Panic attacks: signs, symptoms, causes

Medical information is reliable Checked by Shaidullin Renat Flyurovich

Panic attacks are attacks that occur unpredictably, accompanied by severe fear and anxiety. They are characterized by vegetative symptoms: increased sweating, chills, hot flashes, difficulty breathing, rapid heartbeat and others. It all depends on the individual characteristics of the body and the level of anxiety. If a person is in good health, he does not complain of weakness, and is not registered in the hospital - this condition is easier to tolerate.

The diagnosis is made on the basis of the clinical picture, if somatic pathology leading to similar attacks is excluded. The treatment of panic attacks at Dr. Isaev’s Clinic is complex, consisting of drug relief of symptoms and psychotherapeutic methods of influencing the patient. The period between crises can be kept under control if the patient is promptly trained in ways to independently overcome such a condition.

Our doctors work with patients anonymously. If you are afraid that your secret will leave the hospital, these fears are unfounded. We do not enter information into special databases and do not record the fact of contacting a psychiatrist. This means that people who contact us have no reason to worry about the confidentiality of facts relating to their mental state.

Signs of panic attacks

The term “panic attack” was introduced into medical use in 1980. Currently, it is included in the International Classification of Diseases; the patient is not able to independently cope with periodic attacks. He needs the help of a specialist; perhaps other pathologies will be identified during the examination.

A similar condition was previously considered within the framework of vegetative-vascular dystonia, but now this version is not relevant. The psychological factor is considered primary, and vegetative symptoms are considered secondary. Attacks are classified as neuroses, and the accompanying disorders at the physiological level are classified as autonomic dysfunction.

Panic paroxysms are common, especially common among residents of megacities. They experience frequent stress; the dynamic rhythm of life leaves no chance for relaxation and good sleep. The typical age for the first attack is between 25 and 45 years. In older people, panic paroxysms occur with less severe symptoms; they affect the emotional sphere to a greater extent.

What are panic attacks and their types

A panic attack is an inexplicable phenomenon of a severe attack of anxiety, fear, which is accompanied by other mental and autonomic symptoms. Some symptoms persist for a long time after the main symptoms disappear. This is an anxiety disorder of a neurotic level associated with stress. The condition can be an independent disease or a symptom of a mental disorder.

There are several types of panic attacks:

• attributive – attacks are associated with specific phenomena;
• not associated – attacks are spontaneous and not associated with stress factors;
• atypical.

Panic attack symptoms

A sudden and uncontrollable attack of anxiety with various somatic disorders indicates a disorder of the nervous system. If a person is in danger or feels his life is threatened, he has a peculiar reaction to a stressful situation. Increased heart rate, trembling in the limbs, vomiting - for such a case this is the norm. As soon as the danger passes, all physiological disturbances disappear and the condition returns to normal.

The difference between a panic attack is that the patient cannot explain its cause. Such attacks often begin in places where there are large crowds of people. This can happen on the subway, in a store, or on the street. Panic often occurs in a confined space, its intensity varies. If paroxysms are observed frequently and are regular, the patient may have a more serious mental disorder that requires immediate diagnosis and treatment.

Typical symptoms of panic attacks include:

• fear of death - it seems to a person that he will die right now, without having time to do what seems so necessary to him;
• a feeling of doom and unreality of what is happening;
• general physical weakness, infirmity;
• loss of control over your thoughts and actions;
• rapid heartbeat, there is a feeling that the heart is actually jumping out of the chest, that it cannot cope with the load and will stop;
• numbness of the limbs;
• nausea and vomiting;
• chills, fever;
• dizziness;
• increased sweating;
• dry mouth;
• difficulty breathing, shortness of breath similar to an asthma attack

These symptoms can intensify, which brings significant discomfort to a person’s life. He cannot predict how each next attack will end, and is constantly worried about what others will think of him at this moment.

The average duration of a panic attack can take from 10 minutes to 1 hour, an acute state - about 15 minutes. After an attack, patients feel overwhelmed and empty, they cannot work or perform household duties, and want to retire and relax.

In some cases, the symptoms are accompanied by disturbances in the functioning of the gastrointestinal tract: heartburn, vomiting, nausea, pain in the epigastric region. Patients complain about the loss of a sense of their own “I”; the personality seems to be watching itself from the outside and cannot intervene. Sounds become muffled and objects around you become blurry.

Symptoms

A panic attack is an attack that can last from a few minutes to several hours. The average duration of one attack is 30 minutes. The frequency of attacks for some is 1-2 times a day, for others – several times during the month. But once a person experiences it, he will remember the attack for the rest of his life.

Mental

The mental symptoms of panic attacks are more pronounced. In some cases, a feeling of trouble and danger forces a person to hide and limit communication. The attack is accompanied by the following symptoms:

• panic;
• fear;
• increased anxiety;
• confusion of thinking;
• feeling of a “lump in the throat”;
• impaired perception of reality;
• loss of control over one’s own actions and events;
• clouding of mind;
• a feeling of unreality of what is happening;
• rises in sleep, nightmares.

Physical

The cause of physical symptoms is stimulation of the autonomic nervous system, the release of adrenaline, norepinephrine, and dopamine into the blood. This causes the following symptoms to appear:

• hot or cold flashes;
• cardiopalmus;
• chills;
• increased body temperature;
• hand trembling;
• dyspnea;
• feeling of lack of air;
• hard breath;
• nausea, bowel dysfunction;
• increased urination;
• convulsions;
• blood pressure surges;
• temporary hearing and vision impairment;
• dry mouth;
• sweating

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Prerequisites and causes of panic attacks

There are several factors that can become prerequisites for the occurrence of such a condition.

• Genetic predisposition.

If the patient's close relatives suffered from uncontrollable attacks of anxiety and fear, there is a high probability that this disorder will manifest itself in adulthood.

• Severe stress.

Chronic nervous tension, constant quarrels and conflicts in the family or at work, divorce or the loss of a close relative lead to the emergence of inexplicable fear. This feeling is irrational, the patient often cannot explain why he experiences it, he has no objective reasons to be afraid.

• Thyroid gland dysfunction.

This organ is responsible for producing hormones that affect the condition of the body. Increased or decreased production of these substances provokes the occurrence of symptoms characteristic of panic attacks. Perhaps this is autonomic dysfunction that will not develop into paroxysm; in any case, a thorough examination is necessary.

• Low self-esteem.

If a person is guided by the opinions of strangers, is afraid of disgracing himself in society, is a suspicious person, he belongs to the risk group.

• Uncontrolled use of medications.

Often, in order to normalize their condition, patients use various medications - sedatives, sedatives, and blood pressure lowerers. The availability of such drugs and the lack of need for a prescription leads to the constant use of questionable self-prescribed drugs. If a certain dose does not help, the patient increases it, thereby harming his body. Negative consequences include exhaustion of the nervous system and frequent disruptions in its functioning. Also, mental disorders are a consequence of regular consumption of large volumes of energy drinks or drinks that contain a high percentage of caffeine - black tea, natural coffee.

• Alcohol.

Chronic addiction disrupts the functioning of the entire body, primarily affecting the nervous system. In the morning after drinking a large dose of alcohol, a feeling of irrational fear may arise. It often accompanies asthenic syndrome, in which all the patient’s thoughts are only about the next portion of alcohol. Panic attacks caused by alcoholism do not go away on their own; only qualified medical help will help you get rid of paroxysms and overcome addiction.

• Sleep disturbances.

If a person is awake at night and constantly lacks sleep, this depletes the nervous system. It begins to malfunction and gives incorrect commands to the body, which are expressed in fear and anxiety for no reason. Experts recommend sleeping at night; the daily sleep requirement is at least 8 hours. Daytime sleep for 1-2 hours is allowed; it is important during the period of recovery of the body.

• Phobias.

These are mental disorders in which a person is afraid of something specific. This could be a fear of heights, enclosed spaces, or places with large crowds of people. It is impossible to get rid of them on your own; you need the help of a psychologist or psychotherapist; in advanced conditions, you need to consult a psychiatrist.

Also among the possible causes of panic attacks are mental disorders; in this case, PA develops as a secondary disorder. For such conditions, a specific treatment regimen is selected.

If you do not consult a doctor in a timely manner, the intensity of symptoms increases with each new attack. As a result, a person strives for social isolation; the only true way out for him is the decision to stay at home and not go out. Our doctors will teach the patient to cope with attacks, he will be able to fully prepare for the onset of a panic attack, and will not be afraid of embarrassing himself in front of others.

Panic attack in a dream

Panic attacks in sleep are a separate type of disorder that occurs at night, in silence. At this time, a person tends to concentrate his attention on certain actions and moments, often negative, that provoke an attack. Another cause of a panic attack during sleep can be a nightmare. Most often, anxiety and fear overtake a person between 24 and 4 hours.

The following symptoms are typical for a panic attack during sleep:

• awakening;
• fear, horror;
• a sharp jump in body temperature;
• respiratory spasms;
• violation of orientation in space;
• chills;
• the appearance of cold sweat;
• involuntary urination;
• nausea, diarrhea;
• short-term paralysis of part or all of the body.

As the severity of the attack decreases and awakening, traces of fear and horror gradually fade away, leaving behind confusion and anxiety.

Night attacks significantly undermine a person’s health, since insufficient rest provokes headaches, chronic fatigue, decreased concentration, nervousness, and irritability. Over time, insufficient rest becomes the cause of depressive disorders, and the regularity of panic attacks increases. This provokes the formation of phobias.

What happens during an attack

The patient’s first attacks occur after a strong emotional shock; it is this that provokes the severity of the disease increasing each time. Next, a certain trigger is needed for the paroxysm to take possession of the person again.

A similar factor may be close contact with other people, strong sound or unpleasant smell. Most often, triggers are associated with a traumatic situation. At first, the heart rate increases, the sweat glands begin to work to the maximum. They produce a large amount of sweat, perspiration appears on the forehead, and their hands become damp.

After a few minutes, panic sets in, the manifestation of which will vary from person to person. Some experience a strange feeling of confusion, forget where they are going, others are overcome by severe fear. They seem to freeze in one place, not finding the strength to make any movement.

The attack can last several minutes, for some it ends after one or two hours. The specificity of PA is the high rate of increase in symptoms. After the first attack, there is constant anxiety and concern for one’s health on a subconscious level. All organs and systems can operate uninterruptedly. Our clinic provides treatment for mental disorders; here you can undergo treatment for mental retardation and schizophrenia, and receive professional help in correcting the consequences of dementia and other pathologies.

Mechanism of attack

The human brain reacts to external stimuli in different ways, but triggers a single defense mechanism at the first sign of approaching danger. During a panic attack, a threat is signaled even if it does not actually exist. Tension in all parts of the nervous system increases fear. On a physiological level, this manifests itself in the production of large amounts of the stress hormone (cortisol), followed by a powerful surge of adrenaline.

The brain gives a command to the body to save life in any way, increasing the intensity of the manifestation of physical symptoms. If the threat is real, such hormonal surges can make a person stronger and more resilient, in this state he can do a lot. But if this happens in a state of rest, when there is no need to run anywhere and defend yourself, then there is a negative impact on mental health. The danger lies in losing control over your actions and thoughts.

Causes of panic attacks

Panic attacks are traditionally provoked by physiological, biological and psychogenic factors. Often there is a combination of factors, one of which causes the initial attack, and others – its relapses.

Physiogenic triggers appear as a result of physical overload, high insolation, acclimatization, meteorological fluctuations, drug use, etc. Some medications can also, to one degree or another, affect the occurrence of panic attacks: cholecystokinin (used in diagnosing the gastrointestinal tract), bemegride (added for induction of anesthesia), some types of steroids.

Patients prone to panic attacks mostly have similar character traits and personality traits. For men, this is an unusually reverent concern for their own health. Women have a desire to be in the center of attention, attracting interest to themselves, drama and excessive demonstrativeness. People who prioritize caring for others over being selfish about themselves have never experienced panic attacks.

What happens if PA is not treated?

Each subsequent attack is accompanied by more acute sensations. A person may develop a new phobia - a strong fear of repetition of paroxysms; he continues to live in constant tension, expecting the situation to worsen. Regardless of the intensity of the physiological symptoms, this disorder is not fatal. Treatment of panic attacks is necessary to prevent the development of phobias, increased anxiety and nervousness.

The patient begins to radically change his life and adapt to his condition. He avoids places with large crowds of people, supermarkets, and stops using any public transport. Gradually, such a person isolates himself from society, prefers not to engage in professional activities, and spends all his time indoors. He stops communicating on confidential topics with his loved ones, and there is a risk of developing serious mental complications. Patients with panic attacks often suffer from neurasthenia, neuroses, sleep disturbances, depression, and asthenia. The nervous system is exhausted, the person tries to relieve the symptoms with self-selected medications.

Regularly recurring attacks lead to loss of appetite and disruption of the functions of important organs, in particular the gastrointestinal tract. Conscious refusal of food leads to physical exhaustion. In this case, treatment of dystrophy is often required; this process is lengthy and is not always completed successfully. It all depends on the condition of the body, the presence of internal reserves to fight the disease.

Treatment

Panic attacks disrupt a person’s life and also cause complications. To prevent them and return to a full life without anxiety and fear, you need to seek help from a doctor. Various methods are used in treatment, but the most effective is the combination of psychotherapy with medications.

Is treatment possible at home?

You can cope with attacks yourself by following these recommendations:

• find an “anchor”, a support that will allow you to take a stable position;
• Do breathing exercises regularly, and during an attack you can use some exercises or simply breathe into a paper bag;
• wear a bracelet that can be pulled back during an attack - the blow shifts the focus of attention, distracts from the trigger;
• remember pleasant moments, persuade yourself to calm down, try to shift your attention from the cause of anxiety;
• don’t be shy about asking for help; you can also repeat the names and contact details of your relatives out loud, which will allow you to coordinate those who are trying to help.

These recommendations will only help you cope with the symptoms of attacks, and will also teach you how to control them.

To completely eliminate the causes of the disorder, you need medical help, physical activity, a balanced diet, sleep, and giving up bad habits. Sometimes changing your type of activity, place of residence, or life attitudes helps to cope with anxiety and fear.

Drug treatment

Drug therapy is prescribed by a psychotherapist based on the patient’s condition and the severity of the attacks. Today, pharmacotherapy in the CIS countries is considered the most accessible, but not the most effective, since medications only help eliminate symptoms, while the trigger remains. During treatment, the doctor may prescribe the following groups of medications:

• Sedatives. Their effectiveness in treating panic attacks has not been proven. However, having medications with a sedative effect on hand can reduce anxiety and distract you, since for some, taking medications is a ritual with a powerful sedative effect.
• Tranquilizers. They are able to quickly cope with anxiety symptoms, eliminate fear, and stabilize mood. However, drugs in this group have many contraindications. They are prescribed in short courses, and dosages are selected individually.
• Neuroleptics. Helps cope with vegetative and mental symptoms of attacks.
• Nootropics. The effectiveness of these drugs has not been proven. There is an opinion that the use of nootropics for panic attacks increases mental and autonomic symptoms.
• Antidepressants are a group of drugs that have proven effective in treating anxiety disorders. Doctors prefer selective serotonin reuptake inhibitors, which are relatively safe and have minimal contraindications. The duration of taking antidepressants is individual - the minimum course is a month, and the maximum is 1 year.

Psychotherapy

Psychotherapy together with drug treatment will not only alleviate the condition and help you endure attacks more easily, but will also help you find the cause of anxiety and fear and cope with them. Cognitive-behavioral practice is most effective in treating panic attacks.

During treatment, the psychotherapist will help:

• find the causes of fear, anxiety, as well as risk factors, teach you how to control them;
• analyze thoughts and reasoning that destroy a person;
• learn self-help techniques;
• adjust behavior;
• motivate for recovery;
• resolve internal conflicts.

In addition to cognitive behavioral therapy, the following will also be effective: family therapy, psychoanalysis, art therapy, music therapy, animal therapy. In severe cases, hypnosis may be prescribed.

Phytotherapy

To alleviate the condition during attacks or the appearance of causeless fear and anxiety, herbs that have a sedative effect can be used at home. These include chamomile, valerian, mint, lemon balm, motherwort, St. John's wort, and linden. Based on these herbs, you can prepare soothing teas and drink them with honey.

Herbal medicine is not an independent method of treating panic attacks and can only be used as an auxiliary measure.

Breathing exercises

Breathing exercises help you relax and breathe normally, deeply, which is necessary during an attack. They can be performed anywhere at any time, as no additional equipment is required. The exercise is performed as follows:

• place one hand on your chest, the other on your stomach;
• take a deep breath through your nose, increasing the size of your belly, while your chest should remain motionless;
• As you exhale, tighten your abdominal muscles, slowly releasing the air.

Diaphragmatic breathing helps not only to calm down and relax, but also to stabilize blood pressure and eliminate other vegetative symptoms.

During the exercise, you may experience weakness and slight dizziness, which is normal and is associated with a decrease in blood pressure.

Physical exercise

In the fight against stress and normalization of the functions of the autonomic system, physical activity is effective, which promotes the release of endorphins into the blood. It is useful for people suffering from panic attacks to ride a bicycle, rollerblade, walk in the fresh air, or swim.

Meditation to relaxing, pleasant music is also effective. It is not necessary to have special skills. It is enough to sit on the floor with a straight back and close your eyes. Next, concentrate on breathing and think about the good, that the panic attacks will subside and will no longer bother you.

With proper treatment with psychotherapy, medications, and lifestyle changes, panic attacks can be managed forever.

Diagnosis of the disease

PA is a specific mental disorder that causes difficulties in diagnosis. It is not always possible, even after an examination and conversation with a psychiatrist, to determine what caused this condition - problems with the cardiovascular system, autonomic dysfunction, mental disorder. The neurologist checks reflexes, listens to the lungs, measures blood pressure, and examines the patient's abdomen to rule out internal bleeding. It is important to establish that these are paroxysms, and not a heart rhythm disorder or a heart attack. The patient undergoes an electrocardiogram, MRI, breathing tests, and an ultrasound examination.

Panic attacks: how to deal with it yourself

We categorically do not recommend self-medication. Such events aggravate the patient's condition. He cannot independently determine whether he has concomitant mental disorders.

Pharmacology taken uncontrolled can provoke an increase in symptoms and make the patient’s condition more severe. This complicates further therapy in the hospital, increases the time of recovery and complete restoration of the body. The Clinic of Dr. Isaev provides round-the-clock care for patients in serious condition who, due to mental disorders, are unable to care for themselves.

How to treat panic attacks

When you notice the first symptoms of PA, you need to contact a psychiatrist or neurologist. Drug treatment consists of prescribing sedatives and antidepressants that reduce anxiety and calm the nervous system. Such medications have a cumulative effect, the effect begins on the 3-4th day of administration, the result lasts for more than 7 days. Doctors prescribe mainly those medications that are not addictive. Stopping their use does not lead to a sharp deterioration in health.

Psychotherapy is very popular; a course of sessions allows you to get rid of uncontrollable attacks of fear for a long time, in most cases forever. Depending on the condition and form of the disease, the following directions are used:

• cognitive-behavioural;
• body-oriented;
• hypnosis;
• psychoanalysis;
• family therapy.

The cognitive behavioral approach has proven itself in the field of eliminating panic attacks, fears and phobias. Psychotherapists are of the opinion that informing the patient as fully as possible about his condition is the first step towards recovery.

The doctor explains the principle of the occurrence of paroxysms, as well as the reasons why they periodically appear. A set of classes aimed at teaching methods of meditation, visualization, and breathing techniques helps the patient, when he senses an approaching attack, to normalize his condition.

The technique of “breathing into a paper bag” is often used, which the patient should have with him, especially in crowded places. A sharp inhalation and exhalation reduces the supply of oxygen, stopping the attack. A body-oriented approach helps reduce anxiety and relax the nervous system. It is based on various breathing exercises that help achieve complete relaxation. Alternately tensing and relaxing the muscles of the limbs allows you to normalize your emotional state and get rid of fear.

Hypnosis is a popular technique that involves placing the patient in a trance state. He disconnects from the influence of external stimuli, but retains the ability to listen to the therapist’s commands. The patient is instilled with the idea that an attack of PA is not life-threatening; it is important to find ways to overcome the paroxysm. The doctor offers patients various auto-training techniques that act as prevention.

Psychoanalysis is a line of work that will be effective only in individual cases. The process itself takes several months or even years. The doctor’s goal is to find an internal conflict in the unconscious, to determine which psychotrauma became the trigger for the occurrence of attacks.

Family psychotherapy implies the involvement of all family members in the process, regardless of how many people from this microsociety suffer from attacks of uncontrollable fear. During a conversation with a specialist, relatives understand what feelings their loved one is experiencing, what the threat is, what words and actions can be used to support.

What to do during a panic attack: first aid

A panic attack occurs at any time and it doesn’t matter whether the person is in a company or at home alone. When an attack occurs, you need to pull yourself together as quickly as possible and help yourself. For this:

• go out into the fresh air, and if this is not possible, open the door wide open and unbutton tight clothes;
• wash with cold water;
• breathe slowly, deeply, deeply, and to increase the concentration of carbon dioxide in the body, you can breathe into folded palms;
• switch your thoughts to something good, and if that doesn’t work, then count slowly to 100;
• rest your body on a stable surface, grab the table with your hands, which will allow you to gain a feeling of confidence and control;
• convince yourself that the attack will end now and will not cause harm, since this is a figment of the imagination.

If an attack occurs in someone from the environment, it is necessary to help the person, namely:

• do not panic;
• help the victim leave a stuffy room or dangerous place, take him away from the crowd;
• call an ambulance;
• take the victim by the hand if he allows you to do this and listen to him;
• if during a conversation it is possible to determine the cause of the attack, try to eliminate it;
• if there is shortness of breath, let the victim breathe into a paper bag;
• switch attention to other objects or others.

During a panic attack, victims often perceive the person who wants to help negatively, with fear, and sometimes aggressively. In this case, it is enough to simply be nearby to help the person when their condition worsens or to prevent dangerous actions.

Most often, panic attacks develop with mental illnesses such as phobias, depression, schizophrenia or other endogenous mental illnesses, post-traumatic stress disorder, obsessive-compulsive disorder.

Symptoms of a panic attack in women

PA in women occurs for several reasons:

• severe stressful situation;
• unbearable mental stress at work;
• cardiac or oncological diseases;
• peculiarities of upbringing - overprotection, strict control or perception of the child as the center of the universe;
• schizophrenia and other mental disorders;
• changes in hormonal levels - the onset of sexual activity, menstrual cycle disruption, pregnancy and childbirth, lactation, menopause;
• tendency towards hypochondria, suspiciousness;
• physical inactivity.

During a panic paroxysm, a woman experiences depersonalization and derealization, a feeling of impending disaster, motor disinhibition or stiffness. This condition is not an obstacle to pregnancy, but symptoms may intensify after the birth of the child.

Panic attacks often accompany postpartum depression, fears for the child, fears of being a bad mother, and general dissatisfaction with life arise. During menopause or menopause, there is an intense release of stress hormones, which provokes the disorder. The quality of life is deteriorating, the woman does not feel happy, she is constantly in nervous tension, waiting for the next PA. Often women do not realize what exactly is happening to them at this moment, and this is more frightening than the physiological symptoms.

Our patients turn to the doctor with complaints of an incurable disease. They don’t yet know what happened to them, but they believe that some kind of system has suffered a serious failure. We act openly. We immediately stipulate that panic attacks are treatable, they can and should be fought by learning self-regulation in difficult life situations.

How is normal anxiety different from a panic attack?

The mechanism that triggers a panic attack is no different from what causes ordinary anxiety - both are psychophysical reactions to danger. The difference is that a panic attack is a reaction to danger in the absence of danger. However, a false alarm triggers the same cascade of reactions as a normal alarm - the sympathetic system is activated, and adrenaline is released.

A panic attack can occur due to excessive physical activity, fatigue and exhaustion, as well as due to the abuse of stimulants and alcohol. In addition, stress and unresolved conflict situations can trigger an attack. A lack of understanding of one's own experiences and feelings, a tendency to avoid and ignore negative emotions also increase vulnerability to panic disorder.

Questions and answers

Have there been any cases of death due to PA in medicine?

No, the concept of PA implies a feeling of fear, as well as a number of other physiological changes. They are strong in intensity, but not so strong as to lead to the death of the body.

Who is more susceptible to the disease - men or women?

Individuals, regardless of gender or age, are prone to the disorder.

What mental disorders can cause the disorder?

At risk are schizophrenics, people diagnosed with bipolar affective disorder, manic-depressive psychosis, and various phobias.