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  • Lemuel Tan

Anxiety Attack & Panic Attack

What is the difference between an Anxiety Attack and a Panic Attack? Most people would use them interchangeably. However, there is a notable difference, specifically that Panic Attacks occur unexpectedly. The person may be doing something neutral such as cooking or driving the car and suddenly experiencing an episode. It feels like it occurs without a trigger or cue. It catches them off guard as if it happened for no apparent reason. About 5% of Australians would experience a panic attack in their lifetimes.

The DMS-V defines Panic Attacks as ‘an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes with four (or more) of the following symptoms’:

Note: The abrupt surge can occur from a calm state or an anxious state:

1) Palpitation, pounding heart, or accelerated heart rate

2) Sweating

3) Trembling or shaking

4) Sensations of shortness of breath or suffocating

5) Feelings of choking

6) Chest pains or discomfort

7) Nausea or abdominal distress

8) Feeling dizzy, unsteady, light-headed or faint

9) Chills or heat sensations

10) Paresthesia (numbness or tingling sensations)

11) Derealisation (feeling of unreality) or depersonalisation (being detached from oneself)

12) Fear of losing control or “going crazy”

13) Fear of dying

The attacks would also need to have been followed by 1 month or more of either or both of following:

1) Persistent concern or worry about additional panic attacks or their consequences.

2) A significant maladaptive change in behaviour related to the attack.

The DSM-V surprisingly does not have a diagnostic code for Anxiety Attacks. However, it does acknowledge them under Panic Attacks calling them “Expected Panic Attacks” with the definition being that an obvious cue or trigger can be identified. In general, one could explain Anxiety Attacks as a build-up of worry with possible known or relatable triggers.

Those struggling with anxiety and panic attacks sometimes describe the attack as a heart attack or a stroke. Many describe the experience as “I thought I was going to die”. The fear of having a panic/anxiety attack is real and some might even alter how they behave, live or think just to cope with it. This results in more fear and worry resulting in the possibility of increasing further panic attacks.

I would describe anxiety and panic attacks using the analogy of having a faulty alarm in the brain. Imaging cooking your favourite meal on a stove top. You are happily cooking your meal and the phone rings. You decide to answer your phone and it turns out to be an old classmate of yours. You start talking and planning your meet up when BBBRRRRRRIIIIINNNNGGGG!!!! The fire alarm in your house has gone off as you had burnt your food.

Anxiety and panic attacks are akin to an emergency alarm in your brain. The alarm is there to keep you safe. We want it to wake us up in the middle of the night when it senses smoke and fire. However, a false-positive alarm (which is activated when there is no trigger for it) is unhelpful to us. Using this analogy, Anxiety Attacks could be defined as an attack occurring when you are aware that you are cooking but with the alarm going off. While Panic Attacks occur when you are just walking down the hallway to feed your gold fish – without any associated trigger(s).

We do not really know how Panic Attacks occur but the current prevailing theory suggests that it has something to do with the sensitivity of our brains in threat detection. We may not necessary be fully and consciously aware, however, the amygdala (stress response part of the brain) has picked up a perceived threat and starts sending SOS calls throughout our brain and body, telling it to brace for the incoming threat. The heart starts beating faster to produce more oxygen and blood, parts of your body shut down – numbness kicks in, parts of your body start feeling hot/cold, you start sweating, you struggle to speak and you start noticing the physical bodily sensations. The experiences sometimes result in further fear and worry worsening the attack.

A typical anxiety/panic attack could last up to 10 or more minutes and takes about 30 minutes to subside. Usually when it occurs, it is hard to stop it and the individual has to ride the experience out. Having a safe person around you can help. This signals to your brain that there is another present to soothe and help you even though there is a perceived threat,. Psychological therapy for anxiety attacks is largely about re-training the brain to acknowledge that it is now safe - there is no need to ring the emergency alarm (even though there might be a very good reason to do it in the first place). It takes willingness, courage and practice to help the brain understand that it is no longer under attack.

Things to do during an attack:

  • Do not tell yourself to stop panicking. It is like telling yourself to not think about the pink elephant or flying pig. It actually makes it worse.

  • Acknowledge that it is a faulty alarm within your brain. It is just uncomfortable.

  • Do not focus on your symptoms, e.g. – my heart is beating very fast.

  • Attempt to shift your focus to things that are outside your body - practise grounding (noticing and naming things that are around you), count backwards from 100 in increments of 7, read out aloud the lyrics of your favourite song, etc.

  • Practice relaxation strategies after the attack: breathing techniques, bodily relaxation - yoga or Pilates. It is hard to use relaxation strategies during the attack as your brain has already been hijack but you can definitely practice after the attack to facilitate in its calming down.

Disclaimer: The material on this blog is not to be used by any commercial or personal entity without expressed written consent of the blog's author. The article above is an opinion of an individual clinician and should not be taken as full clinical advice. The statements on this blog are not intended to diagnose, treat, cure or prevent any mental health or mental illnesses. Always consult your doctor for medical advice or seek professional therapy.

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