Understanding Fear: The Truth About Panic Attack Symptoms and Treatment

You’ve probably heard the words “anxiety attack” and “panic attack” used interchangeably, but in reality anxiety and panic attacks are treated as two different mental health challenges. In fact, an “anxiety attack” is not defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). Rather, anxiety is viewed as one of the primary features of disorders that fall under one of the three following categories:

• Anxiety Disorders
• Obsessive-Compulsive and Related Disorders
• Trauma- and Stressor-Related Disorders

Panic attacks, on the other hand, are short bouts of terror characterized by shaking, dizziness, a fear of dying, and a number of other symptoms. While some of these symptoms overlap with anxiety, anxiety is typically longer in duration and less intense, manifesting over a long period of time—from days and weeks to months.

Adding to the confusion is the fact that panic attacks are considered to be a the core symptom of Panic Disorder, which falls under the category of “Anxiety Disorders” in the DSM-V. So yes, panic attacks are at the root of Panic Disorders, but they can also manifest in other disorders such as Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder. Mental illness is rarely clear-cut, and this is a perfect example of the complexity of anxiety and panic disorders and the various ways that they are intertwined.

If you’re living with a Panic Disorder, your treatment plan—and the ways you will learn to deal with your disorder—will differ depending on the distinctions described above. Panic Disorder treatment will place a strong focus on triggers and learning to identify and control them in your intense bouts of panic. Conversely, treatment plans for a challenge like Generalized Anxiety Disorder will focus more on broader lifestyle changes, like exercise and diet, that are conducive to recovery. That’s not to say that there won’t be overlap between coping strategies, but anxiety and panic are two different problems that will naturally require two different solutions, and knowing these distinctions can help you focus on what’s best for overcoming your struggles.

Think about the last time you had a panic attack, and remember what fears were running through your head—there’s a good chance that fainting was one of them. The fear that you experience during panic attacks doesn’t stem from any real threat—you might feel like you’re going to die, but you’re not, and you might feel like you’re going to faint, but you probably won’t.

These subjective experiences stem from hyperactivity in the amygdala, the region of your brain responsible for regulating fear. With this area in overdrive, your fight-or-flight response kicks in, causing the increased blood pressure and heart rate that can give you the feeling that you’re going to faint, when in reality these fears are unwarranted.

Fainting, for example, occurs only very rarely in conjunction with an attack. In most cases, fainting is actually caused by low blood pressure—the opposite of what takes place during a panic attack. This kind of fainting is prevented by making sure that you’re always properly hydrated and maintaining proper fluid intake. But fainting associated with stress or dysfunctions in the nervous system are typically rooted in external triggers.

Using the various therapies offered by residential treatment programs, you can uncover these triggers, reduce the (already minimal) chances of fainting during your panic attacks, and address the other fears that your attacks stem from. At the end of the day, the goal of therapy is to give you the tools to continue living your life despite any apprehensions that you have—to “feel the fear and do it anyway,” as self-help author Susan Jeffers would say.

During a panic attack, fast breathing causes a reduction in the amount of blood supplied to the brain and a constriction of blood vessels. This can make you feel disoriented, disconnected from your body, and at times, like you’re experiencing some kind of psychosis. Although this is a symptom rarely linked to panic attacks, it can manifest in the form of delusions or auditory hallucinations. But this doesn’t mean that you have a psychotic disorder—rather, it’s more likely that your panic attacks have psychotic features.

While panic attacks with psychotic features are rare—meaning no antipsychotic medications have been designated for specifically treating them, and research on the link between anxiety disorders and psychosis is still in its early stages—with the right help, they can be treated. If you experience these kinds of panic attacks, it’s important that you address them in a comprehensive treatment setting capable of conducting proper diagnostics. Using these tools, your therapists and psychiatrists can devise a plan to address your mental health challenges in a way that takes all of the unique features of your personal challenges into consideration.

When it comes to calming your nerves, we’ve all probably heard the age-old tip of “taking a deep breath.” And while this can certainly be an effective technique when used in a controlled setting such as mediation, research has shown that deep breaths are actually the opposite of what you need to do if you are experiencing a panic attack—normal shallow breathing is the most effective solution. This is counterintuitive when you’re in the midst of a panic attack, as they can be scary, suffocating situations that make you feel desperate for air, but these phenomena actually stem from too much carbon dioxide being released from the body.

“It’s not because they have a lack of oxygen, it’s because they’re exhaling too much air,” said Alicia Meuret, first author of the paper. “‘Take a deep breath’ is not a helpful instruction.”

Despite the instantaneous feeling of panic attacks, Meuret and her team also found that the changes in breathing and heart rate associated with attacks begin occurring approximately an hour before their manifestation. By understanding what sorts of breathing techniques exacerbate the physical symptoms that stimulate panic and which ones help—a process that can be honed through in-depth treatment—you can sometimes prevent them from happening altogether.

This is done by harnessing control over the symptoms that take place during the hour-long period prior to their acute phase. For example, closing your eyes and focusing on your breathing is a great way to cut yourself off from the external triggers of your panic and help you focus on regulating your breathing back to a more normal, shallow rate. Ultimately, these kinds of techniques can be the difference between experiencing a panic attack and preventing one from happening.