Panic Attacks: Symptoms, Causes and Treatments

When you have a panic attack You experience a sudden experience of intense fear or discomfort, accompanied by symptoms such as:

• Heart palpitations.
• Feeling of choking.
• Chest pain.

An example may be that of Marta, 30:

After going to sleep, she wakes up with a slight feeling of apprehension, feeling strong heartbeats and chest pain. Feel that you are dying or are having a heart attack. In addition, you feel a sense of unreality; As if she were not in control of herself.

There are 3 kinds of panic attacks:

• Attack associated with situations: attacks associated with specific situations, such as riding a bus, train or going to places transited. They are common in specific phobias or social phobia.
• Unexpected attacks: they can happen unexpectedly in any situation or place.
• Situational predispositional attack: an attack is more likely to occur because it occurred earlier in one place. For example, not knowing if an attack will occur in a mall, although it has happened before.

Isolated attacks can be done without worry. However, when attacks occur frequently, it may be developing Panic disorder .

Symptoms of Panic Attacks

Panic attacks often appear when you are away from home, although they can occur anywhere and at any time.

Usually the signs and symptoms increase and reach their peak at 10 minutes. Most end at 20-30 minutes of their start and rarely last more than an hour.

A panic attack includes a combination of the following signs and symptoms:

• Hyperventilation or little air.
• Heart palpitations.
• Feeling of choking.
• Feeling detached from the external environment.
• Sweat.
• Nausea or upset stomach.
• Numbness.
• Feeling cold or hot.
• Fear of dying, losing control or going crazy.
• Feeling dizzy, lightheaded or faint
• Discomfort or pain in the chest.
• Tremors or shaking.

Symptoms of Panic Disorder

You can feel an isolated panic attack without other complications or episodes. If you've only had one or two, you would not have to worry.

However, if these attacks occur frequently you can develop panic disorder. This is characterized by repeated panic attacks, combined with major changes in behavior.

You can have panic disorder if:

• You experience frequent and unexpected panic attacks.
• You worry too much about having another panic attack.
• You behave differently, like avoiding places you did not fear before.

If you have panic disorder, attacks can result in a high emotional cost; Although the attacks may last only a few minutes, the memory of them may be intense and may Influence self-esteem And impair the quality of life.

As they develop, these symptoms appear:

• Anticipatory anxiety: anxiety caused by fear of future attacks.
• Avoidance of places or situations: avoid situations or environments that were previously not feared and that objectively are not dangerous. This avoidance can be based on the belief that the situation or place caused a prior attack. You can also avoid places where it is difficult to escape or ask for help.

Causes

The type of emotional reactions that occur in panic attacks do not have a single cause, but several: biological, psychological, environmental and social.

The tendency to be nervous or tense may be hereditary, but also influence your sense of control over the world (something learned), your environment and your social circumstances.

Biological factors

If there is a tendency in your family to"be nervous,"you will be more likely to inherit that trait.

It is not that there is a single gene that predisposes to anxiety. Rather, the influence is due to a set of genes.

That is to say, there are many genes that produce the tendency to be too anxious.

In addition, those genes will affect the development of your anxiety when you meet a number of psychological, environmental and social factors.

Environmental factors

For example, it is known that adolescents who smoke more cigarettes are more likely to develop anxiety disorders when they are adults, especially generalized anxiety disorder And panic disorder.

Psychological Factors

The fear you feel in panic attacks can be the result of a conditioning or learning.

According to this model, in childhood or adulthood you would have developed an uncertainty about your ability to control and cope with events.

The feeling of lack of control is the most vulnerable factor to anxiety: you may feel that you will do poorly in a presentation or that you will suspend an exam no matter how much you study.

There are many studies that support the influence of parental education on children's sense of control:

• Overprotective parents, who do not let their children experience adversity, help children learn that they can not control what is happening.
• Parents who stimulate the exploration of the world by children, parents who respond to the needs of their children, predictable and let them get things for themselves, encourage the development of a sense of control.

Another psychological factor is cognitive conditioning:

Maybe during a real alarm you have a high sense of fear, and you have associated it with external signals (for example car riding) or internal signals (for example strong heartbeats) that occurred in the real situation.

That way, when you feel the external or internal signals, you have the sensation of fear, although not of the real dangerous situation.

For example, one day you have a car accident and you feel a strong fear. From then on, you can associate getting into the car in fear or getting into the car with loud heartbeat.

This learning or conditioning can be difficult to separate because the keys that trigger the emotional responses of fear may be unconscious.

This association of panic attacks to internal or external signals is called learned alarms.

Social factors

Cultural or social customs such as having to excel at work, college or college can also contribute to the development of anxiety or panic attacks.

Different vital circumstances, such as examinations, divorces, or family deaths, act as stressors that can trigger reactions in you such as panic attacks or Headaches.

Panic attacks can also be triggered by medical conditions and other physical causes:

• Hyperthyroidism (overactive thyroid gland).
• Hypoglycemia (low blood sugar).
• Use of stimulants (amphetamines, cocaine, caffeine).
• Withdrawal of medication.

Diagnosis

Diagnostic criteria according to DSM-IV

Temporary and isolated appearance of intense fear or discomfort, accompanied by four (or more) of the following symptoms, which begin abruptly and reach their maximum expression in the first 10 minutes:

1. Palpitations, heart shaking, or heart rate elevation.
2. Sweating.
3. Tremors or jolts.
4. Feeling of choking or shortness of breath.
5. Feeling of choking.
6. Oppression or chest discomfort.
7. Nausea or abdominal discomfort.
8. Instability, dizziness or fainting.
9. Derealization (feeling of unreality) or depersonalization (being separated from oneself).
10. Fear of losing control or going crazy.
11. Affraid to die.
12. Paresthesias (feeling numb or tingling).
13. Chills or suffocations.

Treatments

Cognitive Behavioral Therapy Is the most effective way to treat this disorder. It is based on modifying the patterns of thought and behavior by more adaptive ones.

To address panic disorder, the strategy may be focused primarily on education about the disorder itself and on learning techniques:

1-Education

It is about teaching the person what happens and why it happens.

Some aspects to teach are:

• What is anxiety?
• The adaptive value of anxiety.
• Components of physiological, cognitive and behavioral anxiety, and how they interact with each other.

2-Activation control techniques

The techniques to be taught are:

• Diaphragmatic breathing: controlling the respiration reduces physiological activation.
• Muscle Relaxation Training : Aims to reduce muscle tension and can use progressive muscle relaxation, yoga, autogenous training or meditation.

3-Exposure Techniques

• Exposure to internal stimuli: the goal is to expose the patient to the symptoms he fears so that he perceives that his automatic thoughts are not real, so that he becomes habituated and that he learns to control the symptoms. It is performed with several simple exercises that cause physiological changes similar to those of the panic attack.
• Exposure to external stimuli: the goal is exposure to places or situations that cause anxiety. It is intended that the person becomes habituated and perceives these situations as normal or not catastrophic.

4-Cognitive restructuring techniques

The goal is to identify catastrophic irrational thoughts and to change them by more positive interpretations.

5- Medication

Medication can be used temporarily to reduce some of the symptoms of panic disorder.

However, it alone does not solve the problem, it is especially recommended in the most severe cases and is most effective when combined with cognitive-behavioral therapy.

Medication includes:

• Antidepressants .
• Benzodiazepines .

Pathophysiology

The physiological process of a panic attack can be understood as follows:

1. First, there is the appearance of fear from a stimulus.
2. This leads to the release of adrenaline, which triggers the fight or flight response in which the person's body prepares for physical activity.
3. This leads to increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating.
4. Hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood.
5. This causes changes in the pH of the blood (respiratory alkalosis or hypocapnia), which can cause symptoms such as tingling, dizziness, feeling faint or numbness.
6. The release of adrenaline also causes vasoconstriction, resulting in less blood flow to the head, which causes dizziness and lightheadedness.

Some Tips for Attacks or Panic Disorder

Although treatment with professional therapy is what makes the biggest difference, there are certain indications that you can carry out for yourself:

• Learning about panic: Knowing about fear and attacks can decrease your symptoms and increase your sense of control. You will learn that the feelings and feelings that you have during an attack are normal and that you are not going crazy.
• Avoid Caffeine or Smoking: In people who are susceptible, tobacco and caffeine can trigger panic attacks. It is therefore best to avoid smoking, coffee and other caffeinated beverages. It is also necessary to review the chemical compounds of drugs that may contain stimulants.
• Learning to control breathing: Hyperventilation causes many sensations that occur during the panic attack. On the other hand, deep breathing can decrease symptoms. By learning to control your breathing you develop a skill that you can use to reassure yourself before you feel anxious.
• To practice relaxation techniques : Activities such as progressive muscle relaxation, meditation or yoga stimulate the body's relaxation response, the opposite of the panic and anxiety response.

References

1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text rev., P.479). Washington, D.C.: American Psychiatric Association.
2. DSM-TR diagnostic criteria for panic disorder.
3. Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Health and Clinical Excellence. Clinical Guideline 22. Issue date: April 2007.
4. "Panic attack - Definition and More from the Free Merriam-Webster Dictionary". M-w.com. 2010-08-13. Retrieved 2012-06-15.
5. November 12, 2013. What is a panic attack? National Health Service. Retrieved: 4 February 2015.
6. Bourne, E. (2005). The Anxiety and Phobia Workbook, 4th Edition: New Harbinger Press.
7. Image source.