The anatomy of a panic attack

Panic attacks revolve around terror. Though mainly associated with the mind, they’re actually constellations of symptoms, both physical and cognitive. Your brain is seized by fear; your body responds, and it can be hard to make sense of it all.

Most experts define a panic attack as a sudden onset of intense fear, as opposed to a condition like general anxiety, which usually manifests as almost constant worry.

People having panic attacks are bombarded by mental and physical symptoms, which can vary. Their hearts might race. They may feel that they cannot breathe. Their limbs might tingle. Sometimes they shake. They may grow nauseated.

Their chests could tighten. Some people may suddenly feel hot and sweaty, others feel like they have the chills.

And then there’s the churning and destabilising fear. In the throes of a panic attack, people may worry that they are going insane, losing control of their minds and bodies. They may think it’s a heart attack or even that they are going to die.

Most people who regularly experience panic attacks do not experience all of these symptoms, but may have many of them. A small subset of people, however, have limited symptom panic attacks, in which they encounter three or fewer.

And, almost as suddenly as panic attacks come on, they typically dissipate. Symptoms mount over the course of 10 minutes, and usually fade within half an hour, although there may be lingering effects.

The experience can be traumatic, however, and people may start to fear sensations that remind them of their symptoms, like feeling out of breath after climbing a flight of stairs. They might also avoid anything that reminds them of the episode — the grocery store where their heart pounded, the food they were eating when the panic hit.

Some people may develop panic disorder, which psychologists define by repeated, unexpected panic attacks that interfere with daily functioning. While 15 per cent to 30 per cent of people will have at least one panic attack in their life, only 2 per cent to 4 per cent will develop panic disorder, said Dr. Franklin Schneier, co-director of the Anxiety Disorders Clinic at New York State Psychiatric Institute. A subset of those people — roughly 1 in 3 — also develop agoraphobia, an anxiety disorder that can involve extreme fear of public or crowded places, public transit, standing in line or leaving one’s home at all.

The causes

A diverse set of stressors — like traumatic events, financial worries or even public speaking — can prompt panic attacks. But they can also occur unexpectedly.

Intense stress activates the sympathetic nervous system, a network of nerves that trigger the “fight or flight” response to perceived danger. The body releases chemicals like epinephrine, also known as adrenaline, and norepinephrine, which cause the heart to go into overdrive, pupils to swell and skin to release sweat. The parasympathetic nervous system returns the body to its original state. If it does not activate after some time, a panic attack can suspend a person in that heightened state of arousal.

Many researchers believe that panic attacks might occur when the brain isn’t properly able to send messages between the prefrontal cortex, which is associated with logic and reasoning, and the amygdala, which governs emotional regulation. During a panic attack, the amygdala is hyperactive, while the prefrontal cortex is less responsive, causing us to spiral.

Anyone can experience a panic attack. The risk, however, is highest for teens and people in their 20s. If you haven’t had a panic attack by age 45, you’re less likely to have an episode later in life.

Women are more than twice as likely as men to get panic attacks, but researchers aren’t entirely sure why.

Easing one in the moment

– This article originally appeared in The New York Times