A panic attack is usually a sudden episode involving various symptoms associated with an intense fear of dying, fainting, losing control of one’s actions, or losing control of one’s thoughts.
The most common symptoms are:
- Palpitations/rapid heartbeat, difficulty breathing/shortness of breath/a feeling of suffocation, a sensation of pressure in the chest or of the chest “sinking.”
- Cramping or discomfort around the stomach, abdominal tension, an urge to urinate or defecate, nausea.
- A feeling of swaying or instability, a sensation of having a “confused head” or an “empty head,” tinnitus (ringing or buzzing in the ears), a feeling of being unable to walk properly or of sinking. Tingling, numbness in parts of the body, including the head or tongue, sensations like “pins and needles,” muscle tension or a feeling that the muscles are weak or sore, sudden fatigue, internal trembling, sweating.
In theory, all of these symptoms can result from many different causes, and taken individually they do not clarify the nature of the disorder.
During panic attacks, however, none of the things that the symptoms might suggest usually actually occurs: there is generally no heart attack, the person does not lose consciousness—or not completely—does not suffocate, does not vomit, and so on.
Some signs, such as an increased heart rate, pallor, or high blood pressure, have no specific meaning in themselves.
After the attack, people generally feel exhausted and confused. It may be difficult to concentrate or to continue whatever they were doing. They may then feel melancholy, become prone to crying for no apparent reason, or feel irritable.
Usually, fear is the predominant symptom, and the fear that another attack will occur remains strong, even if no further attack occurs in the following days.
After the first attacks, the person tends to adopt defensive behaviors, withdraw, limit their movements, or take precautions so that they can receive help if necessary. They may avoid ever being alone, entering or remaining in enclosed and crowded places, or going into open and isolated spaces.
This is what is known as agoraphobia, which can force a person into a secluded or severely restricted life, marked by the need to avoid a range of situations in which another attack might occur or in which they fear they might become unwell.
The Scream by Edvard Munch
Within these limits, the attacks may also stop occurring or become less severe, but the person becomes a prisoner of the anxiety that another attack might return and is no longer completely free or independent.
For long periods, the person may become convinced that something is physically wrong with them and undergo repeated medical tests, with the concern returning every time another attack occurs.
People who have been agoraphobic for years may resist treatment because they have become terrified of doing things that they have long since excluded from their lives, and even thinking about them can evoke a feeling of fear—for example, traveling or sleeping alone.
Panic disorder is treatable.
If a person has not been independent for many years, once treatment has been started it is necessary to gradually expose them to the situations they fear, while maintaining pharmacological treatment, in order to overcome the conditioning that has developed over time, once the attacks have been “blocked.”