Anxiety can cause physical numbness for days

Panic Attack: Symptoms, Causes, and Therapies

Panic attack sufferers avoid situations and places that frighten them.

A panic attack is a temporary, intense fear and alarm reaction of the body without an objective threat from outside. Classic symptoms include fear of death, increased heartbeat, sweating, dizziness, tremors and shortness of breath. It is estimated that up to 30 percent of all people will experience a panic attack at least once in their lifetime. Two to three percent of adults suffer from panic disorder (also known as panic syndrome), which is one of the most common anxiety disorders and is associated with recurring panic attacks.

There are three types of panic attacks:

  • unexpected panic attacks that occur completely suddenly (without a trigger)

  • situation-related panic attacks that are triggered by a specific stimulus (sometimes it is enough for the person affected to just imagine the stimulus)

  • situation-favored panic attacks that are favored by a specific stimulus, but not immediately triggered by it (the panic attack does not take place immediately after the stimulus confrontation)

Heart anxiety syndrome - the "false heart attack"

Dr. Heart / team of experts

Unexpected panic attacks are more common in younger adults in their second and third decades of life. Women are about twice as vulnerable as men. Symptoms are usually most pronounced in their mid-30s, and from their mid-40s the risk of suffering a panic attack for the first time decreases. Panic disorder is chronic in every fifth person affected.

Symptoms of panic attacks

According to international diagnostic criteria, a panic attack is a clearly recognizable episode of intense anxiety in which at least four specified physical and psychological symptoms suddenly appear and peak within about ten minutes.

Classic signs of a panic attack are:

  • Extreme fear of (death)

  • Racing heart

  • Sweating (hot flashes)

  • Trembling, trembling

  • Difficulty breathing, shortness of breath, hyperventilating

  • Chest discomfort (pain, pressure, or tightness)

  • Nausea, abdominal pain, gastrointestinal discomfort

  • high blood pressure

  • Dry mouth

  • Shivering

  • Dizziness, lightheadedness, feeling of insecurity

  • Tingling, numbness

  • Derealization (everything seems unreal, like in a dream)

  • Depersonalization (the feeling of not being there yourself)

Many of the listed panic attack symptoms are misinterpreted. For example, the person concerned concludes from his accelerated pulse: “Now I'm going to have a heart attack”, from his shortness of breath: “I'm about to suffocate”, from dizziness: “I have a brain tumor” or from derealization: “Now I've gone crazy ".

A panic attack is considered to be the body's false alarm. What exactly is going on physiologically has not yet been conclusively clarified. It is believed that a panic attack starts in the brain stem.

Common reactions of those affected to a panic attack are to flee, call a loved one or seek help in some other way. However, there are also those affected who do not show anything to the outside world. This can increase the psychological stress.

The symptoms of a panic attack usually subside after 30 minutes at the latest (usually much earlier). Seizures lasting several hours are extremely rare. An attack lasts around 15 minutes on average.

Panic disorder with agoraphobia

Panic disorders are often related to other mental illnesses such as social phobias, depression, eating disorders, or alcohol addiction. They are particularly often associated with agoraphobia: the fear of places from which it would be difficult to escape or where a panic attack would cause a great stir, for example public transport or elevators, crowds at major events or wide open spaces.

Patients with agoraphobia no longer go out of the house or only go out when they are accompanied. When shopping, they choose small, manageable shops that make it easy to escape. For the same reason, they take a seat near the exit in a restaurant, theater or cinema. The lack of an immediately usable escape route is one of the key symptoms of many agoraphobic situations. In addition, those affected avoid public places and do not travel alone by train, bus or plane.

What are the causes of panic attacks?

As a rule, it is not a single but the interaction of several factors that favors a panic disorder or the occurrence of a panic attack.

General causes:

  • Genetic reasons: Experts suspect a biological vulnerability (genetically determined sensitivity) behind anxiety disorders that occur in families. Study results suggest that an excess of the messenger substance norepinephrine can promote panic disorders.

  • Personality structure: Panic patients have a high need for security and evaluate events and situations more negatively than healthy people. It is particularly stressful for them when they cannot control situations.

  • Role models: Whether a person is very anxious or not is also influenced by the role model of their parents or other custodians. Anyone who has experienced panic attacks from close caregivers as a child is more inclined to look for symptoms in themselves.

  • Life story: Sometimes panic attacks are caused by unprocessed, negative experiences in childhood and adolescence (such as abuse, separation of parents, serious illness, accident).

  • Learned behavior: Fear reactions can be linked to certain occurrences or situations. Then, for example, using an elevator triggers panic because the person concerned was previously locked in an elevator. The more the corresponding situation is avoided, the stronger this connection becomes, because no positive experiences can be made that dissolve them.

  • Physical illnesses: Brain, cardiovascular and thyroid diseases can also trigger panic attacks. In this case, one speaks of secondary anxiety (about five percent of all cases).

  • Crises and loss events: Serious illnesses, family problems, fear of the future, professional or financial worries, the death of a relative, separations, relocations and the like can also increase the risk of panic attacks.

Acute triggers and amplifiers:

  • high physical exertion

  • lack of sleep

  • extreme temperatures

  • strong time pressure and stress

  • psychoactive substances: caffeine, alcohol, nicotine, medication (e.g. neuroleptics, sleeping pills or certain antibiotics)

  • Fear of fear: Anyone expecting a panic attack can trigger a corresponding alarm reaction of the body (self-fulfilling prophecy).

  • Self-observation: The more closely a person observes himself for signs of a possible panic attack, the more likely it is that it actually occurs.

  • Incorrect interpretation of body stimuli: Normal physical processes such as palpitations or dizziness are interpreted as pathological (for example as a heart attack or a fit of faintness). The resulting fears and tensions can lead to panic.

  • Strong emotions: negative thoughts, anger, aggression, brooding, but also horror films or otherwise strongly emotionally upsetting media content are possible triggers.

How does the doctor diagnose a panic attack?

If anxiety or panic disorders are not treated, they can solidify (chronify), intensify and significantly limit the everyday life of the person concerned.

Who noticed that

  • he is restricted socially and mobile due to panic attacks (e.g. no longer attending concerts, no longer traveling or no longer daring to go out on the street alone)

  • Regular thoughts torment him

  • his quality of life suffers from the threat of attacks

  • he thinks about death more often than usual

should get help immediately. Proper treatment is important. The correct contact person is initially the family doctor, who will refer the patient to a psychiatrist or psychotherapist if necessary.

The doctor first clarifies whether there is a physical illness (for example a lung, cardiovascular, neurological or hormonal disease) or a mental illness (for example a phobia, a depressive disorder or an addiction).

A thorough medical history is followed by psychiatric, physical, and laboratory tests. For example, an electrocardiogram (EKG, recording of the heart voltage curve) is made, the blood pressure is measured and the patient's blood is analyzed for specific disruptive factors (such as hormonal imbalance, atypical blood sugar levels or deficiency symptoms).

Imaging methods for the representation and function of the brain (for example magnetic resonance tomography, MRT, or computer tomography, CT), electro-encephalography (EEG, brain wave measurement), specific tests and questionnaires can complete the diagnosis if necessary.

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Therapy: How can panic attacks be treated?

If the specialist has diagnosed a panic disorder, there is a wide range of effective therapy options, which are usually combined with one another (multimodal concept).

Psychotherapeutic treatment

Cognitive behavioral therapy (CBT): harmful, negative thoughts and beliefs are to be replaced with more realistic, positive ones. In addition, calming strategies are learned (for example breathing and relaxation techniques). 80 percent of all patients with panic disorders feel better over the long term with cognitive behavioral therapy, and many are symptom-free afterwards.

A component of cognitive behavioral therapy can be exposure therapy (also stimulus confrontation or exposure therapy), which aims to ensure that the patient confronts the fear-inducing situation and is confronted with the physical symptoms in a protected setting. The aim is to reduce the fear of fear. In this way, very good effects are achieved, particularly in the case of agoraphobia. In the case of depression, psychosis, heart disease, seizure disorders and the like, exposure therapy is usually not used.

If no or only an inadequate effect is achieved through cognitive behavioral therapy, psychodynamic psychotherapy is considered useful. Psychodynamically working psychotherapists support people with panic attacks in dealing with typical fearful situations and in recognizing and understanding physical symptoms. This is based on the assumption that the fears are caused by internal conflicts that stem from formative relationships (for example with parents or siblings). The goal is a more positive, healthier and less stressful lifestyle.

Drug treatment (pharmacotherapy)

Panic disorders and attacks can have physical causes, such as "communication disorders" of the nerve cells. For a smooth transmission of the signals, messenger substances (neurotransmitters) such as serotonin or norepinephrine are required. This is where certain antidepressants come into play.

If the corresponding medication is effective, it should never be discontinued without authorization, but instead, after consultation with the psychiatrist, continue to be taken for half a year to a full year at the same dose (maintenance therapy). Long-term treatment may be necessary if the disease is severe or if panic attacks recur after tapering off (slowly stopping) the tablets.

Complementary therapies

  • Relaxation methods: Techniques such as progressive muscle relaxation or autogenic training can (both generally and directly used in panic situations) reduce physical tension.

  • Exercise: Regular physical activity can also improve panic disorder. Above all, endurance training is recommended.

  • Participation in meetings of self-help groups: The exchange with other affected persons is often helpful for patients and relatives. In this way, social isolation is also counteracted.

How is an acute panic attack treated?

Most of the time the seizure is over or at least subsided by the time medical or psychological help arrives due to its short duration. Most of those affected calm down at the latest when a doctor or psychologist arrives. If the person concerned is not injured, no medical treatment is usually necessary: ​​the panic attack itself has no health consequences.

In exceptional cases, a sedative can be administered. Against hyperventilating, it helps to breathe into a paper bag or hold your breath for about ten seconds. Ideally, the emergency doctor who has been called will explain panic attacks and advise you to consult a psychiatrist or psychotherapist.

Preventing panic attacks: dealing with fearful situations

A balanced lifestyle with a healthy, varied diet, enough sleep and breaks, sufficient exercise and sport, an active social life and little (negative) stress is a good basis for a healthy mind. However, it is not a guarantee of avoiding mental illnesses such as panic disorders.

If there is a (familial) risk of panic attacks or if an attack has already occurred, smoking and large amounts of alcohol and caffeine (coffee, tea, cola, energy drinks) should be avoided. The same goes for drugs. Medication should always be taken exactly as prescribed by the doctor. Learning a relaxation technique is also useful.

In principle, specific anxiety situations (provided they do not pose any real dangers) should not be avoided, as this increases the likelihood of further panic attacks.

In order to be able to establish connections with internal and external influences (and to be able to discuss them with the treating doctor or therapist), a diary is helpful in which panic attacks that have occurred and their precise accompanying circumstances are noted.

Relatives, friends and colleagues as well as all treating doctors and therapists should be informed about the tendency to panic attacks.

Experts advise:

  • to consciously allow the attack so that it loses its threat

  • distract yourself: observe the surroundings, drink water, look at photos on the smartphone

  • Concentrate on breathing: inhale deeply into your stomach through your nose and exhale longer through your mouth

  • Laugh out loud: even an artificial laugh sends a relaxation signal to the brain, which can help alleviate the panic attack

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