Panic attack

Summary

A panic attack, also called an anxiety attack, is a brief episode of intense anxiety that causes the physical sensations of fear. These can include a racing heartbeat, shortness of breath, dizziness, trembling and muscle tension. Spontaneous panic attacks occur unexpectedly and are not related to any external threat.

A panic attack is a brief episode of intense anxiety, which causes the physical sensations of fear. These can include a racing heartbeat, shortness of breath, dizziness, trembling and muscle tension. Panic attacks occur frequently and unexpectedly and are often not related to any external threat. A panic attack can last from a few minutes to half an hour. However, the physical and emotional effects of the attack may last for a few hours.

Panic attacks are common. Up to 35 per cent of the population experience a panic attack at some time in their lives. A panic attack can also be called an anxiety attack.

Without treatment, frequent and prolonged panic attacks can be severely disabling. The person may choose to avoid a wide range of situations (such as leaving their home or being alone) for fear of experiencing an attack.

Some people may develop panic disorders

For many people, the feelings of panic occur only occasionally during periods of stress or illness. A person who experiences recurring panic attacks is said to have panic disorder, which is a type of anxiety disorder. They generally have recurring and unexpected panic attacks and persistent fears of repeated attacks. 

Symptoms

Symptoms of a panic attack can include:

• Heightened vigilance for danger and physical symptoms
• Anxious and irrational thinking
• A strong feeling of dread, danger or foreboding
• Fear of going mad, losing control or dying
• Feeling lightheaded and dizzy
• Tingling and chills, particularly in the arms and hands
• Trembling or shaking, sweating
• Hot flushes
• Accelerated heart rate
• A feeling of constriction in the chest
• Breathing difficulties, including shortness of breath
• Nausea or abdominal distress
• Tense muscles
• Dry mouth
• Feelings of unreality and detachment from the environment.

The ‘flight-or-fight’ response

When the body is faced with immediate danger, the brain orders the autonomic nervous system to activate the ‘flight-or-fight’ response. The body is flooded with a range of chemicals, including adrenaline, that trigger physiological changes. For example, heart rate and breathing are accelerated and blood is shifted to the muscles to prepare for physical combat or running away. 

A panic attack is said to occur when the ‘flight-or-fight’ response is triggered but there is no imminent danger. A person may experience the symptoms of a panic attack in harmless and apparently stress-free situations, such as watching television or while asleep. 

Some of the factors that can prime the body to inappropriately activate the ‘flight-or-fight’ response include:

• Chronic (ongoing) stress – this causes the body to produce higher than usual levels of stress chemicals such as adrenaline.
• Acute stress (such as experiencing a traumatic event) – can suddenly flood the body with large amounts of stress chemicals.
• Habitual hyperventilation – disturbs the balance of blood gases because there is not enough carbon dioxide in the blood.
• Intense physical exercise – for some people, this may cause extreme reactions.
• Excessive caffeine intake – the caffeine in coffee, tea and other beverages is a strong stimulant.
• Illness – may cause physical changes.
• A sudden change of environment – such as walking into an overcrowded, hot or stuffy environment.

Causes other than anxiety

Some symptoms that are common to panic attacks may also occur in some physical conditions. Some medications and drugs – such as tranquillisers, alcohol and caffeine – may also induce panic-like symptoms. 

Always seek professional advice

Always seek medical advice if you are not sure whether your symptoms, or another person’s symptoms, indicate a panic attack. In an emergency, dial triple zero (000) for an ambulance. 

It is important to see your doctor for a check-up to make sure that any recurring physical panic-like symptoms are not due to illnesses, including:

• Diabetes
• Asthma
• Inner ear complaints
• Hyperthyroidism (overactive thyroid gland)
• Cardiac (heart) complaints
• Post-partum (after childbirth) hyperthyroiditis.

Self-help suggestions

Suggestions on how to cope with a panic attack include:

• Avoid ‘self-talk’ that focuses your attention on your symptoms – don’t tell yourself ‘Stop panicking!’ or ‘Relax!’
• Remind yourself that the symptoms of a panic attack are uncomfortable, but not life threatening. Reassure yourself that you’ve felt these feelings before and nothing bad happened to you.
• Focus your attention on something outside your own body and symptoms. For example, distract yourself by counting backwards in threes from 100, recall the words from a favourite song or concentrate on the sights and sounds around you.
• Fleeing from the situation will only reinforce the perception that your panic attacks are unbearable. If you sit and allow the symptoms to pass, you gain confidence in your ability to cope.

Medical treatment options

If the physical anxiety symptoms are caused by physical illnesses, such as diabetes or hyperthyroidism, proper treatment for these illnesses should stop the panic-like symptoms from recurring. If the panic attacks are due to anxiety, treatment options can include:

• Medications
• Psychotherapy, including cognitive behaviour therapy
• Biofeedback therapy
• Stress management techniques
• Proper breathing techniques
• Relaxation techniques
• Learning problem-solving skills
• Lifestyle adjustments, such as attention to diet, exercise and sleep.

Things to remember

• Symptoms of a panic attack include extreme anxiety and physical sensations of fear, such as increased heart rate, shortness of breath, trembling and muscle tension.
• Triggers for panic attacks can include overbreathing, long periods of stress, activities that lead to intense physical reactions (for example exercise, excessive coffee drinking) and physical changes occurring after illness or a sudden change of environment.
• Panic attacks can be treated with a range of therapies including medications, psychotherapy and stress management techniques.