Sunday, July 22, 2012

What is a panic attack?


A panic attack is actually a completely normal physiological response.  It is otherwise known as the "fight-or-flight" response or an adrenaline rush.  This same biological response occurs if you are in a near-car accident or are hiking in the woods and run into a bear and her cubs.  This response has evolved to protect you by either preparing you to fight, or preparing you to run away from the danger.  The key to a panic attack is that this response comes at an inappropriate time.  You have this huge adrenaline rush and a feeling of intense fear....but maybe you are just sitting on your couch.  Or at a grocery store.  There is no bear, there is no car accident.  And so you can only assume that something terrible is happening to your body.  You must be having a heart attack or brain aneurysm.

Your first panic attack was probably a combination of a variety of biological and psychological factors that happened to all peak at the same time.  For me, 1)  I have always been a bit of a hypochondriac.  Growing up, if I had any physical symptoms I would immediately look them up on the internet and worry until they went away.  In this way, I probably just happen to have some personality characteristics that make me more prone to anxiety and panic attacks.   2)  The weeks leading up to my first attack I had a variety of life changes: I graduated from college, I left all of my friends and moved back home, I was about to start a new job, my boyfriend and I broke up, I was about to take the GREs, my grandpa had just passed away.  And although I didn't consciously feel any stress about this, looking back I know that I was probably more vulnerable to anxiety because of this combination of events.  3)  At the same time, the day of my attack I had a huge breakfast and then knowing that I would be having an early dinner, I skipped lunch.  Well the dinner kept getting pushed back and back and so I probably had incredibly low blood sugar at the time of my attack.  Taking all of these factors into account when I felt myself becoming lightheaded from the low blood sugar, combined with the anxiety I probably felt about everything that was happening in my life and my predisposition to health anxiety, I misinterpreted the signals that my body was giving me.  Instead of thinking "Oh, I probably should eat something I'm not feeling too well" I responded with fear: "What is happening to me?!" and thought that I was about to die. 

There is a region in your brain called the amygdala.  It is a very primitive part of your brain and one of its important jobs is to press the "on" button to turn on your fight-or-flight response.  It has evolved to protect you from danger, and importantly it has the ability to learn what is dangerous.  Just say you are hiking and you encounter a bear and its cubs.  You are not an experienced hiker so you don't understand the danger of approaching the trio.  So you go ahead and try to pet one of the cubs.  The momma bear rears up on her hindlegs and roars ferociously.  Your brain then decides the best thing to do is to run away.  The amygdala does its job and presses the "on" button, turning on the fight-or-flight response and you are luckily able to flee your attacker.  The amygdala then stores all of the important information from this event so that next time you see a bear, you will feel fear and remember the danger involved.  It is a response designed to protect your life.  Unfortunately, the amygdala is pretty stupid so it doesn't really know what counts as "important" information.  So it will store information related to the bears but also related to the weather, to what you are wearing, what you were thinking at that moment and who you were with. 

Coming back to my panic attack, I became very afraid because I did not know what was happening to me.  In response to this, my amygdala immediately woke up and turned my fight-or-flight response on.  Unfortunately this made matters much worse.  To understand why, lets look at the details of a fight-or-flight response....

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