For Panic Attacks & Agoraphobia

A panic attack is a sudden surge of intense fear. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a panic attack must include at least four of the following symptoms:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Chills or heat sensations

• Paresthesias (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from one-self)

• Fear of losing control or “going crazy”

• Fear of dying

When your brain perceives danger, it triggers the fight-flight response, which causes the sympathetic nervous system to raise your heart rate, direct blood away from non-essential areas, speed up your breathing, and make you sweat.

All the effects of the fight-flight response aid you in fighting or running away from danger. It is imperative to survival. In fact, all mammals experience the fight-flight response. One of the significant effects of the sympathetic nervous system is the release of adrenaline and noradrenaline from the adrenal glands located on the kidneys.

Sympathetic nervous system activation impacts heart rate, blood flow, breathing, and sweating.

• Cardiovascular symptoms: Many people describe a fast and heavy heartbeat during a panic attack. This is because, during fight-flight activation, blood flow to the muscles speeds up to deliver more oxygen and remove waste, readying the muscles for fighting or fleeing danger. Blood is also steered away from non-essential areas like fingers, toes, and skin to provide more blood to large muscles. As a result, people may look pale and feel cold, especially near the extremities. Sometimes, people report feeling hot instead, which can occur if the heart speeds up before blood is redirected. Additionally, the blood supply to the head may slightly decrease; while this is not dangerous, it can lead to blurred vision, dizziness, confusion, or a sense of unreality. Although many people experience a fear of fainting, this is actually less likely to occur during a panic attack, as blood pressure increases rather than decreases.

• Respiratory symptoms: Breathing can speed up or become deeper because the body requires more oxygen for fighting or fleeing. Sometimes, people report sensations of breathlessness, choking or smothering, and pain or tightness in the chest.

• Sweat-gland symptoms: People often report sweating more during a panic attack. Sweating cools the body, facilitating fighting or fleeing without collapsing from the heat.

You can think of a panic attack as a false alarm during which the brain mistakenly interprets a safe situation or physical sensations as dangerous and triggers the fight-flight response.

Panic attacks typically last 10 to 30 minutes but occasionally up to an hour. A panic attack can't continue forever or spiral to ever-increasing and damaging levels.

This is because we all have a counterpart to the sympathetic nervous system called the parasympathetic nervous system. You can think of the parasympathetic nervous system as a built-in protector that stops the sympathetic nervous system from getting carried away. Furthermore, adrenaline and noradrenaline are eventually destroyed by other chemicals in the body.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of agoraphobia include:

• Intense fear or anxiety about at least two of the following situations: public transportation (e.g., cabs, trains, planes), open spaces (e.g., parking lots, bridges), enclosed spaces (e.g., theaters), standing in line or being in a crowd, and being outside of the home alone.

• The above situations are avoided due to worry that it might be difficult to escape or get help if a panic attack occurs.

• Facing agoraphobic situations almost always causes fear or anxiety.

• Agoraphobic situations are either avoided entirely, require the presence of a companion, or endured with intense fear or anxiety.

• The fear or anxiety is disproportionate to the real danger of the situation and the sociocultural context.

• The fear, anxiety, or avoidance persists for 6 months or longer.

• The fear, anxiety, or avoidance causes significant distress or impairment to important areas of life such as relationships or career.

• The fear, anxiety, or avoidance cannot be attributed to a medication, drug, medical condition or another mental health condition.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of panic disorder include:

• Recurrent unexpected panic attacks.

• At least one panic attack has to be followed by a month or more of repeatedly worrying about having more panic attacks or their consequences (e.g., passing out, having a heart attack, losing control, “going insane”) and/or attempts to avoid situations where a panic attack may occur.

• The concern and worry about having a panic attack cannot be attributed to a medication, drug, medical condition or another mental health condition.

• Panic disorder can occur with or without agoraphobia.

Anxiety is focused on worrying about the future (e.g., “What if I get a panic attack if I get on the plane?”). In contrast, a panic attack is a physiological fear reaction to what feels like an immediate threat. It is accompanied by thoughts about the immediate situation (e.g., “Oh no, I’m having a heart attack”). Furthermore, while symptoms of a panic attack are sudden, intense, and last a short amount of time, symptoms of anxiety are longer-lasting, occurring over days or months, are usually less severe, and may include muscle tension, restlessness, irritability, sleep disturbances, and fatigue. Anxiety can build up to a more intense level that may feel like an “attack”; however, an actual panic attack would also include preoccupation with an immediate rather than a future threat.

Notably, while panic attacks are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), anxiety attacks are not.