Panic
A panic attack is a sudden surge of intense fear peaking within minutes, with pounding heart, breathlessness, dizziness, trembling and a sense of imminent catastrophe (dying, losing control, going mad). Panic disorder is recurrent unexpected attacks plus persistent fear of the next one and changes in behaviour to avoid it.
What drives it
A false alarm in the threat system: normal bodily sensations are misread as dangerous, the fear amplifies the sensations, and the loop escalates. Avoidance and safety behaviours then keep the misreading alive.
How it shows
Work
Leaves meetings abruptly, sits near exits, avoids lifts, flights or crowded trains, works from home more without a clear reason, keeps water or medication close. Has been to A&E with chest pain that turned out to be nothing cardiac. Can appear entirely composed between attacks.
Relationships
Needs a 'safe person' on trips, avoids cinemas, supermarkets or motorways, plans routes around escape. Life can shrink gradually without anyone naming it. Partners may become part of the safety system.
Self
You notice your heartbeat and immediately think something is wrong. You fear the attacks more than any situation. You catch yourself checking your pulse or scanning for the nearest exit.
What tells it apart
Generalised anxiety: Generalised anxiety is a steady background of worry about many topics; panic comes in sudden spikes with intense physical symptoms and the main fear is of the attack itself.
Health anxiety: Panic fear is acute and about immediate catastrophe in the next minutes; health anxiety is a longer preoccupation with having a serious illness, with repeated checking and doctor visits between any acute episodes.
Amygdala hijack: An amygdala hijack is a popular label for an emotional overreaction to a real interpersonal trigger, often anger; a panic attack can come from nowhere, is dominated by bodily alarm, and leaves the person afraid of their own body.
A test
Ask what they fear will happen during an attack and what they avoid because of it; a first episode with chest pain or breathlessness needs medical exclusion, and recurrent attacks with growing avoidance warrant psychological treatment, which has high success rates.
Questions to carry
- During an attack, what is feared will happen, and what has been avoided since because of it?
- Where has fear of the next wave of panic made my life smaller, and when did that start?
How strong the research is
strong
Where it comes from
Donald Klein, 1964 (distinguished panic from generalised anxiety); panic disorder in DSM-III, 1980; cognitive model by David Clark, 1986
On the family tree: Melanie Klein