Help I’m Alive: Coping With Panic Attacks
Come take my pulse, the pace is on a runaway train. Help, I’m alive. My heart keeps beating like a hammer. Beating like a hammer.
~ Metric, “Help, I’m Alive”
The first time I experienced a panic attack was at the age of 23.
I awoke violently from a deep sleep, unable to breathe. The center of my chest was being crushed by an invisible anvil. I was consumed with a profound sense of dread. Each shallow, gulping breath felt like the one that would stop my heart from beating. Every instinct of urgency and distress screamed at me that I was about to die.
My freaked-out girlfriend drove me straight to the hospital where an incredulous ER doctor kept asking me what I had taken. It was Saturday morning at 3AM, and she gave one glance at my chart (no history of anxiety) and one look at my girlfriend (purple hair and a lip ring), and absolutely refused to believe that I wasn’t on some kind of recreational drug. (I wasn’t.)
By that time, I didn’t feel like I was dying anymore. My body was a pile of cold gelatin and I was sitting in a puddle of my own sweat, but I knew how to breathe again, and I was pretty sure that I would live to see the sunrise.
The doctor hooked me up to an EKG only to find that my heart was perfectly fine. Normal sinus rhythm. I wasn’t having a heart attack. She practically rolled her eyes when she told me. Clearly, she had better things to do, but I was okay with that. I’d much rather her reaction be dismissive than concerned.
She told me that I’d probably had a panic attack. I asked the doctor what caused it and she half-shrugged, too indifferent to even bother saying “How the hell would I know?”
They discharged me from the ER and my girlfriend drove us home. We were both exhausted, our nerves were shot, but we were still able to catch a few more hours of sleep. We woke up the next morning as if nothing had even happened, the only evidence of the previous nights emergency was the hospital admissions bracelet I was still wearing as a souvenir.
When I spoke with my father later that afternoon, he told me that my grandmother had suffered panic attacks all her life. So had my uncle. It was a thing in my family, and I’d never even known.
Since that night, I’ve averaged about 1 or 2 full-blown panic attacks per year. They’re still terrifying, but I’ve learned healthy ways to effectively cope with them, and their intensity and frequency are to the point now where I don’t even consider them a problem.
The Physiology of a Panic Attack
As an expression that’s entered our everyday language, having a panic attack can mean different things to different people. Nevertheless, it’s a clinical term with a very specific set of criteria.
Let’s crack open the DSM-5 to get a clear definition:
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
- Palpitations, pounding heart, or accelerated heart rate.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization or depersonalization (feelings of detachment from reality or oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
For those of you who’ve lived through a panic attack, you don’t need a dry list of symptoms to understand that wet, visceral fear — the kind of fear that might keep you alive in the face of actual danger, but absent any threat, can cripple you with physical symptoms that are terrifyingly real.
When I woke up in the midst of a full-blown panic attack, my sympathetic nervous system had already triggered my fight-or-flight response. Though it acted with the best of intentions, I had been betrayed by my own brain, specifically, a little almond shaped cluster of nerves called the amygdala.
The amygdala is the brain’s throbbing hub of fear and aggression, so it’s no surprise that this primal cluster of nerves is closely associated with the pathogenesis of panic attacks.*
The ultimate irony is that our amygdalae want to keep us safe. Their processes are specifically designed to keep us out of danger, but when they’re falsely cued by an emotional or environmental trigger —something you see, smell, hear, taste, or feel — a cascading chain of hormonal and physiological reactions lead to an attack of irrational and uncontrollable panic.
Seeking Treatment for Panic Attacks
People seeking treatment for panic attacks often want to jump right to medication. Selective serotonin reuptake inhibitors (SSRIs), for example, are frequently prescribed for people who suffer from persistent panic attacks and anxiety. Benzodiazepines are occasionally prescribed to manage acute symptoms.
Useful though it may be, medication has its limits, and only psychotherapy can address the underlying behavioral and psychological triggers that ramp up a threat response into a full-blown panic attack.
I highly recommend you watch this video about therapy and panic attacks. It’s good stuff.
The first time I went to see a therapist was for help with my panic disorder, and while my underlying causes were different than the ones in the video, the process itself was remarkably similar.
As a psychotherapist who knows all too well what it feels like to experience the crippling terror of a panic attack, I have unique understanding of what my clients are going through when they seek treatment for panic attacks and panic disorder.
If you live in Tennessee and would like to discuss your therapeutic options for dealing with panic attacks, feel free to contact me. I’m more than happy to discuss them with you.
Here’s a cocktail party fun-fact: the amygdala is also associated with right-wing politics. A 2011 study correlated political orientation with brain structure, so if you’ve ever wondered why conservative politics are so fear-based while liberal politics are more fact-based, it’s because liberalism is associated with increased gray matter, whereas conservatism is associated with increased amygdala size. One might say that millions of swollen amygdalae — and a collective lack of grey matter — are directly responsible for Donald Trump’s presidency.