?
We do not know exactly what causes panic attacks although there may be a genetic cause that has not yet been identified.
Some people can feel like their panic attacks come out of nowhere, whilst others may have a particular trigger that causes them.
Common triggers for panic attacks include:
- Specific triggers such as claustrophobia / public speaking / aeroplanes / the dark / exams
- Drinking alcohol
- Drinking caffeine
- Smoking cigarettes
- Taking certain drugs such as cannabis
- Feeling stressed
- Hormonal changes such as those that occur around menstruation and during pregnancy or the menopause
The above situations do not trigger panic attacks for everyone. Some people may even experience seemingly random panic attacks which they cannot identify a trigger for. These may happen only occasionally or may be frequent, occurring multiple times a day.
What are the symptoms of a panic attack?
Panic attacks can take different forms and are not the same for everyone. Some people may become very emotional and cry during an attack, whilst others remain quiet and still. However, some of the symptoms are more common than others.
Typical panic attack symptoms include:
- Your heart beating very quickly
- Feeling palpitations or fluttering in your chest
- Chest pain
- Feeling sick or having a stomach ache
- Feeling faint or dizzy
- Finding it difficult to breathe
- Feeling hot
- Pins and needles or numbness
- Dry mouth
- Temporary changes to your vision or hearing
These symptoms will be different for everyone and may even vary between panic attacks. This means that it can be difficult to describe what a panic attack looks or feels like, but it should not stop you from getting the help you need. Trained medical professionals understand the variety of possible symptoms, and will be able to recognise the features of panic attacks that you describe by asking you some questions and examining you.
Panic attacks tend to last for 10 to 30 minutes, but this varies from person to person. Some people also find that they have a lingering feeling of anxiety after a panic attack, and may have difficulty sleeping or resting afterwards.
How do panic attacks affect quality of life?
For some people, panic attacks can hugely affect their day to day life, whilst for others, they are a mild inconvenience.
Living with panic attacks can be stressful, particularly if there is no specific trigger or warning before an attack begins. This can lead to difficulties at work, at school, or when out in public, and can result in embarrassment and even further anxiety.
Panic attacks are not something to be embarrassed about and explaining the situation to a friend, relative or colleague may help to improve the situation. This is particularly true if you find yourself needing time off of work or school due to panic attacks.
If you think somebody you know is suffering from panic attacks, try and bring it up in a non-confrontational way. They may not want to talk about it, but if they do, offer support and encouragement and let them know that they are not alone. Whilst difficult, talking about their experiences may aid them in starting the process of seeking help and in time, improving their anxiety issues. You can still offer somebody a lot of support and advice even if you have never had a panic attack yourself.
Can a panic attack kill you?
No, panic attacks cannot kill you. They may feel like they are causing you harm, but even though they can be unpleasant, the symptoms are not dangerous. Of course, extreme feelings of panic or anxiety may lead someone to accidentally or deliberately hurt themselves, but this is uncommon and usually not a direct result of the panic attack.
Panic attacks can be scary, but they are not dangerous
Some of the symptoms of panic attacks can be severe and frightening, and sometimes they can make people feel as if they are seriously unwell or going to die. For example, feeling like you cannot catch your breath or having chest pain can be extremely scary, but these symptoms are not actually dangerous, as long as they really are caused by a panic attack alone and not some other medical issue.
If you suffer from panic attacks or know somebody who does, you can be reassured that whilst unpleasant, panic attacks are not harmful for your physical health. Having said this, you should always bear in mind that some other medical conditions may feel a little bit like a panic attack and should be taken seriously if there is any doubt at all.
Which other conditions have similar symptoms to panic attacks?
Feelings of anxiety and panic attacks can also be a symptom of an underlying medical problem. Also, some panic attack symptoms such as chest pain or difficulty breathing may actually be caused by a separate, more dangerous medical condition. It is important that you are aware of this and seek medical attention if you are concerned there may be a medical cause for your panic attacks, or if your panic attack symptoms feel different.
Examples of conditions that have similar symptoms to panic attacks include:
An overactive thyroid, known as hyperthyroidism, causes too many thyroid hormones to be produced, which can cause symptoms of anxiety similar to those seen in panic attacks.
An asthma attack can make you feel like you cannot breathe, and can cause feelings of panic.
People who have had a heart attack sometimes report feeling panicked as if something bad is about to happen, and they often have chest pain which can sometimes feel similar to the chest pain felt during a panic attack.
Abnormally high or low levels of blood sugar can cause a panic attack like episode which can indicate a problem with blood sugar levels. This most often happens in people with diabetes.
A stroke is a serious condition caused by a clot or a bleed in the brain which can cause changes to your speech, numbness, dizziness and weakness of the arms and legs. These strange sensations can sometimes also be felt during a panic attack.
A severe type of reaction is called anaphylaxis. This type of allergic reaction is deadly if it is left untreated. The symptoms include shortness of breath, swelling of the face and tongue and a rash in some cases. The shortness of breath can feel similar to the difficulty breathing during a panic attack.
Whilst most panic attacks really are “just” panic attacks, it is important to be aware of the other possible causes of your symptoms and to get help from a medical professional if you have any concerns at all.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat a panic attack?
Treatment for panic attacks can be divided into:
- What to do during a panic attack
- Longer-term treatment options to try and control or stop them from happening again
What to do during a panic attack
Panic attacks are frightening and it can be difficult to remember what you have been told about easing them. Even so, there are some simple things that you can do to try and help you get through a panic attack.
- Control your breathing – Concentrate on taking deep, slow breaths. It may be helpful to count to 5 each time you breathe in or out to give you something to focus on.
- Find a safe space – If you can, remove yourself from the trigger or environment that led to the panic attack. Somewhere quiet that feels safe can be a good place to recover.
- Tell someone – Let a friend, relative or colleague know what is happening and what they can do to help you.
Long term treatment options
If you have frequent or severe panic attacks which do not go away, you may wish to think about longer-term treatment options. These are generally provided through a medical professional, and may require referral to a specialist, such as a psychologist.
The treatment options include:
- Psychological therapy
- A combination of the two
In order to decide which option would be the best for you, it is important that you speak to a doctor or medical professional in order to be fully assessed.
Medications used for panic attacks include:
Beta blockers are quick acting medications that can be used to treat the symptoms of panic attacks. They work by reducing the effect that adrenaline has on our body when we feel anxious, which in turn can stop the physical symptoms of panic attacks such as a fast heart beat. However, they do not take away the feeling of anxiety.
Examples of beta blockers used to treat panic attacks include:
Selective serotonin reuptake inhibitors (SSRIs) are actually a type of antidepressant medication. They work by increasing the amount of serotonin, a chemical that is found in the brain and can affect our mood.
Studies have shown that these medications can also be effective in treating conditions like panic attacks. They can help to decrease the frequency of panic attacks, or even stop them altogether.
Unlike beta blockers, SSRIs can take weeks before they start working. Some people can also feel worse before they start to feel better when they are taking SSRIs, and they can have side effects including nausea, difficulty sleeping and headaches. Despite that, SSRIs can help to reduce the feelings of anxiety and panic, as well as help to reduce the physical symptoms of panic attacks.
Examples of common SSRIs that are used to treat panic attacks include:
If you start taking SSRIs and you think that it is not helping after about two months of treatment, or if you are experiencing unpleasant side effects, you should speak to your doctor as soon as possible. They will review your treatment and help you find a solution.
There are several other medications which may be helpful in combating panic attacks, however, they have not yet been licensed to treat panic attacks. These include:
- Magnesium - A mineral which may help to ease anxiety
- Melatonin - A substance currently used to treat autism and sleep problems.
You may read about these medications online even though they are not currently in regular use against panic attacks.
Psychological therapies used to treat panic attacks include:
Also referred to as talking therapy, this often involves talking issues through with a professional psychologist or counsellor. There is no set plan of what to cover during the sessions, so you are able to talk through your thoughts and feelings at length. Your counsellor will be able to listen to you and offer advice on how to overcome your feelings of panic.
The most common psychological therapy for panic attacks is CBT.
CBT involves exploring why you have panic attacks, and helps you develop strategies to cope with them.
CBT tries to change your behaviour over time by focusing on your beliefs and thoughts, and how they affect your feelings and behaviour. This technique can help you make sense of overwhelming feelings or thoughts by breaking them down into smaller parts. It often follows a set programme, and your psychologist is likely to give you tasks to think about at home in between your sessions.
CBT can come in many forms, including:
- Self-help material - such as books or leaflets
- Online CBT programs that take place over a number of weeks
- Phone CBT sessions with a therapist
- Group CBT sessions with other people who have panic attacks
- Individual CBT sessions with a therapist
It involves taking time to relax and focuses on breathing techniques and positive thoughts. It helps you to focus on the present and not think about the past or the future, which can help to reduce feelings of panic and anxiety.
Lifestyle and alternative therapy for panic attacks
In addition to the treatment options your doctor may offer you, there are a large variety of things that you can do yourself which can help if you suffer from panic attacks. These include both:
- Making lifestyle changes
- Seeking alternative therapies (these are treatments which you may or may not find helpful but have either not been fully studied, or are not officially approved so cannot be provided by your doctor)
Alternative therapies may be helpful but as they are less well regulated, should be approached with caution.
Some ideas for lifestyle changes and alternative therapies that may help you treat your panic attacks include:
- Eating healthily
- Stopping smoking
- Drinking less alcohol and caffeine (such as tea or coffee)
- Getting regular exercise – Yoga can be particularly useful as it combines exercise with breathing techniques and mindfulness
- Ensuring you get enough sleep
- Acupuncture or EFT (Emotional Freedom Techniques) – These are two types of alternative therapy that use pressure points around the body to try and improve anxiety
- Hypnotherapy – This can be used to improve anxiety. Practitioners describe it as a way of using your mind to build on calming feelings which you can rely on during a panic attack
Can you prevent yourself from getting panic attacks?
If you follow the advice given regarding helping with stress, anxiety and feelings of panic, you may be able to reduce your risk of suffering from panic attacks. However, you cannot stop yourself from developing them as their causes are unclear, and unfortunately out of our control.
If you already experience panic attacks, there are plenty of treatment options available. Some people find that after the right therapy for them and some time, their panic attacks may even go away completely.
Is there a cure for panic attacks?
There is no one size fits all cure for panic attacks. They can however, be successfully managed with psychological therapy and medications, which aim to reduce the frequency and severity of attacks, as well as to help you understand what is happening and why.
Successful treatment can lead to what is called remission, which means that the panic attacks go away. 39% of people in one large study found that after treatment, their panic attacks disappeared. 7
As with any other mental health condition, there is always a chance that at some point in the future, the panic attacks may return. This could be for an obvious cause such as due to a stressful event, or it could seem to come out of nowhere. A second course of therapy or medication may be required if this happens. Although going back to get a second course of treatment might feel worrying, it is important to return to your doctor and seek help.
However, not everyone will need to go back for more treatment. Just because someone has panic attacks now, it does not mean that they will have them for the rest of their life.
Living a healthy lifestyle and keeping up with meditation or mindful practices can help to prevent recurrence of panic attacks.
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- Panic disorder. nhs.uk. https://www.nhs.uk/conditions/panic-disorder/. Published 2020. Accessed July 18, 2020. (Access here)
- Iraq Mental Health Survey 2006/7 Report. Applications.emro.who.int. Published 2009. Accessed July 18, 2020.(Access here)
- Dissociative disorders. nhs.uk. https://www.nhs.uk/conditions/dissociative-disorders/. Published 2019. Accessed July 23, 2020.(Access here)
- Taylor C. Panic disorder. BMJ. 2006;332(7547):951-955. doi:10.1136/bmj.332.7547.951 (Access here)
- How to deal with panic attacks. Nhsinform.scot. https://www.nhsinform.scot/healthy-living/mental-wellbeing/anxiety-and-panic/how-to-deal-with-panic-attacks. Published 2020. Accessed August 4, 2020. (Access here)
- Doyle N, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress—A Systematic Review. Nutrients. 2017;9(5):429. doi:10.3390/nu9050429 (Access here)
- Keller M, Yonkers K, Warshaw M et al. Remission and Relapse in Subjects with Panic Disorder and Panic with Agoraphobia. J Nerv Ment Dis. 1994;182(5):290-296. doi:10.1097/00005053-199405000-00007 (Access here)
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