Panic attack has been described as an episode of incredibly intense fear or apprehension that is of sudden onset. The DSM-IV describes a panic attack as a discrete period of intense fear or discomfort in which (at least 4 of 13) symptoms developed abruptly and reached a peak within 10 minutes.
According to the American Psychological Association, the symptoms of a panic attack commonly last approximately thirty minutes. However, panic attacks can be as short as 15 seconds, while sometimes panic attacks may form a cyclic series of episodes, lasting for an extended period, sometimes hours. Often those afflicted will experience significant anticipatory anxiety and limited symptom attacks in between attacks, in situations where attacks have previously occurred.
The effects of a panic attack vary from person to person. Some, notably first-time sufferers, may call for emergency services. Many who experience a panic attack, mostly for the first time, fear they are having a heart attack or a nervous breakdown. Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person's life.
Triggers and causes
* Long-term, predisposing causes — Heredity. Panic disorder has been found to run in families, and this may mean that inheritance plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overly cautious view of the world expressed by parents and cumulative stress over time have been found to be causes.
* Biological causes — obsessive compulsive disorder, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma and inner ear disturbances (labyrinthitis). Vitamin B deficiency from inadequate diet or caused by periodic depletion due to parasitic infection from tapeworm can be a trigger of anxiety attacks.
* Phobias — People will often experience panic attacks as a direct result of exposure to a phobic object or situation.
* Short-term triggering causes — Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change, and as seen below, stimulants such as caffeine or nicotine, can act as triggers.
* Maintaining causes — Avoidance of panic provoking situations or environments, anxious/negative self-talk ("what-if" thinking), mistaken beliefs ("these symptoms are harmful and/or dangerous"), withheld feelings, lack of assertiveness.
* Lack of assertiveness — A growing body of evidence supports the idea that those that suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also characteristically un-assertive. This un-assertive way of communicating seems to contribute to panic attacks while being frequently present in those that are afflicted with panic attacks.
* Medications — Sometimes panic attacks may be a listed side effect of medications such as Ritalin (methylphenidate) or even fluoroquinolone type antibiotics. These may be a temporary side effect, only occurring when a patient first starts a medication, or could continue occurring even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage, or type of drug. Nearly the entire SSRI class of antidepressants can cause increased anxiety in the beginning of use. It is not uncommon for inexperienced users to have panic attacks while weaning on or off the medication, especially ones prone to anxiety.
* Alcohol, medication or drug withdrawal — Various substances both prescribed and unprescribed can cause panic attacks to develop as part of their withdrawal syndrome or rebound effect. Alcohol withdrawal and benzodiazepine withdrawal are the most well known to cause these effects as a rebound withdrawal symptom of their tranquillising properties.
* Hyperventilation syndrome — Breathing from the chest may cause overbreathing, exhaling excess carbon dioxide in relation to the amount of oxygen in one's bloodstream. Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness which can trigger panic attacks.
* Situationally bound panic attacks — Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behavioral predisposition to having panic attacks in certain situations (situationally bou