Panic attacks can happen to anyone! So, what's it like to have a panic attack?

Panic attacks are very common. They can happen to anyone! Most people will experience a panic attack at some point in their lives, but where it becomes recurrent, Panic Disorder can develop. This is where anxiety, marked bodily sensations, and fear of these (fear of fear) last for more than six months. 

So, what’s it like to have a panic attack? I experienced a panic attack on a train when I was younger. I thought I was dying, although the physician in the emergency room thought otherwise! I now realise that having a panic attack is a common experience, and certainly did not mean there was something seriously wrong or weak about me. I also found that it was very treatable.

Shiva Naipaul describes a panic attack he had in 1966 while a student

…walking back to my rooms in college, having just been released from another unremarkable tutorial session. My feeble attempts to stitch together a point of view on the use of the inductive method in the construction of scientific hypothesis had made no perceptible impression on my tutor and had left me feeling a little jaded. Strolling along St. Giles, I was neither happy nor sad. I may have been thinking how peasant it would be to get hold a punt, to spend an hour or two on the river.

Sometimes panic attacks can seem to come out of the blue. 

…Approaching broad Street, I suddenly became aware that something peculiar was happening to me. Inexplicably, my heart had started to race, my palms to moisten with sweat, my head to swim.

‘Symptoms’ in panic include palpitations, sweating, trembling, shaking, short of breath, choking, chest pain, nausea, feeling dizzy, faint, feeling of unreality, feeling detached from oneself, tingly fingers, lips, chills, hot flushes, fear of dying, fear of going crazy, losing control. If you have four of these and it is not due to another physical cause, it’s probably a panic attack. If concerned you should check with a medical practitioner who can rule out a physical cause. If you have repeated chest pain, see a doctor ASAP, but if a heart condition has been ruled out, and you are still fearful, a likely explanation is panic, which is much more common, and very treatable.

… I realised I was terribly afraid. But afraid of what? What was there to be so afraid of on this soft, blue afternoon? Dazed, barely able to maintain my balance, barely able to breathe, I huddled against the wall of Balliol. The summer sky, so benign, so unthreatening, was transformed into a wheeling amphitheatre of undefined menace; a maelstrom of annihilating vacuity. Staring at it, wave upon wave of raw fear swept through me. I imagined myself a body: a nameless corpse to be picked up from the street. It was as if all the secret terrors accumulated from birth had broken loose of their chains and come upon me in one overwhelming, retributive flood. How long I remained huddled against that wall, I cannot say. Maybe no more than a minute of two.

As you can see, it is a highly unpleasant experience, but it is not dangerous, and no-one has ever died from a panic attack. Yet it is common and can be a disabling anxiety disorder. The fear that something bad might happen is all consuming, as symptoms, or normal bodily sensations, are interpreted as catastrophic, as if a physical or mental disaster is about to strike.

…The worst of the panic receded. In its place came exhaustion, a sensation of such utter weariness and debilitation that, for an interval, I could do nothing at all, lacking even the small amount of strength required to lift my arms and dry my seat-soaked forehead. Shoulders hunched, I remained half collapsed against the wall, staring at the passers by who, although they moved within touching distance of me, although I could hear the soft snatches of their laughter and talk, seemed remote and enigmatic creatures, holographic projections  from an external world that had lost its solidity. 

People might fear that they will be ignored, or that no one will help, that they will never get home, or that they will be embarrassed or ridiculed, or trapped. This is when agoraphobia can develop alongside panic. It is a common cause of school refusal in teenagers. As adults people might stop doing things, like travelling, or working.  A feeling of unreality, feeling detached from oneself is a common sensation, often interpreted catastrophically as losing control or going ‘crazy’. 

…When some semblance of strength was restored to my muscles, I made my way to nearby pub and, swiftly, unthinkingly, drank three pints of beer. Returned to my room, I stretched myself out in front of the electric fire and, stupefied by the beer, went to sleep.

What keeps the panic going? Firstly, it is a selective attention to body sensations and their meaning. Then there are ‘safety behaviours’ for example, drinking alcohol or taking unprescribed and sometimes prescribed medications, and avoidance, to name just two. It is no co-incidence that substance abuse and addiction can emerge as an unintended consequence of trying to self-manage anxiety and panic. Alcohol will also disrupt sleep.

…All the same, that night I found myself wide awake in the small hours, staring blankly into the darkness. For the first time I properly understood the meaning of the word ‘desolation’; for the first time I felt myself to be entirely alone and helpless. Lying there, I noted with a start of dread the creeping onset of a fresh rush of terror that had already become familiar. It was too much for me. Throwing on my dressing gown, I fled from the room out into the empty quad and hammered on a friends’ door. I cannot imagine what he must have made of the trembling apparition standing on his threshold. ‘I think I’m dying,’ I said to him–or words to that effect. ‘You must help me. I’m dying.’ 

 Typical thoughts in a panic attack might be: ‘I will die’; ‘I am having a heart attack’; ‘I will faint’; ‘I will go crazy’; ‘I will lose control’; ‘I will stop breathing’; This anxiety will kill me’.  It’s natural that we’d try to keep safe from a catastrophe. But what if no catastrophe was going to happen?

Specialist CBT, Cognitive Therapy for panic Disorder, is an effective and enduring treatment. Effectiveness of Cognitive Therapy for Panic Disorder in seven randomized control trials showed that 87% of participants diagnosed with panic disorder were panic free at the end of treatment, and 84% were panic free at follow up. The typical number of sessions required for treating panic disorder in Cognitive Therapy is 6-8.