A panic attack can be described as a situation wherein one experiences a sudden episode of severe apprehension, triggering a variety of bodily as well as psychological responses in the body. Tightening of the chest, feeling dizzy, difficulty breathing, palpitations, nausea are some of the many overt symptoms seen in an individual experiencing it.
Along with these vulnerabilities also comes the panic attack symptoms, such as, elevated sense of vigilance, being extremely anxious, irrational thinking, feelings of detachment from reality, fear of death etc. Over the years, researchers have found that panic attacks can be set off or triggered by a range of factors such as stress, any traumatic experience from the past, use of addictive substances like marijuana, cocaine, benzodiazepines etc, amongst many others.
Often wrongfully used interchangeably, there exists a stark difference between anxiety and a panic attack. The duration, impact and severity are the key factors that differentiate the two. Normal anxiety is usually moderate in nature and is pretty manageable, a panic episode on the other hand, has the power to cause severe disruption in a person s life as the symptoms are far more intense and occur suddenly without any warning. In order to manage these attacks, it is often required for a person to either seek therapy or rely on prescribed medications.
Understanding the science behind panic attacks gives insight into the extreme physical and emotional experiences individuals endure during these episodes. What happens during a panic attack, the body s "fight-or-flight" reaction is enacted without impending risk, resulting in a surge of adrenaline. This chemical speeds up the heartbeat, increases breathing rate, and might in fact cause dizziness, all as a survival component intended for real dangers. However, during a panic attack, these reactions can feel overwhelming and add to the distressing sensations that sufferers experience.
The science behind panic attacks also helps to explain why they can occur so unexpectedly and feel out of control. As adrenaline flows through the body, it can cause physical symptoms, for example, chest pain, sweating, and nausea, which might emulate those of heart attack. This misconception frequently intensifies the fear, prompting even more anxiety. Researches show that understanding these physical responses as a feature of the panic reaction can really assist people with feeling more in control and reduce the fear related to future episodes.
The Body’s Alarm System: How the Fight or Flight Response is Triggered
What happens during a panic attack, the sympathetic nervous system (SNS) is responsible for putting the systems of our body on alert. It prepares us to either fight the perceived danger or flee from the situation. This phenomenon unfolds when the amygdala in our brain, through the sensory input received by our body, detects the potential threat and signals the hypothalamus, activating the adrenal medulla and sympathetic nervous system. After which various stress hormones such as adrenaline (epinephrine) and norepinephrine are released from the adrenal glands. When activated, our body starts to experience many physiological changes. Our lungs start expanding to allow in more amounts of oxygen, in order to better facilitate the delivery of oxygen to the muscles. The blood in our body is also deflected and redirected to other crucial organs like the muscles, heart and lungs. Apart from all these changes, the sensory processing is also elevated leading to quicker reactions.
Panic attack symptoms can be sudden and intense, frequently triggering an overwhelming physical reaction. The body s reaction to panic attacks includes enacting the sympathetic nervous system, delivering adrenaline and planning for a "fight or flight" response. This response, despite the fact that it is established in survival mechanisms, is frequently disproportionate to the situation, causing a scope of sensations that feel uncontrollable and troubling.
Hormonal Changes
Apart from adrenaline, other hormones in our body are also just as vital in controlling our stress response. The primary role of Adrenocorticotropic hormone (ACTH) during a panic attack is to stimulate the outer part of the adrenal glands known as the adrenal cortex, responsible for releasing the body s key stress hormone, known as cortisol. When responding to stress, ACTH elevates the availability of energy in the body, via cortisol. However, there can be a dysregulated response in the Hypothalamic-Pituitary-Adrenal (HPA) axis in the person experiencing an episode, resulting in an abnormally high ACTH level, increasing the duration as well as intensity of the symptoms of a panic attack.
A study conducted by Abelson and others in the year 2007 explored the relationship between different hormones and panic disorder. They evaluated patients suffering from panic disorder in three different conditions, at rest, before and after effects of doxapram (stimulant) and cholecystokinin (agonist). The results showed that patients with activated doxapram in their body had elevated levels of cortisol and ACTH as compared to the ones at rest. It was also determined that the findings of this study were consistent with the conclusion that the dysregulation in the HPA axis during PD is commonly due to vulnerability to certain contextual cues.
The Role of the Brain
Amygdala: The amygdala, located deep within our brain, is an almond shaped structure especially in charge of processing the emotion of fear. In the individuals who are prone to panic attacks, there are times when the amygdala may become hyperactive, where even the normal environmental cues or sensations can trigger the fight or flight response. This alone can initiate a panic episode even when there is no danger.
Prefrontal Cortex (PFC): The front part of the brain, involved in functions such as reasoning, decision making and emotion regulation is known as the prefrontal cortex. It helps deal with assessing if the situation our body is exposed to is truly threatening. However, the ability of the PFC to calm the brain may struggle to curb the distress signals triggered by the amygdala with its rational thinking, in turn, making the attack persist longer.
Hippocampus: This part of the brain, responsible for the formation of our memory, becomes hyper-sensitized to specific environments and associates them with the panic episode that might have occurred in the past. This leads to a person falling into the never-ending loop of anticipating the future attack, making them even more anxious and vulnerable to more episodes in the near future.
The Role of Adrenaline
Learning how the body response to panic attacks can be engaging for people who experience the effects of them frequently. When the body’s Sympathetic Nervous System is activated in order to prepare the body for responding to a perceived threat, the adrenaline is released. Despite the fact that panic attacks may take place in the absence of an actual danger, the amygdala, located in our brain, can also mistakenly interpret the sensations that are normal (e.g. shallow breathing ) as a sign of a potential threat, leading to adrenaline being released. While experiencing a panic attack, people frequently notice symptoms like a rapid heartbeat, shortness of breath, and sweating. These are important for the body s response to panic attacks as it endeavors to adapt to perceived risk. Despite the fact that there s typically no genuine danger, the body s intense reaction can be physically exhausting, driving certain individuals to mistakenly accept they are having a health related crisis.Apart from rapid breathing, elevated blood pressure, increased blood flow and heart rate, adrenaline also causes the dilation of our pupils, wherein they become larger, in turn improving our vision to better focus on the danger.
Heart Palpitations and Shortness of Breath: Cardiac Response to Panic
When we suffer a panic attack, the release of the stress hormone called Adrenaline, causes our heart to beat more forcefully and at a much faster pace. This sensation is known as heart palpitations, a feeling of irregular and extremely fast heart beat. In many cases, individuals have described it as if their heart is “skipping beats” or “racing”. This is when our heart rate exceeds the normal 60-100 beats per minute.
Shortness of breath, on the other hand, happens when the phenomenon of bronchodilation takes place after the airways in the lungs dilate to allow the intake of increased levels of oxygen. This may prove to be useful during a physical activity, however, in case of a panic attack, our body might go into overdrive, ultimately leading to hyperventilation or a sensation of suffocation or choking. In a few cases, pain in the chest or tightness may occur during an episode, further increasing the sense of breathlessness. The cause behind this is the combination of muscle tension, increased heartbeat and rapid breathing which can lead to a situation called Hypercapnia, wherein the level of carbon dioxide in the blood starts to diminish leading a sense of dizziness
Digestive Distress
Digestive issues and panic attacks usually go hand in hand due to the gut-brain axis, which is the linkage between the CNS and ENS (enteric nervous system) located in our digestive system. So what happens during a panic attack, the functioning of the gut is influenced by the signals sent by the brain. Similarly, the feelings of discomfort, fear and anxiety are elevated after the signals from the digestive area experiencing issues are sent to and received by the brain. For instance, if an individual experiences nausea during an attack, they are very likely to fear future episodes, which in turn hightenes their stress and apprehension creating more issues in the gut, leading to a vicious cycle that is extremely hard to break. Irritable bowel syndrome (IBS) has also been found to be very common in people with panic disorder. Some of its symptoms include bloating , constipation, pain in the abdomen as well as diarrhea.
A better understanding of the relationship between gut problems and panic attacks can be gained by reviewing a study conducted by Kalpan, Masand and Gupta (2011), aimed at determining the prevalence of Irritable Bowel Syndrome (IBS) in adults. The participants were divided into two groups, one with forty-one patients that were seeking treatment for panic disorder and a control group of another forty patients wanting treatment for other medical issues. The findings suggested that groups with patients suffering from Irritable Bowel Syndrome as well as panic disorder were more likely to display symptoms of back pain as well as a history of bowel issues compared to the ones with panic disorder but without IBS. It was concluded that IBS is common in people searching for treatment of panic disorder.
Long Term Physical and Emotional Exhaustion
After the triggering of the fight-or-flight response, elevation of our heart rate can make us feel drained afterward. As we hyperventilate our chest feels like it s tightening or closing up, our muscles also tense up and that leads us to feeling sore from holding on to that tension. The rush of adrenaline may cause trembling or shaking that are involuntary in nature. Along with feeling helpless and emotionally exhausted during a panic attack, we might become hyper-sensitive to the sensations in the body as well as the thoughts in the head. This intense alertness can lead to us feeling like we are being drained out mentally. Even after the episode has occurred, the emotions felt during it can still persist. The feelings of guilt, embarrassment or worry with regard to when the next panic attack might take place, can aggravate the already existing emotional exhaustion.