What causes panic attacks?
There is no specific known psychological reason for panic attacks, including the supposedly “hidden” ones which, precisely because they are “hidden,” no one can establish with certainty or demonstrate to be meaningful.
Over time, many people become discouraged by the limitations caused by panic and convince themselves that they have more or less complex and particular problems with various situations, or that they are generally “fearful” people.
Panic is a disorder in which an alarm reaction develops through a mechanism that uses the brain’s natural alarm system, which is connected to the entire organism, but causes it to go off too often and “for no reason.”
Why do people suffer from panic even when they have no particular problems in their lives?
Panic is, by definition, “without a reason.” It has no specific object.
Fear of fainting, dying, suffocating, being unable to breathe, losing control of oneself or one’s consciousness, “exploding”—these are some of the sensations or ideas associated with a panic attack. They either refer to symptoms of the attack itself (for example, a feeling of suffocation or faintness), or they are more generally fears of losing control, as when someone experiences an acute physical illness.
Life events are not absolutely decisive, whereas changes in environment often are. When people change their surroundings, move house, or move away from their place of origin for educational, family, or work-related reasons, they may develop panic attacks. This can happen even when the change is positive and the person has adapted well.
How can you tell whether certain symptoms are “just panic” or whether something is physically wrong?
This is the wrong question.
Panic originates in the brain and is therefore “physical.” Panic has its own specific symptoms: those of fear and of the body’s adaptive responses to fear, as well as the ways in which these symptoms are reported, recalled, and subsequently feared.
A diagnosis by exclusion is common, but it is not the most appropriate way of approaching the problem. The diagnosis of panic is based first on the symptoms of panic and then on excluding any other hypotheses that may arise from those symptoms.
How can an attack be controlled?
The attack essentially controls itself, in the sense that it eventually stops.
Many people are convinced that they are able to control their attacks because they sometimes use certain methods and do not have an attack. Typically, however, these are methods that seem to work sometimes and not others.
Certainly, anyone who has experienced severe attacks has not, during the attack itself, been able to find a way to make it stop or even reliably reduce its intensity.
Naturally, if one waits, the attacks pass. But they last long enough to make the person fear that they will never end, or that they will cause death or insanity.
The most common fears are that, even if the episode is “only panic,” the attack might strain and stress the heart, lungs, or brain to the point of actually causing a heart attack, suffocation, and so on. The stronger the attack, the more uncontrollable these fears become.
The severity of an attack is measured precisely in terms of the intensity of the fear.
When people are being treated for panic, especially at the beginning, they may occasionally experience episodes with the same symptoms as before but without the fear. They therefore describe them with a certain detachment, as though they were different phenomena: panic “without the panic.”
There are techniques for managing the fear of having an attack and for dealing with the period after an attack. As for preventing attacks, there are specific and relatively straightforward treatments.
What is the purpose of an anxiolytic?
An anxiolytic is used to eliminate the fear of having a panic attack.
When a person takes an anxiolytic to control their heart or breathing, what they are essentially doing is reducing the fear associated with that symptom, or the attention focused on that particular part of the body.
Many attacks involve a sensation of the heart pounding or racing, but the heartbeat is then essentially normal, and above all similar to what occurs when one is running, exercising, or experiencing any strong emotion.
All of these situations involve bodily parameters that are very similar to those of panic. What is missing is the fear—the alarm.
For many people, an anxiolytic helps eliminate the fear of having an attack and therefore allows them to leave the house, go to work, travel, move around, take planes, trains, cable cars, and so on.
Unfortunately, anxiolytic medication is often left in the patient’s hands, and the person usually ends up taking it frequently or regularly, remaining convinced that it has a preventive or attack-controlling effect. In this way, they may lose the ability to learn that they can tolerate anxiety without it developing into panic.
A dependence on the anxiolytic can consequently develop, in which the person mistakenly believes that they do not have panic because they take the medication, or because they have taken it shortly beforehand. They may then take it without any longer understanding when or at what point symptoms may precede panic, simply to keep the fear of having an attack under control.
Don’t panic attacks go away on their own?
Often they do.
The problem is that they frequently end in a pathological way, meaning that a limitation develops as a result.
Beginning to avoid a range of situations is a spontaneous way of trying to prevent attacks. Many people, for example, give up career or leisure opportunities, or simply the freedom to be able to go anywhere alone, because the fear of having a panic attack never leaves them.
Some people organize their lives so that they almost never need to expose themselves to feared situations. Others become dependent on someone accompanying them everywhere. They do not drive, do not remain alone in unfamiliar places, or do not use public transportation for long journeys.
Some people begin to abuse tranquilizers or alcohol, the two substances most commonly used among people with anxiety.
Alcohol use, for example, is common among people who have to travel for work and use it in an attempt to control their fear of panic.
When should panic disorder be treated?
Many people have experienced isolated panic attacks at some point in their lives, or attacks occurring over brief periods without any consequences for their behavior.
Having panic attacks therefore does not automatically mean having “panic disorder.”
For panic disorder to be present—and therefore for it to be treated as such—the attacks must either be frequent or have conditioned the person’s behavior, even if the attacks themselves are not frequent.
Once this diagnosis has been established, there are a number of treatment options, and the general rule is that treating the disorder as early as possible is advisable.
Shouldn’t we understand the deeper causes of panic rather than simply treating its symptoms?
First of all, there are no known “deep causes” in the sense of complex explanations that can be derived from reasoning about past traumas.
The fears are more likely to be the result of the disorder.
Secondly, treatments do not merely treat the symptoms. They act on the mechanism that reproduces the attacks.
Treatment does not consist of learning how to manage, resist, or push away the attacks, because doing so does not make them disappear—and in any case, it is not possible to control them in that way.
Why are people with panic afraid of seeking treatment, and why are they often terrified by the idea of taking “psychiatric drugs”?
This happens because people with panic fear being at the mercy of uncontrollable effects, as though any unfamiliar substance or object might trigger violent, uncontrollable, and potentially dangerous reactions in their bodies.
Medication is therefore initially viewed with suspicion.
At the beginning of treatment, anti-panic medications often do not relieve symptoms immediately. They do so over a period of approximately 2–4 weeks, and during the first few days attacks may continue to occur, or may even become more frequent or present with different symptoms.
After this initial phase, the medication’s actual therapeutic effect becomes established.
Because it is not an anxiolytic that acts immediately to dampen anxiety, a preventive anti-panic medication may actually increase anxiety at first. This may happen partly because it stimulates certain symptoms before subsequently doing the opposite—suppressing them—and partly because the person expects to see an effect immediately, whereas this does not happen.
How much does willpower matter?
It does not correspond to anything clinically meaningful.
So-called willpower is a “luxury” available to someone who is not ill, or whose illness is not severe.
Many people like to think that they were seriously ill, or like to tell the story that way, and that they recovered through willpower. They are free to think so and to tell whatever story they prefer.
However, when such cases are reconstructed in detail, they often do not meet the criteria for full severity. Above all, if the person has retained the ability to manage their crises and continue exposing themselves to feared situations, this is less an indication of an effective reaction to the disorder than a sign that the disorder was relatively limited in severity.
Therefore, one’s willpower should be applied to treatment: being patient and overcoming the discomfort associated with having to seek and undergo treatment.
How long does it take to recover from panic disorder?
The effect of medication on panic attacks is usually assessed over a period of 1–3 months.
The resumption of normal activities may occur immediately or gradually over the following months, sometimes with temporary “blocks” involving specific situations that are particularly feared.