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 reported for
anxiety
attacks every year. The numbers have experienced a 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
reported for
anxiety
attacks every year. The numbers have experienced a . 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.