Dissecting the anatomy of a panic attack | Got Anxiety? | SierraSun.com

Dissecting the anatomy of a panic attack | Got Anxiety?

Barry C. Barmann, Ph.D.
Mary B. Barmann, MFT

Editor’s Note

This is the second in a multi-part series regarding panic attacks, including information on panic symptoms, panic-prone personalities, medical conditions that mimic panic, and strategies for controlling attacks. The series is co-written by Barry Barmann and his wife, Mary.

Click here to read Part 1.

Look to a future Sierra Sun edition for Part 3.

The other day, we were driving over Mt. Rose, en route to Reno. It was raining and visibility was poor.

Suddenly, a car appeared heading directly toward at us, in our lane. A fatal accident seemed imminent. It looked as if there was no escape route.

Within milliseconds (literally), our bodies responded in unison: accelerated heart rates, profuse sweating, arm and leg muscles tight as a knot, a feeling of suffocation and detachment from reality.

It was a moment of pure panic, a time in which the human body displayed a flawless and brilliant performance entitled, “The Emergency Response System.’

Every player did their part to keep us alive. The players, in this case, consisted of the autonomic nervous system, specific brain structures, neurochemicals, and crucial muscle groups.

This was a situation in which it was absolutely necessary for an immediate emergency response team (the human nervous system) to show up and do their job.


In the scenario above, the body’s autonomic nervous system responded to a “true alarm” — real danger that required precise responding for the purpose of survival.

The multitude of physiological responses that surfaced with a sudden onset are identical to those labeled “panic attack” by those who evidence a diagnosis of Panic Disorder. The only difference is the environmental setting in which this emergency response system takes place. Should these physical sensations occur when grocery shopping, attending a concert, sitting in a classroom, sleeping (nocturnal panic), or participating in some other ordinary life event, then they are labeled “panic attack.”

If these physiological responses take place during a life-threatening situation, the term panic attack is ruled out, in favor of “true alarm” — i.e., our body reacting for the sole purpose of survival.

No matter what environmental setting we are in, these physical reactions are harmless. It is what we refer to within our private practice, when treating those who experience panic attacks, as the person’s “second reaction,” which is the real problem.


This second reaction refers to an individual’s tendency to interpret their physical sensations as threatening to their wellbeing, which then triggers anxious arousal and thoughts concerning the exaggerated possibility of loosing control, going crazy or suffocating.

During these non-emergency situations, once danger is perceived, when none exists, the body responds with an even greater intensity level, identical to that which occurs during a true emergency.

This exaggeration of our normal emergency response system causes us to become hyper-focused by these sudden and intense physical sensations, distracting us from rational thoughts related to reassuring ourselves that we are not dying.

Those who experience these bodily changes during illogical moments begin to feel less confident, self-esteem erodes, and activities that used to be considered fun quickly become eliminated from one’s daily schedule.

Should panic attack while alone, the person begins to cling to a “safety person,” such as a spouse, friend, etc., to ensure protection from one’s own body. When panic attacks in non-emergency situations, 3 primary factors trigger these episodes.


Research indicates that 95 percent of those who have experienced a life-threatening illness at some time in their lives are later diagnosed with panic disorder, and 70 percent of these individuals are prescribed anxiety medication.

In addition, 80 percent of patients with chronic lung diseases were eventually diagnosed as evidencing major depression, and 74 percent of these individuals reported being overly preoccupied with their physical functioning. In all cases, their core fear was centered on suffocation and death.


Some people have extreme responses to situations that involve traumatic experiences. Imagine that during the week of the July 4th festivities, you witnessed a near-drowning off the North Shore. The following week, while driving down Highway 28, you become aware of your heart racing, intense sweating, and dizziness.

Those who possess a high degree of “Anxiety Sensitivity” are more prone to ruminate on thoughts of death and experience symptoms of panic after witnessing a frightening event, the death of a family member, or some other traumatic life event.


During the course of our lives, most people will experience life transitions such as moving to another state, the loss of a parent, etc. For some, change is viewed as exciting and challenging. For others, it is perceived as threatening due to the belief that they are incapable of effectively handling new demands, lack specific skills, or the intelligence necessary for managing major life transitions. This fearful anticipation builds into anxious arousal over time, eventually manifesting itself physically via episodes of extreme panic.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. They own the Center for Anxiety & Chronic Worry in Incline Village. Barry may be reached for comment at barry@behaveanalysis.com; visit anxietytreatmentinclinevillage.com to learn more.

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