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Panic Attacks: Symptoms and Treatment

by Josephine Andrews
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Panic attacks are periods of intense anxiety that usually only last a few minutes. Strong feelings of anxiety, tachycardia, shortness of breath and dizziness are typical symptoms. When panic attacks recur, it’s called panic disorder. This is usually treated with medication and psychotherapy. Read more about symptoms, causes and treatment here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

F40 F41

quick overview

  • Symptoms : shortness of breath, nausea, hyperventilation, diarrhea, tachycardia, dizziness, burning in the body, palpitations , tremors
  • Description : phase of extreme fear, which usually lasts only for a short time
  • Treatment : medication (esp. antidepressants), psychotherapy
  • Causes : probably a combination of genetic predisposition and stressful living conditions (eg stress at work)

How does a panic attack feel?

When you have a panic attack, the symptoms usually come on suddenly. For most sufferers, the panic comes out of nowhere. They can’t understand why they suddenly feel so overwhelmed.

In addition to existential feelings of anxiety, those affected often experience physical signs such as tachycardia, palpitations and palpitations. Many feel their pulse intensely, tremble, or have a dry mouth. Some feel tightness or pressure in the chest and abdomen (anxiety). You have shortness of breath and chest pains or hyperventilate. Consequences are often dizziness and nausea.

Some sweat or experience chills during a panic attack. Arms and legs often tingle, become numb or there is a burning sensation in the body. Sometimes the fear is so great that those affected begin to cry. Many feel the physical symptoms so intensely that they fear dying from it. You are scared to death.

Because most sufferers can’t initially find a trigger for their symptoms, they fear losing control or going insane. Often they perceive themselves or the environment as unreal during a panic attack (so-called depersonalization or derealization).

It is not uncommon for those affected to also develop frightening thoughts (“thoughts about catastrophes”), which further increase the fear. They misinterpret the physical signs and suspect they are having a heart attack, choking, or fainting.

The severity of the symptoms varies from person to person. However, since those affected usually find the symptoms severe and exhausting, many are tired and exhausted after a panic attack. The constant fear of the next attack also causes many problems falling asleep and staying asleep.

If the attacks occur more frequently, many of those affected pay more attention to their symptoms and literally wait for them to appear again. You are constantly afraid of the next anxiety attack. This creates a “vicious circle of fear”. A so-called fear of anticipation or phobophobia (“fear of fear”) develops.

Many sufferers therefore avoid places and situations that may trigger a panic attack. As a result, people with panic disorder withdraw more and more from life, which causes problems in their partnership, family or professional life.

Panic Attack or Heart Attack?

Typical symptoms of a panic attack occur in a similar way in other diseases. For example, a heart attack often manifests itself in the form of tachycardia, chest pain and shortness of breath. So if you are unsure whether your symptoms were triggered by your fear, if in doubt, call an ambulance.

panic attacks at night

Up to 40 percent of patients with panic disorder also experience panic attacks regularly at night. There is still no clear explanation for this phenomenon. Experts suspect that nocturnal panic attacks are also triggered by physical reactions such as rapid breathing or an accelerated pulse, which those affected perceive as threatening. This can therefore happen consciously during the day, but also unconsciously at night in a dream.

How long does a panic attack last?

An attack usually only lasts a few minutes and subsides on its own. Symptoms usually peak within ten minutes at most. Courses of more than 30 minutes are also possible. Rarely, however, does a panic attack last for several hours or all day.

What is a panic attack?

According to the ICD-10 classification of mental disorders, panic attacks are defined as sudden attacks of fear (panic) accompanied by a variety of physical symptoms. The states of anxiety that those affected experience are often not limited to a specific situation or particular circumstance and are therefore also unpredictable.

As a result, many develop the fear of suffering from a dangerous physical illness. It usually begins with a long journey from doctor to doctor in the hope of finding the physical cause of the symptoms. However, since there are no physical triggers for a panic attack, it often takes several years for a doctor to make the correct diagnosis.

When does panic disorder appear?

A panic attack often occurs once or only occasionally. However, some sufferers repeatedly experience severe anxiety attacks that severely affect their lives. In this case, doctors speak of a panic disorder (also known as panic syndrome), which is one of the so-called anxiety disorders.

You can find more information about this in our article “ The Fear of Fear ”.

However, according to the ICD-10 classification of mental disorders, panic disorder is not present until the panic attacks recur (at least once a month) and the fear of another attack persists for at least a month.

Agoraphobia with Panic Disorder

Panic attacks also often occur together with other mental illnesses. Especially people with agoraphobia (“fear of claustrophobia”) are often affected by panic attacks.

They are afraid of public places, crowds, or traveling alone or far away. Many do not dare to use public transport, go to the cinema or theater or go shopping in the supermarket. If possible, they avoid places that frighten them (avoidance behavior).

Doctors then speak of “agoraphobia with panic disorder”. This is more common than pure panic disorder.

Other anxiety disorders, depression, obsessive-compulsive disorder or post-traumatic stress disorder (PTSD) often coexist with panic disorder.

panic attacks in children

Panic attacks also occur in children and adolescents, but much less frequently than in adults. Panic disorders are also more common in adolescents than in younger children. Girls encounter it about twice as often as boys.

The triggers for panic attacks are varied. Children are often afraid to speak in front of other people or afraid of animals or the dark when falling asleep.

Children and young people usually have panic attacks when their parents also have panic disorders. They often adopt the anxious behavior of their parents. Small children in particular imitate their parents in order to learn. Panic disorder is also more common in adulthood, especially in particularly shy and reserved children.

Stress is a possible trigger. Especially in school children, pressure to perform often causes panic attacks. Children with separation anxiety are also more likely to experience anxiety attacks. They are also at increased risk of developing panic disorder later in life.

It is therefore important to treat children as early as possible. In most cases, it makes sense to involve the parents in the therapy. In this way, parents learn how best to support their children.

If left untreated, the mental illness can become chronic and have a negative impact on the development of the children. Above all, these children often lack important social experiences because they withdraw more and more out of fear.

If you are unable to calm your child’s fears through talk and attention, it is advisable to seek help from a child and adolescent psychiatrist.

Panic attacks in pregnant women

In some women, hormonal changes during pregnancy can trigger panic attacks. The fear of giving birth and of being a mother often reinforces them. Panic disorder can develop, especially when women have already had a difficult pregnancy or are suffering from an existing mental illness. For this reason, it is important that pregnant women seek help from a gynaecologist, family doctor, psychiatrist or therapist as early as possible if they have persistent fears.

How common are panic attacks?

Isolated panic attacks are relatively common. Up to 20 percent of people will experience a panic attack at least once in their lifetime. Women are affected more often than men. However, a single attack does not constitute a panic disorder. The likelihood of developing panic disorder throughout life is 5.5 percent for women and 2.2 percent for men.

Treatment of Panic Attacks

Psychotherapy and medication help people with panic attacks or panic disorders. In addition, sport and joining a self-help group support the therapy.

First aid for panic attacks

Even though panic attacks often appear out of nowhere, you are not at the mercy of them. If the feeling of fear overcomes you, the following tips can help you to overcome an acute panic attack:

Do breathing exercises

Concentrate on your breathing . Breathe slowly through your nose, counting to four. Hold your breath and count to four again. Then exhale deeply through your mouth and count to eight.

Repeat this process several times until you feel relaxed. Conscious breathing calms the nervous system and gives you back the feeling of control.

If you’re hyperventilating, breathing into a bag helps. No new oxygen is added in the bag and you inhale more carbon dioxide. This increases the carbon dioxide content in the blood and breathing returns to normal.

Control your thoughts

First, realize that you are having a panic attack. Remind yourself that your body is reacting to stress and that this condition will pass soon. What matters is how you assess the situation. Instead of assuming life-threatening causes, try to realize that the symptoms, while uncomfortable, are not life-threatening.

If you experience typical symptoms such as severe heart palpitations, dizziness or nausea, say “stop” to yourself out loud or imagine a red stop sign. With practice, it is often possible to interrupt your negative thoughts.

Relax

Try to relax as soon as you have a panic attack. For example, progressive muscle relaxation, in which you consciously tense certain parts of the body and then relax, is suitable for this. For example, clench your fists and slowly count to five.

Then let go and relax. Squeeze and release your toes at the same time to increase the effect. Repeat the exercise until you feel better. Alternatively, it also helps to gently stretch individual parts of the body or massage your neck yourself.

Accept the attack

Try to accept the panic attack and don’t fight it. This can only make the symptoms worse. Allow yourself to feel, but don’t fixate on them. Be aware of what is happening without obsessing over it. It often helps to talk openly about the panic attacks with someone you trust, such as a good friend.

Take notes in case of an emergency

Write down what helps you with a panic attack (e.g. breathing, relaxation, etc.). This can be, for example, a note on your cell phone or a piece of paper that you always carry with you in your wallet. This allows you to react quickly in an acute panic situation and alleviate the symptoms.

medication

Doctors usually treat people with panic attacks with antidepressants. To do this, he usually uses what are known as selective serotonin reuptake inhibitors (SSRI). These include, for example, active ingredients such as citalopram , escitalopram, paroxetine, sertraline and venlafaxine .

If SSRIs are not effective enough, the doctor may use other antidepressants or anxiolytics such as buspirone , moclobemide or opipramol.

Experts recommend combining drug therapy with psychotherapy whenever possible.

Those affected take the medication daily in the form of a tablet. To avoid side effects, the doctor slowly increases the dose over a few weeks. It sometimes takes up to three weeks for the remedy to work.

After the end of therapy, the patient decides together with the doctor to discontinue the medication. The doctor gradually reduces the dose to prevent renewed panic attacks and side effects such as dizziness or nausea.

Do not discontinue medication yourself, talk to your doctor first!

In some cases, the doctor also prescribes sedatives (tranquilizers) for a short time. These drugs – mostly benzodiazepines – reduce anxiety and have a calming effect. However, these drugs quickly become addictive when patients take them for a long period of time. Therefore, experts recommend administering benzodiazepines only in exceptional cases.

You should only take sedatives under medical supervision and only for a short time – unless your doctor expressly prescribes taking the medication for a longer period of time.

Treatment without medication

psychotherapy

Cognitive behavioral therapy (CBT) helps many people with panic attacks. It is a form of psychotherapy that involves examining, re-evaluating and, if necessary, relearning what you have learned to think and behave. The person affected learns, for example, what happens in their body during a panic attack and that reactions such as palpitations or rapid breathing are not dangerous, but “only” arise because of their fear.

You can find more information in our article ” Behavioral Therapy “.

Therapists also use what is known as confrontation therapy (also known as exposure therapy). It serves to confront the patient directly with his fear. Under the guidance of the therapist, the person concerned then consciously evokes bodily sensations (eg rapid breathing) that trigger fear in him. The aim is for the patient to remain in this fear-inducing situation without avoiding it. The fear then gradually subsides on its own, which is an important experience.

He also experiences that his physical symptoms are not due to a heart attack, but are caused by his breathing and the resulting fearful thoughts.

In the further course of the therapy, the patient repeatedly faces his or her fears, with the fear-triggering stimuli gradually increasing. People with agoraphobia go to public places in a targeted manner – initially perhaps in a supermarket, later in a S-Bahn at rush hour. The fear gradually decreases until, in the best case, the anxiety attacks disappear completely.

To bridge the gap until the start of therapy or as an accompanying measure, instructions for self-help are available to those affected via the Internet. Ask your treating psychiatrist or therapist.

Another psychotherapeutic approach is psychodynamic psychotherapy . The therapist explores the conflicts behind the panic disorder of the person concerned. A panic attack could be an expression of suppressed feelings. The panic attacks often subside when the patient, in discussion with the therapist, reveals the unresolved conflicts that are the root cause of his fears.

Sports

Sports and exercise are also helpful for panic attacks. Research shows that just walking for 30 minutes three times a week reduces anxiety symptoms. Experts therefore recommend that people with panic attacks regularly do endurance sports such as running, cycling or swimming .

symptom diary

It helps some sufferers to keep a symptom diary. In this way, situations and causes that trigger the fears can be identified. The notes also help the person concerned to become aware of their own progress and to motivate themselves.

meditation

Regular meditation is also suitable for reducing stress and thus preventing anxiety.

You can read more about this topic in our article “Meditation”.

Home remedies and herbal ingredients

Certain home remedies can also help against panic attacks. Cold stimuli such as ice cubes placed on the wrist or massages with a hedgehog ball should be suitable for this.

The external stimuli cause the person concerned to concentrate on them and not lose themselves in their feelings of anxiety.

Certain herbal remedies such as valerian or lavender also have a calming effect. These are available in the pharmacy, for example, in the form of teas or capsules.

Panic disorder is a serious psychiatric illness. So talk to your doctor or therapist if you are using self-medication.

Home remedies can at best complement conventional medical treatment, but cannot replace it. Talk to your doctor or therapist about how you can best support the therapy yourself.

homeopathy

There are various homeopathic remedies that are said to help against panic attacks or anxiety. If you want to try these, talk to your doctor or therapist about it. Anxiety and panic disorders are serious mental illnesses that should be treated medically/psychologically.

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

support groups

In self-help groups, people with panic attacks have the opportunity to talk about their fears and worries and receive helpful tips from other sufferers. Many of those affected learn that they are not alone with their illness and that they do not need to be ashamed of it.

Self-help groups:

German Angst-Hilfe eV: https://www.angstself-help.de/

What can relatives do?

If you’re looking to support someone with panic disorder, consider the following:

  • Find out more about the disease, for example from your family doctor, psychiatrist or psychotherapist.
  • Brochures or books can also serve as a source of information.
  • Show understanding and take the person concerned seriously. Don’t downplay his fear.
  • Motivate him to get help from a doctor or support group. But leave it up to him to decide whether he wants to seek help.
  • In fearful situations, remind the person concerned of coping strategies that they have learned in psychotherapy.
  • Show the person concerned that you are there for them and ask them in fearful situations how you can best help them.
  • Take care of yourself. Know your own limitations and get help yourself if you need it.

How can you prevent a panic attack?

A panic attack cannot always be avoided. However, there are some steps you can take to prevent a seizure.

  • Seek professional and knowledgeable support from a psychiatrist, psychotherapist, or support group if your anxiety is interfering with your daily life.
  • Avoid constant tension. Try to take breaks from time to time, even in everyday life. Breathing exercises , progressive muscle relaxation or meditation are suitable for this purpose.
  • Do you do sports regularly.
  • Make sure you get enough sleep.
  • Eat smaller meals regularly to avoid hypoglycaemia.
  • Cut down on caffeine and alcohol.
  • Avoid nicotine and other drugs as much as possible.

What Triggers a Panic Attack?

The cause of panic attacks is probably a combination of genetic predisposition and stressful life circumstances.

inheritance

Panic disorders tend to run in families. Experts therefore suspect that the disease is hereditary to a certain extent. Many of those affected perceive physical signals more sensitively even before the illness (often already in childhood) and are more anxious than other people.

Your vegetative nervous system, which controls processes in the body such as breathing, blood pressure, heartbeat and metabolism, seems to react more sensitively ( vegetative dystonia ).

Even the smallest physical changes often trigger fear in those affected – even if they are not consciously aware of them. For example, they perceive an accelerated heartbeat when climbing stairs or dizziness when standing up as a threat.

stress

Panic attacks often occur during or after stressful situations such as the death of a loved one, during an unhappy relationship, after a breakup or divorce. However, they can also occur after moving house, when there is stress at work (eg due to burnout) or after being laid off.

Even positive events cause stress, such as a wedding, a job promotion, or the birth of a child.

The attacks occur mainly when those affected find these situations very stressful or frightening. They are often under extreme tension, but they don’t really notice it themselves. A seizure then appears to arise out of nowhere and for no reason. Those affected usually cannot explain where the panic attack comes from and why they suddenly feel such fears.

agoraphobia

Panic attacks often result from an existing agoraphobia. Symptoms then appear above all in constricting places such as in the subway or on an airplane or in crowds of people. The seizures also occur frequently when driving a car, in the elevator or in the queue in front of the supermarket checkout. Also before trips and operations.

Other diseases

Other diseases that can trigger panic-like states are:

  • Heartache ( angina pectoris )
  • low blood sugar (hypoglycemia)
  • Fruit sugar intolerance (fructose intolerance)
  • asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • sleep apnea
  • Dysregulation of the muscles and joints in the jaw (craniomandibular dysfunction, or CMD for short)
  • epilepsy
  • Muscle tension (eg in the neck)

In addition, panic attacks also occur in the context of other mental disorders such as depression, obsessive-compulsive disorders or post-traumatic stress disorders.

Panic attacks can also occur due to physical illnesses such as cardiac arrhythmia, thyroid dysfunction, diseases of the nervous system or the adrenal glands.

In some women, hormonal changes, such as during menopause or pregnancy, are also triggers for panic attacks.

Coffee, Drugs and Medicines

Some sufferers report that coffee or a coffee intolerance triggers panic-like symptoms in them. Among other things, the caffeine contained in coffee increases the heartbeat, which many sufferers then mistakenly interpret as a heart attack.

Drugs such as alcohol, nicotine, cocaine, amphetamines or LSD can also trigger a panic attack in this way. Drugs that activate the metabolism and are overdosed (eg thyroid hormones) also trigger similar symptoms in some people.

When to the doctor?

If you experience symptoms of a panic attack repeatedly (at least once a month), it is advisable to consult a doctor as early as possible. This also applies if the situations that trigger an attack in you multiply. The first point of contact is the general practitioner. He will talk to you and examine you for physical causes such as cardiac arrhythmias or an overactive thyroid gland .

If your symptoms are not caused by any physical illness, your family doctor will refer you to a psychiatrist or psychotherapist. In conversation with you, he will rule out other mental illnesses such as depression by asking specific questions such as:

  • Do you sometimes experience bouts of intense anxiety?
  • Does the fear occur together with physical symptoms such as tremors, shortness of breath or dry mouth?
  • After an anxiety attack, are you afraid of having another attack?
  • Is there a specific trigger for the anxiety attacks?

The psychiatrist or psychotherapist may also use questionnaires and tests. An example of a panic attack test is the Hamilton Anxiety Scale (HAMA), which the patient fills out in a conversation (eg, external assessment forms).

However, there are also self-assessment forms that the anxious patient can use to describe their symptoms more specifically (e.g. State Trait Anxiety Inventory, STAI).

Are Panic Attacks Curable?

Rarely does panic disorder go away on its own. If left untreated, the attacks can occur more frequently and more severely. Affected people then often resort to alcohol or tranquilizing medication to combat the fear. In addition to the panic disorder, alcohol or drug addiction can develop. At that point at the latest, the disease causes problems in the partnership, the family and in professional life.

If panic disorder is treated, the prognosis is good. In most patients, symptoms improve or disappear altogether. When panic attacks occur together with other mental illnesses, the treatment is usually a little longer.

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