Dealing with Panic Attacks

Symptoms can feel like a heart attack

Imagine that you’re squeezing in a quick stop to the grocery store after work, your mind whirring away about a million things, when looking around, you notice that you feel oddly distant from the other people in the store. Your chest tightens and your palms grow clammy as you feel a surge of fear. Your heart begins to race, your breathing quickens and you begin to tremble: Is it a heart attack?

This is what panic attacks can feel like, so closely mimicking heart attack symptoms that they send people rushing to the nearest emergency room. “People honestly believe that they are going to die,” says Meghan Baston, MSN, RN-BC, director of Behavioral Health Services at Elliot Hospital.

Panic attacks are psychological experiences with physical components, says Sandra Netto, LICSW, a behavioral health social worker at Elliot Hospital. They are marked by a sudden onset of severe anxiety, typically accompanied by related physiological symptoms such as rapid heartbeat and shallow breathing.

Collectively, anxiety disorders — a category that includes panic attacks — are among the most common mental disorders in the US, according to the National Institute of Mental Health; most people will have one or two panic attacks during their lifetimes, Netto says.

Panic attacks affect more women than men, run in families and can appear to come out of the blue, with no obvious trigger. “It’s like somebody’s chasing you but there’s nobody there,” says Bill B. Gunn Jr., PhD, director of Primary Care Behavioral Health/NH Dartmouth Family Medicine Residency Program at Concord Hospital.

During a panic attack, people sometimes feel detached from themselves, with thoughts of ‘“I’m going crazy,”’ says Gunn. The person’s thinking “feeds on” the physiological symptoms, he says, and the overall experience is like being thrust into “a fight-or-flight response that gets stuck on.”

Panic attacks make “people feel like they need to get out of where they are,” Baston says. They trigger the release of adrenaline and other hormones, which induce the rapid heartbeat, hyperventilation and other hallmark panic attack symptoms. Since there is no easy way for people who have panic attacks to know if they are experiencing bouts of extreme panic or a purely physical problem, however, Baston recommends that panic attack sufferers get checked by a doctor to make sure there is no physical basis for the attacks. “If patients can recognize that they’re having a panic attack and can work through it, that’s wonderful,” but if in doubt, she says, go to an emergency room.

Why panic attacks occur is not fully understood, but stress raises susceptibility, and many people who have panic attacks struggle with other psychological ailments such as post-traumatic stress disorder, obsessive-compulsive disorder, depression or phobias, Baston says. Certain medications and physical attributes can also contribute to the occurrence of panic attacks, as can lifestyle choices. Panic attack sufferers are advised, for example, to avoid smoking, caffeine, alcohol, marijuana and other recreational drugs, which can worsen anxiety and trigger the panic attack response.

Cruelly, worrying about having a future panic attack also raises your risk. For people who have experienced a panic attack, “the anticipatory anxiety about having another one [can be] very high,” Gunn says. In some instances, people grow so fearful of panic attacks that they avoid situations they believe are likely to trigger future episodes. Understandably, they “don’t want to [again] have this feeling that [they are] going to die,” Gunn says. Individuals who have had a panic attack in the past while among a crowd, for example, might avoid going to the supermarket, Gunn says, “or any kind of stores where they just feel like they’ve got to get out of there.”

Medication for panic attacks is used when appropriate as a short-term intervention to lower patients’ anxiety to a point where they can develop psychological and physical coping skills, Gunn says. Many people also find therapy to be helpful. Therapy can help people recognize the early signs of panic attacks, Gunn says, and learn relaxation strategies that calm the psychological and physiological reaction to the attack. Techniques such as meditation and mindfulness can be practiced regularly to help keep stress levels low, and can be employed as needed to shorten the duration of panic attacks, which typically build to an intense level within minutes.

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