“I woke up gasping for air and drenched in sweat. My heart was pounding, there was a tightness in my chest and I was filled with a sense of impending doom. I thought I was going to die. I shook my wife awake and told her to call for an ambulance, because I felt sure I was having a heart attack. As a wave of nausea gripped my stomach, my head began to spin and my surroundings became a blur. “What is going on?” I kept asking myself? “Why has the bedroom become so hot?” I stumbled to the bathroom and somehow splashed some water on my face. The face staring back at me from the mirror looked wild-eyed, sweaty and terrified. I was confused and disoriented, and I leaned against the bathroom wall. The minutes ticked by in a haze of fear as we waited for the ambulance to arrive. Then, gradually, I began to notice that I was breathing more easily, that my heart wasn’t racing quite so fast. And I began to realize that “whatever it was” seemed to have passed, leaving me drained and exhausted.
This was one man’s experience of his first panic attack, and it happened to be a nocturnal episode. (There were several more, all occurring during his waking hours, before he decided to seek treatment). But the sensations he felt and the thoughts that raced through his head encapsulate the typical reactions of those who suffer the sudden, unexpected, all-consuming terror that a panic attack brings on. The physical and physiological maelstrom that accompanies such an attack (chest pain; racing heart; dizziness; sweating; blurred vision) gives rise to fearful thoughts that, in fact, fuel the panic further.
The 7 fears, below, are commonly experienced during a panic attack
“I’m going to have a heart attack.”
“I’m going to have a stroke.”
“I’m running out of air... I know I’m going to suffocate.”
“I have a brain hemorrhage.”
“I have a brain tumour.”
“I feel faint, I’m going to pass out.”
“I feel unreal, I’m going mad.”
Common and typical as these fears are, they are all misinterpretations. The truth is this: A panic attack can be frightening and debilitating, but it’s not dangerous, or even particularly harmful.
What’s it all about?
Broadly speaking, a panic attack is an extreme fear response which occurs when a person is convinced that (s)he is in great danger – although no obvious danger exists. In response to the perceived threat, the body shifts into primitive survival mode, hard-wired into it from ancient times. The stress hormone, adrenaline, and its chemical cousins flood your bloodstream. Your heart rate and breathing speed up, your muscles tense, you may experience chest pain, you may feel a suffocating or choking sensation; you may be overwhelmed by a feeling of terror. This intense rush of adrenaline entering your bloodstream defines the clinical picture of what is called “panic”. The purpose of this chemical boost is to energise your system, hone your senses and increase alertness – all designed to shift you into high gear for the Fight or Flight response – and, one way or the other, get you back into a safety zone.
Once you recognize what is happening and why, you can view the symptoms of a panic attack with an altered perspective:
Thus, the feeling of not getting enough air is due to the shallow breathing that occurs in a panic attack – deep, quick breaths, using the chest rather than the diaphragm, resulting in chronically over-inflated lungs. The key to dealing with hyperventilation is to breathe abdominally, using the diaphragm rather than the chest wall. But even if you just cannot seem to slow down your breathing, remember the bottom line: Relaxed breathing can help to reduce the symptoms of panic, but it is not preventing something terrible from happening – because nothing terrible is going to happen, whether your breathing is relaxed or not. You will still get enough air to live. You will not suffocate.
In a panic attack, you may experience blurred vision or tunnel vision or feel your eyes “go funny”. This does not signal a brain hemorrhage; it means that your eyes are trying to focus to fight the perceived threat.
So, too, the pounding in the head, or the headache – they do not presage a hemorrhage or a tumour. They happen simply because of the increased pressure of blood flowing through the body in order to provide extra energy.
The numbness or tingling that you feel in your fingers or lips is the result of blood being diverted to muscles. It does not mean you’re having a stroke.
The fear of fainting during a panic attack is easily assuaged. Fainting results from a fall in blood pressure; in a panic attack, the exact opposite happens: your blood pressure rises. Despite the dizziness and the shallow breathing that occur during a panic attack, fainting is rare.
A panic attack is not a prelude to a heart attack
During a panic attack, some people may experience chest pains, heart palpitations, dizziness and difficulty breathing: these are disturbingly similar to the symptoms of a heart attack. Because of the overlap, it can be difficult distinguishing between the two especially if you’ve never experienced either one before.
How do you tell the difference? Though the chest discomfort that occurs during a panic attack may appear similar to that which occurs during a heart attack, there are some key differences. One important consideration is that, although movies and TV shows often portray heart attacks as dramatic, chest-clutching events, in real life they often begin with subtle symptoms – such as discomfort that may not even be described as pain. In contrast, panic attacks typically begin suddenly, without warning. They can strike out of the blue, in the most innocuous situations – in the middle of an office meeting, while on the escalator in a shopping mall, driving a car, or when you’re sound asleep.
Here are some more differences between the chest pains in a heart attack and those that may accompany a panic attack:
Heart attack symptoms include:
» Escalating chest pain that reaches maximum severity after a few minutes
» Constant pain, pressure, fullness or aching in the chest area
» Pain or discomfort that travels or radiates from the chest to other areas, such as one or both arms, abdomen, back, shoulders, neck, throat or jaw
» Pain that is brought on by exertion
» Shortness of breath
Panic attack symptoms include:
» Increased heart rate
» Sharp or stabbing chest pain that lasts only 5 to 10 seconds
» Pain that is localized to one small area
» Pain that usually occurs at rest
» Pain that accompanies anxiety
» Pain that is relieved or worsened when you change positions
» Pain that can be reproduced or worsened by pressing over the area of pain
If you’re experiencing an episode that is similar to one you’ve had in the past that turned out to be stress-related, first try practising deep breathing to see if the symptoms subside. If they don’t, seek medical help. Don’t try to “tough out” a possible heart attack longer than 5 minutes. Heart attacks are already often missed, and the bottom-line is therefore to be vigilant and, if you feel at all unsure, get yourself checked out on an emergency basis – especially if you already have an underlying medical condition that constitutes a risk (e.g., heart disease).
In and of itself, a panic attack is not the prelude to a heart attack. As for the heart palpitations that occur during a panic attack, they can be a bothersome symptom but they are rarely life-threatening. (The exception is when the heart palpitations are a symptom of a more serious heart condition such as an irregular heart beat -- arrhythmia -- which may require treatment).
No, you are not losing your mind
It is not uncommon for someone in the grip of a panic attack to fear that (s)he may be losing control, losing contact with reality, or “going crazy”. The unusual mental changes that occur during a panic attack make it easy to see why. After all, it seems pretty weird that one moment you’re at home catching the news on TV, or pushing a trolley around the supermarket, and then the next moment you’re feeling sure you’re going to die if you don’t get outside immediately. As your inner universe takes over, there’s an undeniable sense of losing touch with the normal world, a feeling of being “unreal”, free-floating and disconnected, as though you were perceiving life through a glass pane. It is a fact that some sufferers even do not consult a psychiatrist or a counsellor because they dread a diagnosis of mental illness.
Many of the mental changes in a panic attack occur because of the hyper-arousal of the adrenal system and the cascade of adrenaline through the body. Like a food processor in overdrive, your brain can feel like it is seizing up. The mental faculties that you are used to relying upon may be compromised, and you can end up in a kind of fugue state in which you find it difficult to make decisions, remember where you left something, even remember how to start up your car.
The commonest fear during a panic attack is centred around the mental disorder called schizophrenia. The schizophrenic inhabits a different world, a different reality, from everyone else. His thoughts and speech are frequently disjointed and disorganised, often to the point of not being able to hold the thread of a conversation, and the content of his speech often seems nonsensical. The schizophrenic is also prone to delusions and hallucinations – such as believing that aliens are controlling his mind (delusion) and hearing them issue instructions to him (auditory hallucination).
But here’s the important difference between the unreal state of mind experienced by a schizophrenic and the unreal mental state experienced by a person during a panic attack: Schizophrenia typically begins very gradually, not with the suddenness with which a panic attack comes on. Those who develop schizophrenia have typically shown mild symptoms of anxiety and eccentricity for much of their lives. Many are loners who were often thought of as “odd” children in their growing years.
Although panic attacks (and other anxiety disorders) are fairly common among schizophrenics, the reverse is not true – that is, a panic attack does not, in and of itself, bring on schizophrenia. No one has ever “gone crazy” from experiencing a panic attack. Never. Ever!
(The author is a former editor of 'Health & Nutrition' magazine, and now works as a counseling therapist)