"Am I Having a Heart Attack?" Understanding Panic Attacks and Panic Disorder

One of the frightening things about a panic attack is how physical it can feel.

People describe their heart suddenly racing, struggling to catch their breath, feeling dizzy or light-headed and experiencing tightness or discomfort in their chest. Some feel shaky, sweaty or nauseous, while others describe a strange sense that their surroundings are no longer quite real.

When this happens for the first time, it is understandable that people worry something is seriously wrong.

Some genuinely believe they are having a heart attack. Others fear they are going to collapse, lose control or even die.

The experience can be terrifying.

Understanding what is happening inside the body does not immediately make panic attacks disappear, but it can make them considerably less frightening.

What Is a Panic Attack?

A panic attack is a sudden episode of intense anxiety accompanied by physical and psychological symptoms.

The body's threat system becomes activated, producing the familiar "fight or flight" response that is designed to protect us when we are in danger.

Adrenaline is released. The heart beats faster. Breathing changes. Muscles become tense and the brain becomes highly alert to anything that might represent a threat.

If you were genuinely running away from danger, these changes would be extremely useful.

During a panic attack, however, the same alarm system has been activated when there is no immediate physical threat.

The body is preparing you to escape from something that isn't actually there.

Why Do the Symptoms Feel So Real?

Because they are real.

This is an important point.

Someone experiencing a panic attack is not imagining their racing heart or breathlessness. Genuine physiological changes are happening in the body.

The misunderstanding is usually about what those changes mean.

If your heart suddenly starts beating quickly and you think, "Something is wrong with my heart," that thought naturally makes you more frightened.

Your body's threat response then becomes even stronger.

Your heart beats faster.

You notice it more.

You become more frightened.

A cycle begins to develop in which the symptoms of anxiety themselves become the thing you are frightened of.

"What If It Happens Again?"

For some people, a panic attack occurs once during a particularly stressful period and never returns.

For others, the experience itself creates a new fear.

They begin worrying about having another attack.

Someone who experienced their first panic attack in a supermarket may become nervous about returning to the supermarket. Someone who experienced one on a train may start worrying about public transport.

The person is no longer simply afraid of the original situation.

They are afraid of having another panic attack while they are there.

This fear can gradually begin to influence everyday decisions.

The Avoidance Cycle

Avoidance makes complete sense when something frightens us.

If you experienced a terrifying panic attack while travelling on a train, taking the car instead may feel like the obvious solution.

Immediately, your anxiety decreases.

Unfortunately, the brain may learn the wrong lesson.

Rather than learning, "I could have travelled on the train safely," it learns, "I avoided the train and therefore prevented something terrible from happening."

The next train journey then feels even more threatening.

Over time, people can find themselves avoiding more and more situations because they are worried about where the next panic attack might occur.

This is one of the ways panic disorder can begin to restrict someone's life.

Panic Attacks Usually Peak and Pass

During a panic attack, people often feel as though the symptoms will continue getting worse indefinitely.

They don't.

The body's fight-or-flight system cannot remain at maximum intensity forever. Panic symptoms typically rise, reach a peak and then gradually settle.

This can be difficult to remember when you are in the middle of an attack.

The natural instinct is often to escape immediately or do something to make the sensations stop.

Learning that the sensations can be allowed to rise and fall without escaping from them can be an important part of treatment.

When Should Physical Symptoms Be Checked?

It is important not to assume that every episode of chest discomfort, breathlessness, dizziness or palpitations is caused by anxiety.

These symptoms can have physical causes as well.

If symptoms are new, unusual, severe or medically concerning, appropriate medical assessment may be needed, particularly where there are relevant physical health conditions or risk factors.

Once physical causes have been appropriately considered, however, repeatedly seeking emergency reassurance every time familiar panic symptoms occur can sometimes become part of the anxiety cycle itself.

Understanding the difference is something a healthcare professional can help with.

Panic Disorder Is Treatable

Panic disorder can respond very well to treatment.

Cognitive behavioural therapy, or CBT, can help people understand the relationship between physical sensations, frightening interpretations and avoidance. Treatment may involve gradually learning to experience anxiety without immediately escaping or trying to eliminate it.

Over time, the brain begins to learn that the sensations themselves are uncomfortable rather than dangerous.

Medication can also be helpful for some people, particularly when panic attacks are frequent or significantly affecting everyday life.

The most appropriate approach depends on the individual and the severity of their symptoms.

A Final Thought

Perhaps the most difficult thing about panic attacks is that they create a very convincing illusion of danger.

Your heart is racing.

Your breathing has changed.

Your body is telling you that something is wrong.

It is entirely understandable that your mind responds by searching for an explanation.

Once panic disorder develops, however, the fear of another attack can sometimes become more restrictive than the attacks themselves.

People stop travelling, avoid crowded places or remain close to home because they are frightened about what might happen if panic returns.

Recovery often involves gradually reversing that process.

It means learning that anxiety can feel extremely uncomfortable without necessarily being dangerous and that a panic attack can be allowed to pass without controlling what happens next.

The goal is not necessarily to guarantee that you will never feel panicky again.

It is to reach the point where you are no longer frightened of feeling frightened.

For many people, that change can give them back freedoms that anxiety had gradually taken away.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry