Understanding Panic Attacks
How underlying associations with early childhood trauma and interoception cause panic attacks.
Have you been rushed to the ER believing that you were dying from a heart attack, then to be discharged hours later with a diagnosis of having a panic attack? Much relieved, of course, you then say to yourself: What just happened? It came from nowhere!
What you may not realize is that there are many causations panic attacks. They are serious and very common. It is estimated that 7% to 10% of the population have them. Panic attacks are responsible for about 20% of all emergency room visits. They can occur haphazardly during a calm period of the day or during a point when there is a lot of anxiety, for example, when a person is expected to make a speech in front of a large crowd.
Unexpected vs. Expected
An isolated or unexpected panic attack comes on suddenly with intense fear that reaches its peak within 10 minutes and lasts for about one-half hour. This type of panic attack usually occurs once, maybe twice. There is no identifiable source or trigger for it. These are quite common in people between the ages of 20 to 40 and make up about 40% of the population.
An otherwise healthy person can experience an unexpected, immediate sense of fear accompanied by a racing heart, chest pain, with an impending sense of doom as though they are going to die.
Any social situation or change in life event can trigger a panic attack: a visit with relatives during the holidays, the illness of a loved, being in a large crowd and feeling trapped, standing in a long line, or riding a bus. This past year, the world-wide viral pandemic caused many people to have panic attacks.
However, once a person has experienced an unexpected panic attack, it may happen again in the future when the individual expects to be in a similar situation. They fear having another panic attack and, therefore, they will have one. This recurrence is referred to as expected panic attacks. Because the fear was so intense and frightening both the first and second time, this person may avoid situations associated with their panic. They isolate themselves at home and do not go out. This is called agoraphobia and it is a huge disruption to the person's lifestyle. Sometimes they may need a companion to accompany them if they go out at all. When a panic attack becomes frequent and expected, it can be classified as a panic disorder.
Diagnosing a panic attack
There are many elements to panic attacks that can be quite frightening. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states there is certain criteria to being diagnosed. Basically, an individual needs to meet 4 out of 13 symptoms: 2 need to be cognitive symptoms; 2 need to be physical symptoms.
- Fear of dying or impending doom
- Fear of losing control
- Hot flashes
- Chest pain or discomfort
- Paresthesia (numbness and tingling)
- Nausea or abdominal discomfort
- Diaphoresis (intense sweating)
- Derealization/depersonalization (feelings of unreality/being detached from oneself)
- Chills or hot flashes
- Shortness of breath
Associations with panic attacks
Panic attacks frequently occur at night. For many people, there is a significant fear of sleep and going to sleep, because the person is afraid they will wake up in the middle of the night having a panic attack. This individual has an "intolerance of uncertainty and responsibility for harm." 1 For example, there is an upcoming situation, such as an annual job review with their boss, custody hearing in family court, or a family member is critically ill in the hospital and they don’t know what is going to happen. There is a real fear of the uncertainty of the situation and its outcome.
Interoception within an individual can cause a panic attack. This is when a person has a sudden heightened feeling of an emotion – they feel something intensely inside of them which triggers a spontaneous episode.
There is an association between air pollution and panic attacks. Last year on the West coast there were significant wildfires for several months, the air quality was atrociously low, and many of our patients struggled. If you live in an urban area where there is thick smog, the air pollution can be a significant cause. 2
In addition to social and environmental factors, there is a genetic component: 30% to 40% among monozygotic twins, 50% among schizophrenics, and a 10% inheritability for those whose parents had panic attacks.
Hormones can also be a cause for panic attacks. When we are adolescents, our hormones begin to increase, and as we become older and experience the stressors of life, the combination of hormones and stress can cause panic attacks.
Studies have shown that there is a neurobiological substrate or condition of the brain associated with panic attacks. The fear response is stronger in the right side of the brain, which is associated with our sympathetic nervous system. The hippocampus lives in the medial temporal lobe and is responsible for our memory. It will grow differently in size and volume in people with a history of early childhood trauma.3 The findings state that people with early childhood trauma are more affected by panic disorders.
The mainstream medical treatment for panic attacks are prescription SSRIs (serotonin specific reuptake inhibitors) that help calm down the anxiety responses.
Panic attacks are very real and very common. Panic can occur as an unexpected, spontaneous one-time event to a social situation or as an expected reaction to being in a situation similar to the first panic attack. Panic attacks affect 7% to 10% of the population and often land someone in the ER. Many factors that contribute to panic events are early childhood trauma, heightened feelings or emotion, uncertain social situations, genetics, air pollution, smoking, alcohol abuse, and discrimination.
At Gates Brain Health we use nutritional supplements, dietary changes, and brain rehabilitation exercises to help patients get to the root of their anxiety. Many patients have had tremendous success with hypnotherapists by working on some aspect of childhood trauma that lives in a subconscious level or by seeing a psychotherapist to work through issues that relate to their anxiety.
If you see yourself as having any of the anxiety or panic attack symptoms we discussed in this article, please call our office for a free consultation.
If you experience an emergency event, call 911.
Dr. Randall Gates, D.C., D.A.C.N.B
Gates Brain Health
1Direct® Psychiatry Research. Elsevier. Vol 273, 2019 March, Pages 82-88. Available on www.elsevier.com/locate/psychres.
2Jaelim Cho, Yoon Jung Choi, Jungwoo Sahn, Mina Suh, Seong-Kyung Cho, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin. Ambient Ozone concentration and emergency department visits for panic attacks. J Psychr Res 2020 May 31. Available on www.PubMed.gov.
3Joonho Lee, Yoon Song, Eunsoo Won, Minji Bang, Sang-Hyul, Lee. Clinical Psychopharmacology and Neuroscience. 2020, Korean College of Neuropsychopharmcology. Higher Rightward Laterally of the Hippocampal Tail and Its Association with Early Childhood Trauma. Available on www.PubMed.gov.