When panic attacks: differences between true, false alarms | Got Anxiety?
Mary B. Barmann, MFT
“When I was 25 years old, I had my first attack after I’d come home from the hospital, following a serious operation.
“That night, I went to sleep and woke up around 2 a.m. feeling really anxious. I remember how my heart started pounding, my chest felt tight, I felt like I was smothering.
“I kept feeling hot and cold and started shivering. I thought I was dying, or having a heart attack. I felt dizzy and detached from my body. It seemed like the room was covered with a haze.
“I ran to the bathroom wanting to escape, but I felt like I was a puppet under the control of someone else while I was running. It lasted around 10 minutes, but it seemed like hours!
“My husband called an ambulance and I was taken to the ER. All my tests results came back normal. I was so embarrassed during the ride back home. I wanted to avoid getting back into bed.”
The statement referenced above was made by a patient of ours who gave her written consent to use her words as part of this article. She felt it might help others who suffer from “Panic Disorder with Agoraphobic Avoidance.”
Those who experience the physiological sensations outlined above typically label their experience a “Panic Attack.”
At our Center for Anxiety & Chronic Worry, we discourage using the term Panic Attack because (1) the words themselves tend to trigger heightened feelings of anxiety and (2) the person is not reporting having been attacked by any real danger.
In earlier Bonanza articles, we discussed the difference between fear and anxiety. Fear occurs in the present, and is the result of a real threat, such as being robbed at gunpoint.
Anxiety is anticipatory, and involves predicting future negative life outcomes such as, “What if I never fall in love with someone, and spend the rest of my life living alone?”
Seen below, are the primary physiological characteristics of Panic, as referenced by the American Psychiatric Association (2014).
THE EXPERIENCE OF PANIC
Accelerated heart rate (elevations of approx. 40 bpm)
Sensations of smothering
Depersonalization or the feeling of being detached from one’s body
Numbness or tingling sensations in arms or legs
Chills or hot flashes
In addition to these physical sensations, those who experience panic also report cognitions (thoughts or images) related to the implications or consequences of the attack itself, such as a fear of losing control or going crazy and/or the belief of having a fatal heart attack.
These physical and cognitive responses that comprise the primary characteristics of panic are nearly identical to those experienced by our patient discussed earlier in this article.
However, the problem is not the physical sensations themselves. The real problem is the person’s interpretation related to this experience.
Let’s take a brief look at how our body’s nervous system is constructed, and how this ingenious mechanism helps to keep us safe.
EVOLUTIONARY SURVIVAL RESPONSES
As soon as the fight/flight alarm has been sounded by our amygdala, adrenalin is released, which immediately results in an elevated heart rate for the purpose of pumping blood to vital organs such that we are better able defend ourselves.
Our pupils dilate to help widen peripheral vision, allowing us to better see the “enemy.” Blood clots more quickly to reduce the risk of excessive blood loss following injury.
Muscles tense to give us additional strength and speed. Excessive sweating occurs, lowering our internal thermostat (body temperature) to a safe level, as well as to produce a “slippery victim,” making it difficult for the enemy to hold onto.
Digestive activity ceases, resulting in vomiting or diarrhea, to help expel noxious substances from our body. Pregnant women take note; morning sickness is thought to be the result of this same evolutionary process.
The amygdala doesn’t know what a fetus is, so it acts to expel this foreign object by triggering vomiting. After around 3 months (first trimester), the amygdala gives up, and vomiting ceases.
Each of the physiological responses experienced during the course of a “panic attack” has been genetically programmed since prehistoric man to keep us safe from real danger.
It is not panic we are experiencing, it is our body’s “Emergency Response System” hard at work, at an illogical time. Our subjective response to this process is what creates the feeling of panic.
These evolutionary survival responses, when triggered by real danger (true alarms), are essential for helping to keep us alive. It is only when they occur in the absence of any real threat (false alarms) do they result in sensations of panic.
Part 2 of this series will discuss the difference between both alarms, and the factors that cause each to surface.
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 firstname.lastname@example.org; visit anxietytreatmentincline village.com to learn more.