PANIC ATTACKS: SYMPTOMS, CAUSES, AND TREATMENTS - ARTE - 2025

A panic attack is a sudden experience of intense fear or discomfort, accompanied by symptoms such as heart palpitations, a feeling of suffocation, or chest pain.

Panic attacks often appear outside the home, although they can occur anywhere and at any time. Signs and symptoms usually increase and peak within 10 minutes. Most finish within 20-30 minutes of their onset and rarely last more than an hour.

Isolated attacks can occur, without worrying. However, when attacks occur frequently, panic disorder may be developing.

Classes / types

There are 3 kinds of panic attacks:

• Attack associated with situations: attacks associated with certain situations, such as riding a bus, train or going to busy places. They are common in specific phobias or social phobia.
• Unexpected attacks: they can occur unexpectedly in any situation or place.
• Situational predispositional attack: an attack is more likely to occur because it happened before in the same place. For example, not knowing if an attack will occur in a shopping center, even though it has happened before.

Symptoms

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

• Hyperventilation or little air.
• Palpitations of the heart
• Feeling of suffocation
• Feeling separated from the external environment.
• Sweat.
• Nausea or upset stomach.
• Numbness.
• Feeling cold or flushed
• Fear of dying, losing control, or going crazy.
• Feeling dizzy, light-headed, or fainting
• 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 wouldn't have to worry. However, if these attacks occur frequently, panic disorder can develop. 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 excessively about having another panic attack.
• You behave differently, like avoiding places you weren't afraid of before.

If you have panic disorder, the attacks can be costly emotionally; Although the attacks may last only a few minutes, the memory of them can be intense and can influence self-esteem and harm quality of life.

As it develops, these symptoms appear:

• Anticipatory anxiety: anxiety caused by the fear of having future attacks.
• Avoidance of places or situations: avoiding situations or environments that were not previously feared and that are not objectively dangerous. This avoidance may be based on the belief that the situation or location provoked a previous 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 can be hereditary, although your feeling of control over the world (something learned), your environment and your social circumstances will also influence.

Biological factors

If there is a tendency to "be nervous" in your family, you are more likely to inherit that trait. Not that there is a single gene that predisposes you to anxiety. Rather, the influence is due to a set of genes.

In other words, there are many genes that produce the tendency for you to be overly anxious. In addition, those genes will affect the development of your anxiety when you comply with 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 as adults, especially generalized anxiety disorder and panic disorder.

Psychological factors

The fear you feel in panic attacks can be the result of 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 fail a test no matter how hard 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 cannot control what happens.
• Parents who encourage children's exploration of the world, parents who are responsive to their children's needs, predictable, and let them do things for themselves, foster the development of a sense of control.

Cognitive conditioning

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

In this way, when you feel the external or internal signals, you have the feeling of fear, although I do not know the actual dangerous situation.

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

This learning or conditioning can be difficult to separate, because the cues that trigger emotional fear responses can be unconscious. This association of panic attacks with internal or external signals is called learned alarms.

Social factors

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

Different life circumstances, such as exams, divorces or deaths of relatives act as stressors that can cause reactions such as panic attacks or headaches in you.

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 start abruptly and reach their maximum expression in the first 10 minutes:

1. Palpitations, heart jerks, or increased heart rate.
2. Sweating
3. Shaking or shaking
4. Feeling of choking or shortness of breath
5. Choking sensation.
6. Chest tightness or discomfort.
7. Nausea or abdominal discomfort.
8. Unsteadiness, 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 (numbness or tingling sensation).
13. Chills or flushing

Treatments

Cognitive behavioral therapy is the most effective way to treat this disorder. It is based on modifying thought and behavior patterns for more adaptive ones.

To treat panic disorder, the strategy may focus primarily on education about the disorder and learning techniques:

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.

Activation control techniques

The techniques to teach are:

• Diaphragmatic breathing: controlling breathing reduces physiological activation.
• Muscle relaxation training: aims to reduce muscle tension and progressive muscle relaxation, yoga, autogenic training or meditation can be used.

Exposure techniques

• Exposure to internal stimuli: the goal is to expose the patient to the symptoms that they fear so that they perceive that their automatic thoughts are not real, so that they get used to it and so that they learn to control the symptoms. It is done with several simple exercises that cause physiological changes similar to those of a panic attack.
• Exposure to external stimuli: the goal is exposure to places or situations that provoke anxiety. It is intended that the person gets used to and perceives these situations as normal or not catastrophic.

Cognitive restructuring techniques

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

Medication

Medication can be used temporarily to reduce some of the symptoms of panic disorder. However, by itself it does not solve the problem, it is recommended especially in the most severe cases and it is more 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. In the first place, fear appears 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 an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating.
4. Hyperventilation leads to a drop in carbon dioxide levels in the lungs and later 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 panic attacks or disorder

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

• Learn about panic: Knowing about fear and attacks can decrease symptoms and increase your sense of control. You will learn that the sensations and feelings 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 cause panic attacks. Therefore, it is best to avoid smoking, coffee, and other caffeinated beverages. It is also necessary to review the chemical compounds of drugs that may contain stimulants.
• Learn to control your breathing: Hyperventilation causes many sensations that occur during a panic attack. On the other hand, deep breathing can lessen symptoms. By learning to control your breathing you develop a skill that you can use to calm yourself before feeling anxious.
• 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, DC: American Psychiatric Association.
2. DSM-TR diagnostic criteria for panic disorder.
3. Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalized 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." Mw.com. 2010-08-13. Retrieved 2012-06-15.
5. November 12, 2013. What is a panic attack? National Health Service. Retrieved: February 4, 2015.
6. Bourne, E. (2005). The Anxiety and Phobia Workbook, 4th Edition: New Harbinger Press.