Anatomy of a Panic Attack

After my own personal experience with panic attacks, and years of working with patients who come to me for help, I have set out on a mission to bring some clarity and relief to panic sufferers. I remember quite clearly just how frightening and confusing it can be in the grip of panic. It can also be isolating. I truly believe that understanding the “anatomy” of a panic attack can be a key first step toward recovery.

One of the most significant reasons that panic can quickly take control of our lives is that we often do not understand what feeds it and makes it worse. Once you begin to see what is happening moment by moment, panic can lose its power. The fundamental idea is that when we become more familiar with panic and fully understand its nature, it automatically becomes less frightening.

Getting to know panic means getting to know the facts. First, I find it useful to know that nearly 10 million people in the US will have a panic attack in a given year. I remember feeling alone and embarrassed when I struggled with panic attacks, and I know that many of my patients feel the same way. Understand that panic attacks are a very common human experience and, while they are quite uncomfortable, having panic attacks does not make you a weirdo or a freak.

One surprising fact is that women are twice as likely to experience panic attacks than men. This ratio might be a bit high, as psychologists understand that men tend to under-report psychological symptoms in comparison to women. However, many factors could contribute to the greater frequency of panic attacks in women.

Just as gender seems to play a role, our genetic inheritance makes us more or less likely to have panic attacks and other anxiety disorders. If you know of family members who struggle with anxiety, it's quite likely that you might have inherited a genetic predisposition to anxiety. This does not mean that you will always suffer from anxiety problems, but it may mean that you are more sensitive to anxiety than others.

On average, panic attacks last about thirty minutes. It seems that the symptoms tend to peak quite rapidly and then gradually subside. However, some people report that their panic attacks last significantly longer. It is important to understand that your body will eventually return to its normal state, as this acute level of anxiety can not be maintained over time.

Perhaps you will be surprised to know that fifteen percent of emergency room visits every year are due to panic attacks. I’ve had several patients who ended up in the emergency room because they thought they were having a medical episode, such as a heart attack. They described feeling embarrassed, and also a bit relieved, to be told that it was anxiety. However, they are often sent away with no idea of what to do next.

Aside from the basic facts about panic attacks, it also helps to learn some of the key factors that contribute to the likelihood that someone will have them. What makes one person more likely to experience them than others? I know that many people who have panic attacks are asking the question, “why me?”. That’s what I did. First and foremost, it is not because you are somehow weak or defective. It helps to understand the contributors without a focus on blame.

First, let’s look at some factors that involve your history. The obvious place to start is your genetics. Long before you were conscious, your DNA from mom and dad determined whether you would inherit genes that make you more prone to feel anxious. While you don’t need to blame your parents, as they could not choose their own genetics, it helps to understand that you did not choose your genes. It is not your fault, nor is it theirs.

In combination with genetics, life experience and life events play a crucial role in anxiety disorders. We might learn from anxious parents or other caretakers that we should be worried about even the smallest things, and that we should also be on the lookout for danger. Or, we might have grown up in an environment that is highly stressful or unsafe, making us understandably more anxious. Major life events and traumas can also leave us easily triggered when we are reminded of them. For instance, a child who has a frightening encounter with a dog might immediately feel fear with dogs, even in adulthood.

Life transitions often seem to predict the onset of panic attacks. This is one reason why the average age of the first panic attack is in early adulthood. In general, change can bring about anxiety, and life transitions are typically when we encounter large doses of change. Transitions such as graduation and marriage are usually happy times, but they can also come with anxiety and even panic attacks. Not surprisingly major losses are also contributors to panic.

Along with transitions, current level of stress is a major predictor of panic. Transitions, even happy ones, can be stressful. But aside from transitions, life stress in general is probably the most common trigger of panic attacks. Common sources involve workload, excessive busyness, financial struggles, illness, and even relationship conflicts.

Understanding the panic attack itself is central to breaking out of the panic cycle. On the left of the above diagram, you have some of the extremely uncomfortable symptoms. All of the symptoms make us feel bad, and they are all part of the body’s natural response to threat or danger. The system in our body that is meant to keep us safe becomes the source of our suffering.

Once these symptoms are triggered, for various reasons, we have an immediate reaction or assessment of what they might mean. This reaction will largely determine whether the panic symptoms escalate or subside. The tricky part here is that our immediate reactions are usually hard to pinpoint because they happen so quickly. But, if we can identify our thoughts and reactions to the symptoms, we have a chance to dramatically transform the feedback loop that intensifies the panic.

I want to conclude by covering some factors that are contributing to your panic attacks but are largely open to change. While we can’t change or avoid much of what I’ve already mentioned, the areas shown above can all transform with learning and practice. This gives us hope to be free of panic, but it also gives us hope to change many other internal and external struggles that we might face.

Our actions, such as avoiding things that might trigger panic symptoms, often serve to keep us from getting better. Understand that most of these actions make sense and are very common reactions to the painful symptoms, but we don’t have to keep returning to the same choices that keep panic in our lives. Avoidance, in general, is the main reason that anxiety becomes an anxiety disorder.

We may be unaware of the thoughts that we are having before, during, and after the panic attack. However, these thoughts are typically directly linked to the escalation of panic symptoms as well as the likelihood that we will have another panic attack. Thoughts to look for usually include an over-estimation of the danger surrounding the symptoms, as well as our under-estimation of our ability to handle them. We can learn to get better at identifying these thoughts, and at shifting to less triggering thoughts.

It's clear that emotions are involved in panic, but not in the way that you might think. I tell patients that panic can serve as an indicator that there are other emotions below the surface. Anger and sadness, often from relationships, can be bottled up and buried. When they aren’t expressed or identified, anxiety can bubble up. That is why it is helpful to talk about or journal about important issues and conflicts. You can do this on your own, with a friend or family member, or in with a therapist.

Related to thoughts, our beliefs can also be hard to identify. They are often below the surface of our awareness, and have often been present since childhood. Beliefs can also keep panic around, but can also lead to other mental health problems such as depression. Learning to spot and to change harmful beliefs can transform our relationship with anxiety and panic.

Panic attacks stink, there’s just no getting around it. However, knowledge is power. The good news is that there are a number of ways that you can learn to reduce your panic symptoms and the cycle that is involved.

In my online community, Hello Panic, I focus on educating people about panic so it is no longer the monster in the dark. In a twist that goes against instinct and much of our medical model, I believe that what actually changes panic for good is to stop fighting it. Rather, we can benefit from getting to know it, and by saying “hello” to panic.

If this information has been helpful, you can download the full infographic. I also have a 23-minute long video on YouTube (embedded below) where I will walk you through this infographic step by step.

You can join us at hellopanic.com, follow us on Instagram, and we also have a growing Facebook group.

Best wishes to you on your panic journey, and I hope to hear from you soon!