Panic attacks: symptoms, causes and treatment

By Cristiano Antonino On Jan 18, 2023

Panic attacks occur as an episode of severe fear, anxiety and discomfort, often accompanied by symptoms of a physical nature, such as difficulty breathing, chest tightness, chest pain, dizziness and tachycardia

This disorder may occur as an isolated event or, on the contrary, recur in successive periods.

Typically of rather short duration, despite its strong emotional/psychological impact, a panic attack is not medically dangerous for the person experiencing it.

An episode usually lasts between five and twenty minutes, although it may sporadically last longer.

The latter, however, typically does not exceed one hour.

During a panic attack, the anxiety level is extremely high and the person is seriously worried about his or her safety

The panic attack resolves spontaneously.

The symptoms often vanish after about twenty minutes or so, leaving the person in a state of great anxiety and alarm.

As will be discussed in more detail below, there are various techniques – e.g. breath control techniques – that make it possible to limit the duration of the attack or even prevent it from occurring.

Types of panic attacks

Panic attacks can be divided into two types:

unexpected, when they occur without any apparent triggering factor
expected, when they are related to the main features of the disorder (e.g. an arachnophobic person may develop an attack at the sight of a spider).

Most people with panic attack disorder anticipate and fear having another attack (anticipatory anxiety), so they try to avoid the places or situations that previously triggered the episode.

Panic attacks generate psychological relapses in those who experience them, both on a cognitive and emotional level and on a behavioural level

The patient may be genuinely concerned about his or her health (thinking that he or she has some serious pathology), or develop problems in the social sphere (due to the fear of being judged negatively following an episode), or lead a non-autonomous life (e.g. due to the fear of being alone during a possible new attack).

What are the most common symptoms?

Panic attack symptoms can be cognitive and somatic in nature.

They include:

fear of losing control
fear of going mad or dying
feeling of unreality, estrangement (derealisation), or detachment from self (depersonalisation)
uncontrolled crying
intense sweating
chest pain or discomfort
palpitations
flushing
tremors or shaking
choking sensation
shortness of breath
shivering
nausea and dizziness
tingling or numbness in the limbs

Clearly not all of these manifestations are present during a panic attack, as the symptoms may differ from case to case.

The frequency with which panic symptoms occur, however, defines the severity of the disorder.

Panic attacks may occur relatively infrequently, for instance once a month, or, in more severe cases, even several episodes in the same day.

In the latter case, one speaks more correctly of a ‘panic disorder’.

Panic attacks: possible causes

The causes of a panic attack are not always easy to identify and are in any case the result of a mix of psychological and physical elements.

Generally, the first attack occurs during a period of particular stress for the subject.

The source of the stress may be a single acute event or the combined action of several factors.

The most relevant causes of a panic attack may be:

bereavement
trauma
diagnosis of serious illness
major changes in emotional or working life
periods of overwork or lack of rest
conflict situations
financial problems

After the first episode typically the individual develops a strong worry and lives in a state of perpetual apprehension, a kind of anticipatory anxiety, based on fear of fear that inevitably increases stress levels, thus facilitating the onset of new attacks.

In essence, a vicious circle is triggered, where it is the fear of experiencing a new episode that fuels anxiety.

The latter becomes panic and a new attack is generated.

In some cases, however, panic attacks are part of a more serious disorder (such as depression, eating disorders or post-traumatic stress disorder).

How to treat panic attacks

The treatment of panic attacks may involve pharmacological treatment, psychotherapeutic treatment or an integrated approach encompassing both.

The first action to take is to recognise the problem and seek help.

Such disorders rarely disappear on their own.

Treating a panic disorder by seeking help as soon as possible prevents the disorder from becoming chronic and activating the vicious circle of fear.

After ruling out organic causes, and thus verifying the psychological nature of the episodes, one can proceed with the start of therapy.

Therapies

Pharmacological treatment is possible in the most severe and disabling cases.

There are two main categories of drugs involved in the treatment of panic attacks

anti-anxiety drugs and, in particular, benzodiazepines. The latter, however, should be used for short periods of time because of their undesirable effects and their ability to generate dependency and addiction
antidepressant drugs; SSRIs are currently favoured, referred to as ‘new generation antidepressants’ which, compared to older antidepressants, are better tolerated and have fewer side effects. In any case, it is essential to be assessed by a specialist, who can opt for the most correct and effective therapy, especially in view of the possible concomitance of other disorders.

Psychotherapeutic treatment as an alternative or in addition to drug therapy can be set up according to one of the two most commonly used psychotherapeutic approaches

cognitive-behavioural therapy, the aim of which is to teach patients to work on their dysfunctional thoughts, thus bringing anxiety/fears under control and modifying their behaviour so that it is no longer maladaptive, in order to regain control of their everyday life. In particular, relaxation and breath management and control exercises are recommended, the main fears are addressed, and clarification is given on the non-threatening nature of the panic attack (e.g. the person is not in danger of going mad or dying).
Exposure therapy: this type of treatment exposes patients to their fears so that these may diminish. The person with panic disorder is then gradually and repeatedly exposed to situations or factors that may facilitate panic attacks, always with the constant assistance of the doctor, who helps him or her manage the situation throughout the session. The goal is to let the patient relive the state of anxiety several times until, in essence, the fear loses its effect (according to the so-called habituation process).

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