Panic attack, also known as panic disorder, is a mental health problem characterized by unexpected and unexplained attacks of profound anxiety that affects patients for around 10 minutes. After this time, the symptoms usually resolve without any given treatment. The frequency of these attacks varies from several attacks every day to a few attacks every year. In most cases, it is impossible to trace the real cause or trigger, which is why it is difficult to predict and diagnose. According to the Diagnostic and Statistical Manual of mental disorders, fifth edition (DSM-5), diagnosing panic attacks would require ongoing episodes of panic attacks for one month or longer.
Some patients would also have behavioral changes and other consequences that result from panic attacks, and they typically display persistent worry about having future episodes. In some cases, Patients may have symptoms similar to those described in panic attacks, but they are caused by psychiatric disorders, certain medical conditions or substance abuse. In these cases, a panic attack should be ruled out of the diagnosis. Panic attack syndrome typically leads to a significant change in the quality-of-life of the patients, and even though it only lasts for 10 minutes, they usually have an ongoing worry about future episodes, which affects their day-to-day activities, work, social relationships, and overall mood. For this reason, it is important to understand the signs and symptoms of panic attacks and be able to discern whether or not you are starting to experience this condition.
These are the most commonly described symptoms:
1. Accelerated heartbeat
One of the most prominent conditions in patients with panic attacks is an accelerated heartbeat. There is a catecholamine model trying to explain why panic attacks occur, and one of the most common explanations is an increase in adrenergic discharges. These adrenergic discharges, featuring adrenaline imbalances, result in rapid heartbeat and palpitations, which is clinically known as tachycardia.
Accelerated heartbeat can be caused by fear and apprehension as well, which is something common in panic attacks. Whether it’s a cause or a consequence, tachycardia contributes to the general uneasiness people with panic attack feels during an episode. Sometimes this accelerated heartbeat makes people believe they are having a heart attack, especially those who feel chest pain as well.
However, patients who are already diagnosed gradually come to understand their symptoms and become capable to differentiate when their symptoms are attributed to panic attacks. If you have not been diagnosed with this problem, an accelerated heartbeat with other cardiovascular symptoms should urge you to look for medical assistance as quickly as possible.
Read Also: 11 Warning Signs Of A Heart Attack You Should NOT Ignore!
2. Profuse sweating
There are little to no physical signs associated with panic attacks in patients within the emergency room. However, they often come after the episode has improved and they are able to report various physical changes, and one of them is profuse sweating.
Profuse sweating appears in acute episodes of panic attacks, they affect almost every patient, and do not last longer than the rest of the symptoms. Since panic attack symptoms have their peak after 10 minutes, it is unlikely to find a patient in the emergency room with profuse sweating. However, it is one of the most described symptoms in this ailment.
Profuse sweating appears as a response to the over-activation of the catecholamine system, especially featuring adrenaline, which activates the sympathetic system and stimulates the glands in the skin to produce more sweat. Profuse sweating is common when we are afraid, and in certain medical conditions, such as low blood pressure. It is also common as a part of menopause and in some metabolic issues. Therefore, it is important to ask your doctor whenever you have this symptom, especially when accompanied by others.
3. Unsteadiness or dizziness
The episodes of panic attacks do not last for a very long time, usually with they have a peek in no more than 10 minutes, and after that time it would improve the symptoms steadily until complete remission. In the acute phase of the panic attack, the patient often feels uneasy; they may feel lightheaded, dizzy, and even faint. These symptoms are not meant to last for a longer time than the episode itself, and it’s usually accompanied by several other symptoms that contribute to an inexplicable and unreasonable feeling of distress.
4. Breathing difficulty
Respiratory problems are a major cause of complaints among these patients. Some of them have asthma and other underlying respiratory problems, including chronic obstructive pulmonary disease. In patients with an underlying respiratory pathology, breathing difficulty is even more common or severe. However, almost all patients describe a sense of oppression, sometimes described as if they were choking and running out of breathing air.
Hyperventilation is an important sign in a panic attack. Patients feel the urge of breathing heavily and frequently. In some cases, their respiratory rate might appear to be normal, but they still have hyperventilation and may have difficulty to hold their breath for a long time, with a propensity to sigh continuously. This is a typical response to low levels of oxygen, and some authors have said that panic attack results from hypersensitivity of the receptor of carbon dioxide. As a result of hyperventilation and impaired respiratory function, some susceptible patients may also have seizures.
5. Abdominal discomfort or nausea
During episodes of panic attacks, many patients describe nausea or abdominal symptoms, including abdominal pain and stomach cramps. The gastrointestinal system is closely related to brain function, and these two organs are closely related to each other. For this reason, various mental health problems are associated with abdominal discomfort and ailments of the gastrointestinal tube.
Patients with panic attack are often diagnosed with gastrointestinal pathology, including inflammatory bowel disease or irritable bowel syndrome. Their symptoms may continue for a very long time depending on the disease, but they are often aggravated during panic attack episodes. Patients with no underlying gastrointestinal cause might also feel these symptoms, but they are usually limited to the acute phase of the episode.
6. Chest pain
This is one of the major problems in panic attack, and one of the reasons why patients come to the emergency room, thinking they have a heart attack. In many cases, this symptom misleads doctors, and they perform additional studies like angiography to check the coronary arteries, and everything results to be normal. What’s more, it’s been reported that 30% of patients with chest pain and normal angiography findings have a panic attack and not a heart attack. This is especially the case with a variant of panic attack called nonfearful panic disorder when chest pain and other panic attack symptoms start without any known trigger or perceived sensation of fear.
Panic attack has severe symptoms, and chest pain can be quite troublesome, but it is not a cause of death. However, if you have coronary disease and was diagnosed with panic attacks as well, you may have a higher risk of myocardial infarction during an episode, and there’s a higher risk of sudden death as well. Therefore, it is very important to maintain a continuous check-up of your cardiovascular health and do not neglect panic attack episodes, even if they are short and self-limited.
7. Numbness in extremities
Patients with panic attacks often feel tingling or numbness in their extremities. They are most often in a given part of the extremities, but they are also common in the face and other areas of the body. It may be caused by a circulatory change, a transient alteration to the nervous system, or a combination of both. Therefore, a good idea to improve this symptom would be to massage the affected area and move around your body to improve blood circulation. Sometimes, these areas feel completely frozen, and this may raise serious concern in patients who are led to believe they are having an episode of stroke when symptoms are located in one half of the body.
8. Sensation of imminent death
These patients have difficulty to breathe, chest pain and numbness, they may also have a severe headache. These problems are combined with uncontrolled levels of anxiety, which contribute to making patients feel they are going to die. This becomes a recurrent feeling that troubles patients throughout the episode and makes it truly unbearable. What’s more, it triggers an increasing sense of nervousness that aggravates the rest of the symptoms and makes patients reach a peak of anxiety around 10 minutes after starting the panic attack episode.
This sensation of imminent death makes patients go straight to the hospital, and in most cases, they are not diagnosed because their symptoms disappear before reaching to the doctor and because they have absolutely no physical signs of alteration. However, in some cases, this fear and apprehension contribute to increasing (and even double) patient’s risk of heart attack and other cardiovascular complications. If you have been diagnosed with panic disorder, remember panic attacks are not fatal by themselves. Remember this is a temporary episode and try not to think about fatal outcomes that would increase your levels of anxiety and aggravate your symptoms.
9. Detachment from one’s body
It is also known as depersonalization or derealization. This is a prevalent symptom during episodes of panic attack. Patients say they feel disconnected from their own bodies as if they were looking at themselves through a glass or looking at their surrounding through a dense fog. They feel unfamiliar with themselves and their surroundings, and often feel robotic and outside of themselves. It is very difficult to describe if you have not gone through one of these episodes, but depersonalization and derealization make patients feel even more afraid and anxious, contributing to the rest of the symptoms.
Patients who have been diagnosed have something on their favor because they understand what is happening. Thus, they are able to control their breathing, make efforts to regain their senses. Sometimes pinching your skin or including another sensory trigger helps these patients to go back to their reality and improve their symptoms.
10. Fear of going crazy
Panic attacks are truly terrifying, even if you know it’s not going to hurt you by itself. You feel the symptoms escalating and becoming worse every single minute, and you become unable to control your fear of dying or going crazy. Patients feel they may lose control of themselves in that moment and do something crazy. Not controlling these thoughts might contribute to the severity and duration of the panic attacks. Therefore, one of the techniques used by these patients to improve their symptoms is breathing techniques and trying to clear their thoughts through mindful meditation.
- Panic attacks are often associated with other psychiatric disorders, but in making the diagnosis, we should take into consideration that the symptoms themselves should not be attributed to any other psychiatric condition. Therefore, it’s only in the hands of a skilled physician specialized in psychiatry to diagnose and treat these patients. There are other medical conditions associated with panic attacks especially irritable bowel syndrome, chronic fatigue chronic obstructive pulmonary disease migraine and other types of headache. Pharmacologic therapy is able to control symptoms and 80% of cases or more, but the outcomes of the therapy are variable in each patient.
- In most cases, patients with a brief duration of their episodes would have a better prognosis, but there are still around 20% of patients who would not be able to control their symptoms and still have recurrent episodes. If you’re suffering from panic attacks, it is advisable to search for your triggers. It could be an accident or surgery, personal conflicts, emotional distress, using certain substances such as cocaine amphetamine caffeine and cannabis. However, even if you find your initial trigger, it is a good idea to ask your doctor and follow his instructions carefully. In most cases of remission, medication is the one improving the quality of life of these patients. Thus, do not neglect professional advice and be quick to find a solution to your problems.
References
Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A., & Beitman, B. D. (1996). Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. The American journal of medicine, 101(4), 371-380.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc.
Fleet, R. P., Martel, J. P., Lavoie, K. L., Dupuis, G., & Beitman, B. D. (2000). Non-fearful panic disorder: a variant of panic in medical patients?. Psychosomatics, 41(4), 311-320.
Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic disorder. The Lancet, 368(9540), 1023-1032.
Chen, Y. H., Hu, C. J., Lee, H. C., & Lin, H. C. (2010). An increased risk of stroke among panic disorder patients: a 3-year follow-up study. The Canadian Journal of Psychiatry, 55(1), 43-49.