If you would like to know what it feels like to die, while at the same time continuing to live, you have a number of solid options. You can eat fast food quickly on a 90-degree day; you can lay awake all night mentally rehearsing your greatest failures and then board a packed bus to work; you can experiment, for days or weeks on end, with the kinds of unregulated virility powders they sell at certain gas stations. Or you can just have a panic attack. Many, many people have been convinced, in the first throes of a panic episode, that their systems were permanently shutting down. Thankfully, these people were wrong: a panic attack cannot actually kill you. Cold comfort, in the moment, but good to keep in mind, which is why we’ve made it the subject of this week’s Giz Asks. Below, a number of relevant experts discuss why it feels like you’re dying during a panic attack.
Assistant Director, Columbia University Clinic for Anxiety and Related Disorders (CUCARD)-Westchester
When a panic attack comes on with full force, it can be terrifying, to the point that it feels catastrophic—you can convince yourself that you’re dying. A panic attack is essentially like a storm of nearly intolerable physiological and neurological sensations and emotions that catapult you into a state of fright, internal tumult, and a frantic wish to escape from yourself in order to feel relief. The irony is that although it feels like you are dying, it is actually your body’s way of fighting for its life, so to speak, or responding to what it perceives as danger in the form of an external or internal threat (such as giving a presentation, or the fear of failure).
Freefalling into panic sensations can feel debilitating, like a sense of circling the drain of doom. Sometimes, this is exacerbated by hypersensitivity to cues in our bodies, a distressing sense of loss of control, and detachment from ourselves or our surroundings. Panic can stir and disrupt your digestive system, heighten or blur vision, compel shortness of breath, and bring on chest pain, sweating, tingling, and numbness. Hyperventilation or shallow, rapid breathing can jumpstart feelings that make you feel like your very survival is both urgently stirred and yet rapidly dimming all at once. Biologically, our sympathetic nervous system kicks into gear and opens the floodgates for adrenaline to fight for us and help protect us (often in the form of our breathing accelerating and muscles tensing), while our parasympathetic nervous system and psychological appraisal system then go off like an emergency sprinkler system trying to “put out” the anxiety or bring it down many notches. However, sometimes this emergency system is not strong or fast enough to put out the fire of anxiety right away, and the adrenaline, though an otherwise bolstering and protective agent, takes longer than we would like for it to be flushed from the system. This can frequently lead to fears of having a heart attack, passing out, or going crazy. The mind and body’s combined response can make it feel like your foot is slammed on the accelerator and desperately tapping the brake all at once.
The thing to remember—and what I often discuss with clients—is that even though we may feel the residual effects of panic and anxiety for some time (since our bodies are evolutionarily primed to stay on the lookout and be prepared for future ongoing threats), we are protected by what I call the “gravity of panic.” We want to try and embrace the idea that our bodies are programmed to “equilibrate” or reset themselves in a way that ensures that these feelings and sensations will not last forever: fortunately, when it comes to panic, what goes up must come down.
Clinical Assistant Professor, Psychiatry, NYU Langone
The vast majority of panic attack symptoms are physical. Often a person feels like they are having a heart attack—shortness of breath, choking, heart racing, dizziness, chest pain, sweating, numbness, hot flashes, trembling, nausea. The body is flooded with adrenaline, and the amygdala, the fear center of the brain, is in overdrive. The result is a fear of losing control and specifically a fear of dying—that is, an actual thought process, beyond just the sympathetic system going on high alert. To me, what’s worse isn’t just the one-off panic attack, but rather the anticipatory anxiety, the secondary effects that result. A person is so afraid of having another panic attack, especially in public, that they start to avoid public places. This can cause severe limitations, personally and professionally. So many of my patients with panic attacks got referred to me after expensive, thorough, and only sometimes necessary medical work-ups from their PCP, cardiologists, or the ER, because of the way their symptoms present medically. Cognitive Behavioral Therapy, medications, meditation, and relaxation can all be really helpful in treating this condition.
Professor Emeritus, Psychiatry and Behavioral Sciences, Stanford Medical Center
Panic attacks represent an “overcharge” of our basic survival mechanisms meant to get our attention. They don’t represent any real physical danger, but the fear they produce is intense, and it makes us want to “escape.” People undergoing panic focus on sensations (like somewhat increased heart rates) that make them worry that something is really wrong; and sometimes they can occur because of hyperventilating, which makes one feel a bit short of breath or dizzy. Panic attacks are sometimes linked to real situations that frighten us, but they usually pose no real danger. They often come out of the blue, and even wake us up at night. Those are the scariest, because they are unpredictable. We still don’t know why they occur in people who otherwise may [not have other mental health symptoms.] Fortunately panic attacks usually “peak and pass” quickly—particularly if people remind themselves that the issue is “fear of fear.” And there are, it should be noted, very effective treatments.
Mental Health Researcher, University of Oxford
A panic attack can be a very frightening experience. A rush of anxiety courses through your body, your heart starts to beat fast, you start to sweat. During a panic attack, it can feel like you’re about to lose control; you may even feel like you’re dying. This can be for a number of reasons. When you experience panic, the anxiety and fear that are coming over you can trigger the “fight or flight” response—this is your body’s way of responding to a perceived threat. It is your body’s self-defense mechanism that speeds up breathing, quickens your heart rate, stimulates the production of adrenaline, and leads to a rise in blood sugar levels.
Normally, this “fight or flight” mechanism happens when you are faced with perceived danger, such as coming face-to-face with a wild animal in the jungle, and your body prepares to act—to either fight off the threat or escape (flee). However, once the threat or danger is no longer present, your body calms down, and everything tends to go back to the way it was before you encountered the distressing circumstance. On the other hand, in a panic attack, the “fight or flight” response may be triggered for no apparent reason. You could be lying on the couch reading a paper, and all of a sudden, you start to experience this intense anxiety and fear. Adrenaline is released; you may feel lightheaded, or start to experience shortness of breath, and this can make it feel like you’re dying.
Even though panic attacks may happen out of the blue, without necessarily being triggered by anything in the moment, there are usually some underpinning factors that can be linked to panic. High chronic stress, certain medical conditions, or a major change in your life, such as losing a job or a relationship breakdown, have been linked to panic.
Professor Emeritus, Psychology and Psychiatry, Boston University
Panic is nothing less than the sudden intense experience of our basic emotion of fear. Typical physical symptoms experienced by one of my recent patients, a male, included feelings of weakness, nausea, severe dizziness, blurred vision, and heart palpitations. This patient thought he was dying and asked his friends to call a doctor. Another patient, a female, experienced shortness of breath, chest pain, a lump in her throat, and feelings of unreality. She came to believe that she must have a brain tumor and was losing her mind. But if it was actual fear you were experiencing, you would not have thoughts that these physical symptoms mean that you must be dying; rather, your attention would be fully focused on the object of your fear, perhaps a car that you didn’t see careening toward you as you began to cross the street, or the sight of a rattlesnake suddenly in your path during a relaxing walk on a nature trail. In fact, you would be experiencing pretty much the same symptoms whether it was from experiencing fear from a real danger or from a panic attack. But in the case of fear those symptoms are simply your body getting ready to deal with the danger by ramping up to run away or, if that was impossible, quickly building your strength to deal with an attack.
In other words, those symptoms are your very adaptive flight/flight response that increases our chance of survival when threatened. But much as nature abhors a vacuum, your mind cannot tolerate the unexpected experience of such a severe emotional reaction without knowing why—so a cause or an attribution is created. Almost always, people experiencing these attacks assume they are either dying or “losing their mind” and should be rushed to the emergency room.
Although many people experience panic attacks from time to time (called “nonclinical” panic attacks) while under stress, some who are vulnerable go on to develop panic disorder, with the attacks increasing in frequency and intensity in an unexpected and unpredictable fashion. For these individuals, effective psychological treatments exist, with durable, long-lasting effects for most people—unlike most medications, which can effectively suppress the attacks only to have them recur when the medication is discontinued. These brief cognitive behavioral treatments focus directly on faulty attributions of dying or going crazy as well as providing more correct and rational accounts of the intense physical symptoms, which includes actually inducing the physical symptoms in a safe environment until they no longer evoke the terror associated with a panic attack.
Professor of Psychiatry at Albert Einstein College of Medicine and Director of Psychotherapy Research at PRIME (Psychiatric Research Institute of Montefiore Einstein)
When a person has a panic attack, it triggers a physiological response—it’s a fight-or-flight cascade, a flood of norepinephrine and epinephrine that goes through your whole body, and it’s that flood that brings on the physical symptoms: dizziness, light-headedness, heart palpitations, chest pain, shortness of breath, GI symptoms. The whole laundry list. The idea that they’re going to die is an interpretation of those symptoms—a fantasy. “Oh my god, I can’t catch my breath, I’m dying.” Now, mind you, for asthma patients, it might be: “I can’t catch my breath, I’m having an asthma attack”—panic attacks can trigger asthma attacks; it’s a common comorbidity of panic disorder. But a panic attack cannot kill you.
Luckily, panic disorder is highly treatable. There are a million different treatments that work—medicines, types of psychotherapy, etc.—so if you’re having panic attacks, seek treatment, because it’s got a fabulous prognosis: people get better. If one thing doesn’t work, something else will.
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