WTF Is a Panic Attack?

Yeah, I know you can hit up WebMD for the definition and clinical symptoms, but that’s not what this is for. First, I want to explain to non-sufferers why these are such a big deal. No, your loved one isn’t just being melodramatic. Second, I want to explain to those with panic disorder why, exactly, your brain is being such an asshole. As always, it means well.

A panic attack is, for a short time, the worst thing in the fucking world. It’s a near-death experience, just as truly as if you had been pinned under a semi and weren’t quite sure whether you still had legs. Your brain and body, joined together as if in some sort of conspiracy, are both reporting imminent doom.

The Positive Feedback Loop

A quick point about something called “positive feedback.” This is a mechanism that your body uses to get results, feeding escalating responses back and forth between two or more internal structures, even if it has to completely ignore your discomfort to do so. My favorite example is, of course, pooping.

As your rectum fills with feces (stay with me), this pressure prompts rectal contractions. These contractions increase intrarectal pressure further, prompting more contractions, which increase pressure, which prompts contractions… you get the idea. Eventually you void your bowels, the crisis in your colon is over, the positive feedback loop breaks, and you get to go on with your day. Added without comment: This is oddly similar to the process of giving birth.

Other positive feedback loops in our body are things like puking, diarrhea, fever, and inflammation. The body has a job to do, so it’s going to make the situation more and more extreme until it gets its way.

Sometimes, unfortunately, the body doesn’t know when to stop. Fever can easily braise your brain. Diarrhea is a leading cause of death in the developing world. The body means well, trying to get rid of poison, or kill a pathogen, but it ends up doing something really dumb.

Panic attacks are the result of positive feedback between the body and brain. They feed on each other’s symptoms, putting you in a severe state of crisis. Each gets more and more freaked out, until finally, blessedly, the body-mind apparatus puts on the brakes (something called negative feedback).

Panic Attacks and You

If you have panic disorder, you may need to skip the next few paragraphs. If you choose to push through, I’ve included pictures of pugs to help you along.

Most panic attacks, from the perspective of the sufferer, start in the body. It might be a fluttering of the heart, or a tightness in the chest or throat. This is followed by a cascade of events which can include sweating, light-headedness, perceived constriction of the air passageways, and even physical pain.

Any of these symptoms can be horrific. Imagine being fine one moment, and feeling like the world was ending the next. Imagine everything going wrong simultaneously.

Photo credit: Rick Harris

As this chain of events proceeds, from the perspective of the sufferer, the mind reacts with panic. A sense of dread takes hold, a feeling of impending doom that cannot be shaken off or ignored.

The brain, due to the perceived severity, gives the physical symptoms incredibly high priority. It’s not just “heart fluttering” and “chest tightness”; for those 5 or 10 or 30 minutes, it feels like a heart attack. That wheezing in your chest isn’t just a paradoxical stress response, it feels like drowning.

Photo credit: DaPuglet

Basically, you feel like you’re dying. You feel like it really hard, and no amount of cajoling, convincing, or exhortations to “just breathe” will help. Indeed, these episodes tend to run a certain course: Escalating until they’re unbearable, and then finally leaving the victim exhausted.

Photo credit: Kyle Nabilcy

The Sympathy Conspiracy

So, it seems like severe physical symptoms are causing extreme distress, but that’s not quite right. What’s really happening is based on something that exists in your body for a reason: sympathetic nervous system (SNS) arousal.

I don’t want to get too technical, so I’m going to simplify this a bit. In your body, you’ve got two… fairies… named Sympathy and Parasympathy. They’re sisters.

Parasympathy is the fairy of relaxation and digestion. As she flits gracefully from organ to organ, she keeps your heartbeat slow and even, she helps your intestines move food along, and she allows your internal anal sphincter to open. Whenever you see someone whom you really like, she sprinkles fairy dust on the erectile tissue of your genitals, allowing you to achieve penile or clitoral turgidity.

As you go to sleep, she applies magic kisses to your eyelids so that you dream of bubblegum rainbows and cotton candy volcanoes. She emerges from the cranial and sacral portions of the central nervous system, innervating your visceral organs and inhibiting production of epinephrine and norepinephrine.

Sympathy is the fairy of hard work, stress, and fear. When you work out, she speeds up your heartbeat and your breathing so that you can run far and fast. When something terrible happens, Sympathy sings a magic song to your adrenal glands until they produce a potion called adrenaline.

This potion gives you super strength and speed, letting you bound lithely away from bullies, or smash their heads in with a tire iron. She wings her way ’round and ’round your digestive organs, turning them off until you’ve gotten back to a safe place and washed the blood off of your shaking hands. Sympathy emerges from the thoracic and lumbar regions of your spine, innervates your viscera, and is associated with the fight or flight response. She’s also responsible for orgasms.

Photo credit: Mark Houchin

Summoning Sympathy

Sympathy (your sympathetic nervous system) responds to both your body and your mind. When you see a snake (and yes, we do have a bit of our brain that can recognize snakes from birth), your brain tells your adrenals to kick into gear so that you can leg it. When you receive a painful or jarring stimulus to your body, the same thing happens, even if you don’t know what caused it.

The shitty thing is this: The symptoms of stress are stressful. Adrenaline causes the subjective experience of fear, fear causes the release of adrenaline, which causes more fear, which causes… sound familiar? This is a positive feedback loop. The body has a goal in mind (escape from a snake, neutralize a threat, complete a physically demanding task), and it won’t break the cycle until it senses that you’re out of the situation.

This, my dear friends, is what causes panic attacks. They probably don’t start with physical symptoms. Most likely, you’re stressed out to begin with. You’ve got anxiety. This causes a release of adrenaline, which is largely invisible to your conscious mind. Happens all the time. You only notice once your heart starts racing in response to the stress hormones coursing through your body.

At this point, most people will experience negative feedback: They’ll sense their stress levels rising, and they’ll do something to alleviate the stress. They’ll take a breather, or allow their attention to wander elsewhere.

In someone with panic disorder, this is still usually what happens. Occasionally, however, they will experience an irrational fear of the stress symptoms. This is where the disorder kicks in.

What the fuck is with my heart?” says the brain, causing a fresh flood of adrenal juices to hit your bloodstream. This causes the symptoms to escalate, which alarms the brain even further. By the time the two teams are done hitting the birdie back and forth, you’re huddled in a corner with wide eyes and a fresh appreciation for the ability to take a normal breath.

What To Do?

Here’s what you don’t do: You don’t ignore them and hope they stop happening. Every time you have a panic attack, you’re experiencing massively aversive conditioning to whatever is happening alongside the panic attack. Out on a date while it happens? The dating scene might start seeming less attractive for a while. In an elevator? Time to take the stairs for a few years. Seriously, this is how some phobias start.

This is yet another example of the brain doing something stupid while meaning well. This is classical (or Pavlovian) conditioning, where two situations or feelings get tied together in the brain. Usually this is fine: If you experience pain from touching fire, it’s not a mistake you’ll make twice. If you barf (positive feedback loop!) after eating at a cheap country buffet, you might consider controlling your portion sizes next time. The same happens with happy feelings, and might have something to do with how we fall in love. Thanks, Pavlov!

Panic attacks can seriously screw with your life if you let them gradually reduce your comfort bubble. First you go out less, then you call in sick more, then you start collecting cat figurines and make them act out little playlets.

Here are some steps to take:

  1. Deal with anxiety. Exercise. Meditate. Talk to your boss or teachers about how you can manage your workload without stressing so hard.
  2. Get medicated. The right medication, taken when you start feeling panicky, can actually stop an attack in its tracks. Other meds can reduce your overall anxiety levels, which may prevent panic episodes altogether.
  3. Consider talk therapy. Cognitive Behavioral Therapy has been proven effective for panic attacks, as have things like exposure therapy. Even outside of specific techniques, talking to a trained professional can help you determine the precipitating factors that lead to your panic episodes.
  4. Consider the feedback loop. Anything that you can do to reduce the physical or mental symptoms will be effective, if you can find the right strategies. I plan to release a meditation soon for use during a panic attack, as nutty as that sounds. We’ll see if it works.

Panic Sucks

Panic disorder sucks, and I hope that the non-sufferers in our audience are starting to realize why. For those of you living with it, keep making strides, work with your anxiety, and don’t lose heart. Your body and mind mean well, and soon you’ll start finding ways to throw a wrench in that positive feedback loop. As always, be kind to yourself.

Hit me with some feedback in the comments. Have I left anything out? Does this seem true to you? Was the fairy thing too much? Let me know!

5 thoughts on “WTF Is a Panic Attack?

  1. I, like your Aunt Candy, had written an entire PAGE of advice, etc… pertaining to your awesome blog here, only to have it inexplicably disappear never to be found again! Too bad, too, ’cause it was absolutely STELLAR! What a crying shame ~ Amy Harvey ;'(

  2. Hi! I just found your site through your youtube vids. A lot of your advice has already helped me (TMJ and anxiety blah)….brownie points for the pug pics too 🙂

  3. Hahaha – The fairies were definitely NOT too much. In fact, there are now quite a few things I’ll never view quite the same way! Seems exactly right from my perspective. Thanks for the pugs 🙂 Distractions are absolutely necessary.

  4. I had one few months ago, and i didn’t even know it was a panic attack that i’m having actually…i just thought that i’m dying of some heart condition. I do have a mitral valve prolapse, and it was a bad day with some bad weather, and i felt MVP even more…so that’s what triggered the attack, i found only later…After that, i love myself and all life even more, and i don’t want to experience this ever again. It is the most terrifying thing you can imagine…I couldn’t believe that i survived, i thought that it’s over…i was sure 100% that i won’t make it…so you can imagine how bad it is. Terrible near death experience that certainly changes your life. I’m not the same after that.

  5. Tried to have an mri and freaked out. Having it again Thursday and still freaking the F out. Any suggestions? They will be sedating me this time and still afraid of waking up in that damn tube. Argh

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