Panic Attacks

A panic attack is a brief period of acute anxiety that comes on all of a sudden. It occurs when there is no real danger. It comes without warning.

Four or more of the following symptoms define a panic attack:

	Shortness of breath or smothering sensations
	Sweating
	Choking feeling
	Racing heart rate or palpitations
	Chest pain or discomfort
	Feeling dizzy, faint or light-headed
	Trembling or shaking
	Nausea or abdominal distress
	Hot flashes or chills
	Numbness, tingling in the hands or feet
	Feelings of unreality or being detached from oneself
	Fear of going crazy or losing control
	Fear of dying

A person having a panic attack may rush to an emergency room because they think they are having a heart attack, feel like they are going to die, or think they are going crazy.

Persons who have repeated panic attacks begin to avoid situations they associate with past attacks. For example, if the panic attack took place in a grocery store and the person had to leave the store to get home to feel safe, the person avoids future trips to the grocery store. This can lead to a phobia called agoraphobia. (See “Phobias”.)

A panic attack usually lasts only a few minutes, but seems to last for hours.

A person who has four or more panic attacks in any four week period could have panic disorder. The disorder can also be present if the person has less than four panic attacks in four weeks, but is afraid of having another panic attack.

Panic attack symptoms can be symptoms of many medical conditions. These include heart attack, hyperthyroidism, and low blood sugar. The symptoms can also be a side effect of drug abuse or some medications. It is important to rule out any medical reasons for panic attack symptoms. Most persons who have panic disorder consult with their doctor 10 or more times before their condition is accurately diagnosed.

Treatment

	Medication. Certain antidepressants and anti-anxiety medicines are used.
	Therapy. One type helps the person “reshape” the way they think to avoid panic attacks. Another type uses relaxation methods and a gradual exposure to situations they have avoided due to fear of another panic attack.
	Support groups. These provide understanding and positive feedback to the sufferer.

Questions to Ask

Do all of these apply to you? You have been to your doctor more than once with symptoms like those of a heart attack, such as chest pain, irregular heartbeat and shortness of breath. You’ve been told that your heart and physical health are fine from a thorough examination and proper testing. You continue to have panic attack symptoms.

Do you have recurrent panic attacks that come when you don’t expect them and have one or more of these problems? Continued concern about having more panic attacks Worry about what will happen as the result of a panic attack, such as having a heart attack, losing control or “going crazy” A noted change in things you normally do because of past panic attacks

Do you avoid certain situations or places because they make you feel anxious and you think they will put you in danger?

Do you use alcohol or drugs to help you deal with situations that provoke the thought of another panic attack?

Self-Help

(Note: Many of these tips are used in the context of being in therapy first before the person can do them on their own.)

Ways to deal with panic that has limited symptoms and duration:

	Talk over the source of your anxiety with family, friends and clergy. If this is not enough, you may need the help of a professional counselor.
	Face the fear. Accept it. Don’t fight it. (This may require external help.)
	Remind yourself you are in no real danger.
	Try to imagine that you are “floating” on water.
	Let time pass. Try to think ahead to what tasks you need to do when the panic will be gone.
	Do one or more mental “stress rehearsals.” Imagine yourself feeling calm and handling the situation well.
	Use the “Now Awareness Technique”.
	Use bibliotherapy - read a self-help book on panic attacks.
	Minimize exposure to things that cause distress.
	Keep things with you that will provide comfort and a sense of control in case another panic attack occurs. Examples: Keep a paper bag handy if you think you might hyperventilate (over breathe). Breathe into the paper bag slowly and re-breathe the air. Do this in and out at least 10 times. Remove the bag and breathe normally a few minutes. Repeat breathing in and out of the paper bag as needed. Keep the name and phone number of a person to call in case of an emergency.
	Prepare for stressful situations. For example, if you need to give a group talk or presentation: Have necessary materials and equipment ready ahead of time. Check to see that they work. Put an outline with key points you want to make on note cards. Anticipate problems that could occur and prepare to address them ahead of time. Rehearse what you will do and say.
	Be well prepared for exams or work demands. Prioritize tasks so you’re not overwhelmed.
	Learn and practice stress management techniques. (See “Stress - Self-Help”.)
	Limit your caffeine intake.

What You Can Do for a Friend or Relative

Remain calm during the panic attack. Get emergency care if he or she is having heart attack warning signs.

Feeling of pain (may spread to or be felt in the arm, neck, tooth, jaw, or back), tightness, burning, squeezing, or heaviness in the chest that lasts more than a few minutes or goes away and comes back
Chest discomfort with fainting, lightheadedness, nausea, shortness of breath, or sweating
Unusual chest, abdominal, or stomach pain
Dizziness, nausea, trouble breathing, jaw or arm pain (in the absence of chest pain)
Fast or uneven heartbeat or pulse
Sweating for no reason; pale, gray, or clammy skin

	If your friend or relative is being treated for panic attacks, remind them to do the measures their provider of care advised during a panic attack.
	Do not “force” your friend or relative to stay in or go to a place they cannot handle. Be willing to accept their need for “a way out” of a situation which they can’t deal with. For example, choose aisle seats and plan ahead of time what you are willing to do in case your friend or relative has an anxiety attack in a crowded theater.
	Do not force your friend or relative into a direct, sudden confrontation with their anxiety-provoking situation.

Call 9-1-1 if your friend or relative is having a heart attack.

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March 16, 2007