The article I’m Dying: What a Panic Attack Feels Like is one of the most popular posts on this site, with over 350 comments.
Many of the comments–some are very long–are heartbreaking: relationships wrecked, jobs lost, fear trailing like a shadow.
Over and over people describe how panic attacks affect them:
- In response to heart palpitations: “I’m going to have a heart attack,” or I’m going to die.”
- In response to choking sensations: “I’m going to stop breathing and suffocate.”
- In response to dizzy sensations: “I m going to pass out.”
- In response to sensations of disorientation or feeling “not all there”: “I’m going crazy.”
- In response to “rubbery legs:” “I won’t be able to walk” or “I’m going to fall.”
- In response to the overall intensity of your body’s reactions: “I’m going to completely lose control over myself,” or “I’m going crazy.”
Panic attacks are an intense “fight-or-flight” reaction occurring in a situation that poses no obvious or life-threatening danger, such as sitting quietly at home, driving a car, or attending a social event. Because there is no obvious, external danger, your mind tends to invent or create danger to match the intense bodily symptoms you’re going through.
Your mind can very quickly go through the process: “If I feel this bad, I must be in some danger.” And so it’s very common when experiencing panic to invent any or all of the “dangers” listed above–or more.
The ironic thing is that this reaction is absolutely and always false. Panic attacks are not dangerous. They cannot hurt you physically. Ever.
“I’m going to have a heart attack”
A Panic Attack Cannot Cause Heart Failure or Cardiac Arrest
Two of the most common symptoms of a panic attack are a rapid heartbeat and palpitations.(1) Certainly, these can be frightening sensations, but they’re not dangerous. Your heart is made up of very strong and dense muscle fibers and can beat two hundred times per minute for days without sustaining any damage. If an electrocardiogram (EKG) is taken during a panic attack, it will show no abnormalities–only a rapid heartbeat.(2)
There’s a big difference between what happens with your heart during a panic attack and what happens in a heart attack. During a panic attack, your heart may race, pound, and at times miss or have extra beats. Some people even report chest pains in the left-upper portion of their chest, which pass fairly quickly. Note that none of these symptoms is aggravated by movement or increased physical activity.
During a true heart attack, the most common symptom is continuous pain and a pressured, even crushing sensation in the center of the chest. Racing or pounding of the heart may occur but this is secondary to the pain. Moreover, the pain and pressure get worse upon exertion and may tend to diminish with rest.(3) This is quite different from a panic attack, where racing and pounding may get worse if you stand still and lessen if you move around.
“I’m going to stop breathing and suffocate.”
A Panic Attack Will Not Cause You to Stop Breathing or Suffocate
Many people feel their chests tighten and their breathing become restricted during a panic attack.(1) This might lead you to suddenly fear that you’re going to suffocate. Under stress your neck and chest muscles tighten and reduce your respiratory capacity. In reality, there is nothing wrong with your breathing passage or lungs, and the tightening sensations will pass.
Your brain has a built-in reflex mechanism that will eventually force you to breathe if you’re not getting enough oxygen. If you don’t believe this, try holding your breath for as long as you can and observe what happens. At a certain point you’ll feel a strong reflex to take in more air.(1) The same thing will happen in a panic attack if you’re not getting enough oxygen. You’ll automatically gasp and take a deep breath long before reaching the point where you could pass out from a lack of oxygen. And even if you did pass out, you would immediately start breathing!
“I m going to pass out.”
A Panic Attack Cannot Cause You to Faint
The sensation of light-headedness you may feel with the onset of panic can make you certain you are about to faint. What is happening is that as a part of the “fight-or-flight” reaction the blood circulation to your brain is slightly reduced, most likely because you are breathing more rapidly.(4)
This is not dangerous and can be relieved by breathing slowly and regularly from your abdomen, preferably through you nose. This feeling can also be helped by taking the first opportunity you have to walk around a bit. Let the feelings of light-headedness rise and subside without fighting them. Because your heart is pumping harder and actually increasing your circulation, you are very unlikely to faint.
“I’m going to fall.”
A Panic Attack Cannot Cause You to Lose Your Balance
Sometimes you may feel quite dizzy when panic comes on. It may be that tension is affecting the semicircular canal system in your inner ear, which regulates your balance. For a few moments you may feel dizzy or it even may seem that things around you are spinning. Invariably this sensation will pass. It isn’t dangerous and very unlikely to be so strong that you’ll actually lose your balance.(1)
If sensations of pronounced dizziness persist for more than a few seconds, you may want to consult a doctor (preferably an otolaryngologist——an ear, nose, and throat doctor) to check if infection, allergies, or other disturbances might be affecting your inner ear.
“I won’t be able to walk”
You won’t fall when you feel “weak in the knees” during a Panic Attack
The adrenaline released during a panic attack can dilate the blood vessels in your legs, causing blood to accumulate in your leg muscles and not fully circulate. This can produce a sensation of weakness or “jelly legs,” to which you may respond with the fear that might fall or you won’t be able to walk. But this sensation is just that–a sensation–and your legs are as strong and able to carry you as ever.(5) They won’t give way! Just allow these trembling, weak sensations to pass and give your legs the chance to carry you where you need to go.
“I’m going crazy.”
You can’t go crazy during a Panic Attack.
Reduced blood flow to your brain during a panic attack is due to arterial constriction, a normal consequence of rapid breathing. This can result in sensations of disorientation and a feeling of unreality that can be frightening.(1) If this sensation comes on, remind yourself that it’s simply due to a slight and temporary reduction of arterial circulation in your brain and does not have anything to do with “going crazy,” no matter how eerie or strange it may feel.
No one has ever gone crazy from a panic attack, even though the fear of doing so is common. As bad as they feel, sensations of unreality will eventually pass and are completely harmless.
People do not “go crazy” in a sudden or spontaneous way. Mental disorders involving behaviors that are labeled “crazy” (such as schizophrenia or bipolar disorder) develop very gradually over a period of years and do not arise from panic attacks. No one has ever started to hallucinate or hear voices during a panic attack.(6)
“I’m going to completely lose it”
A Panic Attack cannot cause you to lose control of yourself
Because of the intense reactions your body goes through during panic, it’s easy to imagine that you could “totally lose control.” But what does completely losing it mean? Becoming completely paralyzed? Acting out uncontrollably or running amok? There are no reported instances of this happening.
If anything, during panic your senses and awareness are heightened with respect to a single goal: escape. Running away or trying to run away are the only ways in which you would be likely to “act out” while panicking. Complete loss of control during panic attacks is simply a myth.
In summary
The first step in learning to cope with panic reactions is to recognize that they are not dangerous. Because the bodily reactions accompanying panic feel so intense, it’s easy to imagine them being harmful to your body. Yet in reality no danger exists.
The physiological reactions underlying panic are natural and protective. In fact, your body is designed to panic so that you can quickly mobilize to flee situations that genuinely threaten your survival. The problem occurs when this natural, life-preserving response occurs outside the context of any immediate or apparent danger. When this happens, you can make headway in mastering panic by learning not to imagine danger where it doesn’t exist.
Recommended reading
Healing Fear: New Approaches to Overcoming Anxiety Edmund Bourne, Ph.D.
Footnotes
1.Gleitman, Henry, Fridlund, Alan J, Reisberg, Daniel (2004). Psychology (6 ed.). W. W. Norton & Company. ISBN 0-393-97767-6.1.
2.Olpin, Michael. “The Science of Stress”. Weber State University. Retrieved August 11, 2013. http://faculty.weber.edu/molpin/healthclasses/1110/bookchapters/stressphysiologychapter.htm2.
3.American Heart Association. “Warning Signs of a Heart Attack. Retrieved August 11, 2013. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp3.
4.Stress Management for Health Course. “The Fight Flight Response”. Retrieved 19 April 2013. http://stresscourse.tripod.com/id11.html4.
5.Grohol, John. “What’s the purpose of the fight or flight response?”. Retrieved 18 April 2013. http://psychcentral.com/blog/archives/2012/12/04/whats-the-purpose-of-the-fight-or-flight-response/5.
6.Cistler, Josh; Bunmi O. Olatunji, Matthew T. Feldner, and John P. Forsyth (2010). “Emotion Regulation and the Anxiety Disorders: An Integrative Review”. Journal of Psychopathology and Behavioral Assessment 32 (1): 68–82. Retrieved August 11, 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901125/6.
