Panic Attack
By Ho Shee Wai
Director/Registered Psychologist
Who is more likely to have panic attack?
Research has shown that women are twice as likely to be affected by panic attacks. The mean age at onset for panic attack in US is approximately 21-22 years old. This is more related to a weaker autonomic response to emotional states in older individual compared to younger individuals. Negative affectivity (i.e., proneness to experiencing negative emotions) and anxiety sensitivity (i.e., the disposition to believe that symptoms of anxiety are harmful) are risk factors for the onset of panic attacks, as well as worry about panic. Childhood experiences of sexual or physical abuse are also more common in panic disorder. Smoking is a risk factor also for panic attacks and panic disorders. Personal stressors (e.g., interpersonal conflicts, diseases, or death in family, use of illicit drugs) are often identified as stressors before the first panic attack.
Why do we have panic attack?
Anxiety or panic is a natural reaction of our body to protect us from danger (or perceived danger). When face with danger, our Autonomic Nervous System kicks in and before we have time to realize we were in danger, the body reacted on its own (commonly known as “flight, fight, freeze”). Many of these reactions occur during any activation of the body, not only in the state of anxiety or panic (e.g., during sexual excitement, physical exercise, intense happiness, etc).
In the situation of real danger, our attention is focused on the danger. In the absence of real danger, we then look for a danger to explain these intense sensations. We assume the danger must be inside of us (the impression of dying, passing out, going crazy, losing control, having heart attack, choking). Once these sensations happen again, be it caused by anxiety, physical activity, having sex, eating, symptoms related to an illness, they are interpreted as if they are leading to another panic attack to which we attribute dramatic consequences and we feel the need to get away or to avoid these situations as well as any related situations.
What are the symptoms of panic attack?
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4 or more of the symptoms occurs:
Palpitations
Sweating
Trembling or shaking
Shortness of breath
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Paresthesias (numbness or tingling sensation)
Derealization (feelings of unreality) or depersonalization (being detached from one-self)
Fear of losing control or “going crazy”
Fear of dying
No symptoms of panic or anxiety are dangerous. They are normal, physiological reactions. Experiencing these reactions at inappropriate times is not, in itself, a concern. These panic attacks become problematic based on how we interpret them. If these sensation are correctly interpreted as being due to anxiety, fatigue, or physical exercise, they can often pass relatively unnoticed and the intensity of the symptoms and anticipate them that they take on catastrophic proportions, but remain just as harmless.
What to do during panic attack?
The first concern is safety, so find a safe place to sit down (or even better, lie down), focus on breathing SLOWLY (Big breath in, hold for 4 count, release slowly for 8 counts), get some warm water to SLOWLY sip, comforting physical touch on shoulder or arm with words of reassurance in a quiet tone.
Say “You can do it no matter how you feel. I’m proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It’s not the place that’s bothering you, it’s the thought. I know what you are feeling is painful, but it’s not dangerous. You are so brave!”
The old first aid myth of Paper bag breathing is the attempt to regulate carbon dioxide intake (getting the person to breathe their own carbon dioxide). The reality is a number of things can cause a patient to breathe rapidly to the point carbon dioxide levels drop, including Panic Attack. Therefore, medical authorities no longer recommend having the patient breathe into a paper bag in the pre-hospital setting. Instead, a better alternative is the deep measured breathing recommended.
Carry a “Panic tool kit” with you if you are prone to having panic attack. What you will put in the tool kit is water, some snack or sweet, portable fan, anti-anxiety medication, a list of strategies you will try (e.g., deep breathing, listening to relaxing music, doing mindfulness exercise or meditation, etc), and phone number of people you can call who can seek help from (family, best friend, etc). The purpose of the tool kit is 2 fold: firstly, it gives you the reassurance that you have the tool to help yourself, and secondly it gives you structure in terms of what to do during a panic attack.