Heart racing, difficulty breathing, nausea, feeling lightheaded, and noticing that things around you look strange? You may be having a panic attack. During a panic attack, at least four of the following symptoms are present:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. De-realization and/or depersonalization
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias
13. Chills or hot flushes

Panic attacks can occur in the midst of a number of mental health conditions. They may also present in response to chronic stress as well as intense short-term stress. Panic attacks can be cued (preceded by an identifiable source), or uncued and feel as though they came out of nowhere. No matter the circumstances in which they present, panic attacks are always alarming and individuals experiencing them often report that they feel like their bodies were out of control. The symptoms of a panic attack are scary and sometimes bewildering to experience. Panic attacks have sent a number of people to the hospital fearing that some sort of medical emergency was at hand. The following article will focus on providing some insight and explanation into the symptoms of panic attacks and demystifying the reasons behind your body’s turbulence.

To begin understanding the mechanics behind panic attacks, we must start with an explanation about how and where panic attacks originate. This involves taking a closer look at the nervous system. The component of the nervous system that is most relevant to the origin of panic attacks is called the autonomic nervous system. The autonomic nervous system is responsible for managing our bodies’ involuntary processes, such as our blood pressure, heart rate and respiration, body temperature, digestion, etc. It has two branches: 1) the sympathetic branch, which is associated with the fight or flight response and 2) the parasympathetic branch, which is associated with the rest and digest response. Put another way, the sympathetic branch is the gas pedal that revs up your nervous system, whereas the parasympathetic branch is the brake pedal that slows down the nervous system and allows you to coast.

The fight or flight response is a response that our system initiates when we are confronted with a stressor. Stressors can include (but are not limited to) thoughts, memories, situations, body symptoms, activities, etc. The fight or flight response is an inborn response that enables us to react quickly to stressors and do what we need to in the moment – fight or take flight (or sometimes even freeze) — to remain safe. While this response is an effective survival mechanism that is intended to keep us safe, the problem is that this response is triggered whether the stressor is truly unsafe, such as swerving to avoid a car accident, or stressful (but not dangerous), such as a giving a presentation. It is important to note that not all brushes with the fight or flight response will turn into a panic attack. The response persists until the perceived “danger” has passed and can last for only a few moments up to much lengthier periods of time. So, what exactly happens when the fight or flight response is triggered?

When our brain detects a stressor, it sends a signal to our adrenal glands to release adrenaline. For those of you who aren’t familiar with this hormone, adrenaline is responsible for the feeling of wanting to ride a rollercoaster again after your first ride and for the feeling of being on the edge of your seat while watching a scary movie. Physiologically, adrenaline is responsible for accelerating your heart rate, blood pressure, and respiration as well as heightening your senses and increasing your energy level. These are all responses that we would need to deal with a short-term stressor. If we continue to register the stressor as a threat after the release of adrenaline (this is where our subjective interpretation comes into play), a release of cortisol will soon follow. Cortisol is our body’s primary stress hormone and is released to maintain the activation of the sympathetic nervous system and thereby keep the fight or flight response going until the perceived “danger” passes.

Now, let’s take a closer look at the underlying mechanisms of some of the symptoms of a panic attack:

• The symptom of heart palpitations, pounding, or acceleration can be accounted for by the release of both adrenaline and cortisol. From a survival standpoint, the function of a raised heart rate is to increase the blood flow and thereby oxygenation throughout the body. When we are in fight or flight mode, the increase in circulation is intended to increase the availability of oxygen to our muscles which would enable us to appropriately fight against or flee from the stressor
• The symptom of sweating occurs in response to the increase in heart rate and blood pressure turning up your internal temperature. Also, since sweating is your body’s way of cooling off, it prevents your body from overheating and allows you to remain in motion. Through a survival lens, sweating would also make it more difficult for an attacker to be able to get a grip on you and therefore, it may facilitate staying out of harm’s reach.
• Trembling or shaking is a symptom that is provoked by the rush of adrenaline moving through your system. Adrenaline is putting your system on high alert so that it is ready to respond quickly. The adrenaline surge is helping to prime the body for the appropriate action.
• Experiencing the sensation of shortness of breath is due to the imbalance of oxygen and carbon dioxide in your system. When we are breathing rapidly (as is the case during times of physical exertion or when someone is hyperventilating), this causes an imbalance of oxygen and carbon dioxide in the system which can lead to symptoms such as light-headedness, heart palpitations, and numbness or tingling sensations (paresthesias).
• Feeling of choking. This sensation often goes hand-in-hand with shortness of breath/hyperventilation. During the course of the fight or flight response, muscles throughout the body are tensed (doing so increases the body’s defense against physical damage which may occur during some stressful situations), which may include the muscles in the throat, leading to a feeling of throat constriction.
• Chest pain or discomfort – As adrenaline and cortisol are coursing through the body, the muscles of the chest wall are tensing, and the heart is working harder to quickly pump blood to the big muscle groups in the body. As uncomfortable as this may be, in theory, this is intended to help us to be better equipped to fight against or flee from the stressor.
• Nausea or abdominal distress. The digestion of food is associated with the parasympathetic branch of the autonomic nervous system (rest and digest), which is essentially offline when the fight or flight response is triggered. Consequently, stomach upsets may ensue. The digestive system requires a good blood supply in order to properly do its job and since blood is being diverted to the big muscle groups (and thereby away from the digestive system), feelings of nausea may result.
• Feeling dizzy, unsteady, lightheaded, or faint. This symptom is caused by an imbalance of oxygen and carbon dioxide that occurs when people are hyperventilating. Additionally, the increase in blood pressure may also be responsible for provoking this symptom.
• De-realization (feelings of unreality) and/or depersonalization (being detached from oneself). These two symptoms of a panic attack are often highly unsettling for people who experience them. They may report that things around them seem warped or that they feel as though they are foggy or observing themselves from a distance. These symptoms often precipitate or coincide with the fears of losing control, going crazy, or dying. While it is not entirely clear why depersonalization and derealization occur during a panic attack, some have postulated that these symptoms may occur when the symptoms of the panic attack have become too overwhelming and the person needs to “distance” themselves from these frightening sensations.
• Fears of losing control, going crazy, or dying emerge due to the body feeling out of control. To be clear, none of these things are actually happening, despite the intensity of the symptoms. Many people have gone to the emergency room, convinced that they are experiencing some sort of cardiac event, and are instead told that they are actually having a panic attack. Sometimes people are in a calmer state when they reach the hospital because they believe they will get the proper medical attention. This dial down of symptom intensity upon reaching the hospital demonstrates how powerful our interpretation of panic symptoms can be.
• Paresthesias (numbness or tingling sensations). Since blood flow is being directed to the muscles, it is being driven away from non-essential areas in the periphery of the body, which is why people may report feelings of numbness or tingling sensations, particularly in their hands and feet. As the blood flows away from your fingers and toes, they may feel numb or tingly. This sensation is rather similar to the feeling of your foot falling asleep if you’ve been sitting with your legs crossed (and thereby restricting blood flow) for too long.
• Chills or hot flushes. The increase in sympathetic activation caused by the fight or flight response causes the body to heat up as it pushes blood flow towards the essential areas of the body. Your body is working very hard to facilitate its quick getaway or its combat mode. As the body tries to adapt to this temperature surge, it causes you to sweat so that you don’t overheat. Sweating along with the redirection of blood flow may cause the experience of chills.

While extremely uncomfortable, panic attacks are not dangerous. Unfortunately, once one panic attack has been experienced, individuals may fear the possibility of having future panic attacks. This fear can be immobilizing and cause individuals to significantly restrict their activities so as to not trigger panic symptoms. As with any type of anxious trigger, part of what maintains the anxiety is the person’s reactiveness to the trigger and/or to the experience of feeling anxious. In order words, the more people fear and the more they try to avoid their anxious triggers, the more problematic the anxiety becomes, the more they are looking over their shoulders to try to spot it coming, and the more disruption it causes to their lives. The mental health community has a saying that captures this counterproductive reactiveness: “What we resist persists.” Essentially, the more time people spend trying to evade their anxiety, the more intensely the experience of anxiety is feared and the more they are held captive by their anxiety. Two of the core features of anxiety treatment are to target patients’ reactiveness to their anxiety and to reduce their avoidance behaviors. Treatment seeks to empower patients to say, “Enough is enough!” and to confront their anxiety with the support and guidance of their therapist/psychologist.

Working closely with a mental health professional trained in Cognitive Behavioral Therapy and Exposure and Response Prevention will put you on track for de-escalating your flight or flight response, reprogramming your responses to triggers, increasing your ability to adaptively cope with stress, overcoming your anxiety, and reclaiming or pursuing the life you want to be living! To begin, please take the first step by contacting our office at (630) 522-3124 and scheduling your first appointment with one of our anxiety experts.

Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.