We already mentioned that PAs are not caused by a real psychological or somatic pathology. They come from the “rioting” autonomous nervous system. When you don’t feel balanced, any emotional experience (seeing a bus door, if your first attack happened on a bus, or troubling news, or just recalling the previous PA) – can cause a powerful adrenaline rush. And here it is, your autonomous nervous reaction – asking “Here I am, did you call me? I sense danger!”.
This combination of autonomous nervous symptoms is associated with a grave physical or psychological disorder since it strikes like a powerful force. To begin with, let’s consider – what is the autonomous nervous system?
People have not one but two nervous systems. One is central (it deals with the brain) and peripheral (it deals with the body). The peripheral system consists of two parts: one manages the muscles – it transmits the signals from the brain to the muscles. It controls the movements of the body, the balance, etc. And the second one is autonomous – it is responsible for the workings of the internal organs. Like a director at a large corporation, it delegates various important tasks to different organs: the heartbeat, the blood pressure, the production of urine, saliva, and sweat, the frequency and depth of respiration, peristalsis of the gastrointestinal tract, the production of hormones, and much more. For a PA to occur, the central nervous system must evaluate the environment as dangerous, and the peripheral one needs to pull together all the hidden resources of the body to deal with this danger.
The autonomous nervous system has two parts: sympathetic and parasympathetic. The first one intensifies the functioning of internal organs, while the second one lessens it. As a result, the sympathetic system creates the necessary strain when the organism needs to fight or flee from danger. The muscle tone increases, metabolic processes intensify, breathing becomes frequent and shallow, heart rate rises, blood pressure rises, etc. And the parasympathetic system is responsible for relaxation, digestion, and rest. It takes over when the organism realizes that “everything is fine, I can chill out”.
When a person experiences big emotional upheavals or prolonged tension, the hypothalamus (the area of the brain that produces alarm impulses) starts signaling to the hypophysis about the state of stress (like top-management is sending a directive). The hypophysis, in turn, “communicates” it to the adrenal glands. They, like “shop-floor workers” get to work and inject into the bloodstream such amount of adrenaline that is appropriate in emergency situations, such as fire, ambush, financial crisis, or death of a loved one. At these levels of adrenalin, we will observe the state of panic. Since the decision about having a panic attack is taken by the body as a whole but it is implemented by the “shop-floor workers”, PAs can produce different symptoms for different people.
When a person experiences a PA for the first time, they get very scared and become very afraid of another occurrence of such an event. Nobody wants to experience these “wonderful” strange feelings again.
What happens to the brain at these moments?
Since the emotional charge is so strong, the person gets fixated on their unpleasant physical sensations. They very quickly form a link (neural connections): “Oh, last time it was bad in the subway, next time I will experience the same”. Or, “when my heart is beating like this, I will have problems with breathing and will get overwhelmed by fear”.
When Kate was taking a bus, she experienced a stomach problem (simply put – a bout of diarrhea). She endured 20 terrible minutes before she could run out of the bus and find the nearest restroom. This was a horrifying ordeal for her, and she experienced real panic. Even though she knew that the culprit was the spicy taco she bought from a street vendor, when next time she had to board a bus, she experienced strong fear. Immediately, her stomach started aching…
When a person undergoes a panic attack, they may develop a fear that the attack will repeat itself. Therefore, they may start avoiding certain places and situations that are in their mind connected with the attack. Next thing you know, they are not able to stay alone at home, or to be in crowded places, or to be far away from a restroom, or they avoid elevators, escalators, or subway. However, all these desperate attempts only “feed” their neural network because avoiding only strengthens and solidifies the panic disfunction. The person does everything to evade the same nightmare, but their fixation on “anything but this” is what’s feeding their panic attacks, like blood vessels are feeding a tumor.
All of this entails significant, ever-expanding limitations in the life of a person with panic disorder and reinforces the presence of panic attacks. The person’s conviction that a panic attack is life-threatening and should be avoided at all costs only grows.
Since PA has already happened once, new players are entering the field – triggers. Even if it seems to a person that an attack occurs literally “from scratch”, there are always events, sensations, or thoughts that provoke the onset of a panic attack. And later, everything that is associated with PA can also become a trigger for the onset of an attack. Therefore, with each new attack, the list of triggers can be replenished with those that are now connected with the PAs by association. Previously, PAs were only happening in public transport, then just on the way to work – now the whole road seems to be one continuous trigger.
Such stimuli cause somato-vegetative changes in the human body, which it interprets as an impending threat to his physical (fear of death from a heart attack, from suffocation) or mental health (fear of going crazy or losing control of the situation).
External triggers for panic attacks include: caffeine, alcoholic beverages, nicotine, drugs, stuffy rooms, strong odors, flashing lights, cold or, conversely, hot weather.
The internal triggers for a panic attack are extremely varied. They can be:
- lack of sleep,
- chronic exhaustion,
- intense stresses,
- low blood sugar,
- concomitant somatic diseases (hormonal disorders, high blood pressure),
- negative emotions (intense anger, resentment, fear, shame, jealousy),
- a place reminiscent of the past PA,
- closed or open spaces,
- fear of another attack.
What else does a person who is afraid of panic attacks do? Spoiler alert – it doesn’t work either.
- Use certain methods of controlling their anxiety as “to prevent the trouble”. For example, they take the subway only when accompanied by friends, limit the range of places that can be visited, constantly carry “magic pills” (sedatives).
- Try very hard to avoid strong emotions.
- Use protective behavior. Kate from the example above looks through the route map in advance, noting toilets, and preemptively swallows Imodium.
You can guess that their life becomes increasingly restricted. It turns into an unending struggle to prevent a possible PA. The person sort of lives, but the quality of their life dramatically goes down. They are not able to feel happy and to enjoy simple things.