Wednesday, September 10, 2008

Panic Attacks, Part 1

Have you ever had a panic attack? If you have to ask, "What is a panic attack?" then the answer is "No." Panic attacks are terrifying and many people end up going to the local emergency room because they think they are having a heart attack.

The list of panic attack symptoms is long. Heart palpitations and sweating are very common. Sometimes people tell me their heart is pounding so loud they can't think. Others have described visual distortions like the floor or the sidewalk they are on is moving or waving. Some people find that the inability to swallow makes it seem like they are choking. Physicians are often told about dizziness, nausea or chest pains. Embarrassment can also occur because trembling or shaking may be visible to others. Other symptoms include feelings of heat or cold or tingling sensations. These are just a few of the more common symptoms.

Anyone who begins to experience panic attacks must immediately get a complete physical because certain diseases or physical conditions can also cause the above symptoms. A physical exam will try to rule out heart problems, asthma, hormonal problems, neurological disorders, anemia, withdrawal from alcohol or drugs, medication side effects, excessive caffeine intake or even some type of head injury. There are an entire host of other physical issues that can also contribute to panic attack symptoms.

If the physical exam eliminates all potential physical problems, the likelihood of a "pure" panic attack is highly probably. It is important to understand why your body has panic attacks. To experience a panic attack, one must have two preconditions: one is genetic and one is learned.

Panic attacks tend to run in families. This may sometimes be difficult to determine because the diagnosis is fairly recent – within the last several decades. Panic attacks cannot occur without a genetic predisposition for them. This is why it is often seen in relatives. Emily told me that she had a parent, an uncle and a sibling who had panic attacks. As she thought more about her more distant relatives, she realized that perhaps her grandmother and a great aunt may also have had panic attacks. The family thought them a bit odd, because they often refused to attend family functions or take vacations too far from home.

However, a predisposition to have panic attacks can only be set off by a learned condition called "worry." Worry is something we have to learn to do. Babies don't worry because their brains are not developed enough to do so. Many people have been taught how to worry by others when they were children. I know of no one who has read a book on how to worry and be miserable. By adolescence, worry can become a habit (although I have worked with some younger children who have already developed the habit). There are many types of worry, but only a specific one is associated with worry.

Panic attacks are triggered by making predictions about the future. The prediction takes the form of, "Something bad is going to happen to me and it will be a catastrophe." As this prediction repeats itself in a person's head, that person is getting set up for a panic attack (if they have the required biology).

Once the panic hits, the associated behavior is to escape and leave whatever situation the person is in. When a person leaves the environment of the panic attack, the symptoms will often subside. This is why many people think that situations, places or people "cause" the panic attack. Here, in California, many of my clients are afraid to drive on freeways because that is where they had their first panic attack (no wonder, with all the time we spend in our cars). Like Pavlov's dog, the freeway becomes the trigger that sets off the panic attack.

The environmental trigger is not what really causes the panic attack. Rather, the trigger sets the mental prediction in motion which then sets off the adrenaline overload which is the mechanism for having a panic attack.

In our next blog we will cover the strategies that need to be learned in order to conquer panic attacks. Have you ever had a panic attack? Did it match this description? What have you tried to help manage the panic attacks?

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