From the August 2002 Idaho Observer:

Do you, or someone you know, suffer from panic/anxiety disorder?

compiled by The Idaho Observer

Panic/anxiety disorder is something that can potentially affect anyone. It is important for us to recognize and understand the signs of panic/anxiety attacks in order to either help a friend or ward off the terrifying experience personally. Also, understanding the physiology of panic disorder leads to a better understanding of the body's processes in dealing with stress or emergencies.

It can be extremely frightening for an individual experiencing a panic/anxiety attack.

Panic by definition is unpleasant, yet it is not in the least dangerous. It is a natural response to a danger or threat, whether the danger is perceived or real.

What is panic?

Panic is termed the fight or flight response or the emergency reaction. It is so named because its effects are aimed toward dealing with an emergency by either fighting or fleeing the danger. Thus, the purpose of panic is to protect the organism.

Back in the days when our ancestors lived in caves, it was vital that when faced with danger, an automatic response would take over, causing them to take immediate action and either attack or run.

Even in today's hectic world this is necessary. Imagine if you were crossing the street when suddenly a car sped toward you blasting its horn. If you experienced no anxiety, you would be killed. However, most likely, your fight/flight response would take over and you would run to safety. The moral of this story is a simple one: the purpose of panic is to protect the organism, not to harm it.

After the fight/flight response occurs in response to actual danger, such as jumping out of the way of a car, you will collect yourself, make a mental note, and be sure to look both ways at the corner in the future, and then go about your business. You would not start worrying about your heart beating too fast or feeling tingly all over.

However, if you have a fight/flight surge “when there is no real danger,” then it becomes a panic attack. Since you don't know why it's happening, the panic attack can actually elicit more anxiety and fear and spiral into a terrifying experience. This is particularly true if something has made you worry about being sick to begin with.

For example, did a member of your family recently die of a heart attack? Was your mother always concerned about your health while you were growing up? If so, then health-related concerns may be in the back of your mind, and it is natural that you would think about physical dangers when your body feels out of control during a panic attack.

What does a panic attack feel like?

The “unexpected” aspect of the panic attack is an essential feature. They usually begin with the sudden onset of symptoms that could include: Shortness of breath or smothering sensations; dizziness, unsteady feelings, or faintness; choking; palpitations or accelerated heart rate; trembling or shaking; sweating; nausea or abdominal distress; numbness or tingling sensations; flushes (hot flashes) or chills, chest pain or discomfort; fear of dying; or fear of doing something uncontrolled during the attack.

When panic strikes

The very first panic attack seems to come completely “out of the blue” and occurs while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms, and there is nothing in the present environment to cause such a reaction. Even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, lose their minds, or be totally humiliated.

These disastrous consequences don't occur but they seem quite likely to the person who is suffering a panic attack.

For these reasons, it is important to understand the physiology of panic.

The physiology of panic

The human body is a very complex chemical factory, producing hundreds of chemicals that are regulated by an extremely elaborate and efficient communication network which control a great variety of bodily functions. It would not be improbable to find that the regulation of some of these chemicals can be slightly out of balance in many of us.

Some people are tall, some are short, some produce more of one hormone, others less. There is nothing wrong about any of these things; it is a matter of genetics just how our bodies are constructed and how they function.

A variety of researchers believe that people who get panic attacks tend to have minor abnormalities in the brain's limbic system, one of its emotional centers. Other researchers believe that the brain's chemistry, especially the portion that regulates alertness, may be out of kilter since many panic patients are hypervigilant about their bodily functions and have a general sense of helplessness...patterns that feed the disorder.

Everyone has an alarm reaction in their brain...we'd all panic if we were drowning. But for the panic disorder sufferers, that alarm rheostat is set too tight. These studies indicate that overly sensitive chemoreceptors may be at fault.

The communication network of the body includes the central nervous system (the brain and the spinal cord) and the peripheral nervous system (the remaining network of nerves). The central nervous system operates by billions of electrical impulses traveling along its pathways, carrying sensory input from our senses (hearing, sight, touch, smell) to the brain and relaying instructions from the brain back to the body, telling it how to respond to that information.

Panic disorder may be associated with increased activity in the hippocampus and locus ceruleus, as these portions of the brain monitor all external and internal stimuli and control the brain's responses to them. If neurotransmitters send a message that there is danger, the brain will respond with the appropiate chemicals, sending them throughout the body to either run or defend itself.

It has been well documented that panic disorder patients have increased activity in the adrenergic system, which regulates such physiological functions as heart rate and temperature.

When some sort of danger is perceived or anticipated, the brain sends messages to a section of your nerves called the autonomic nervous system. The autonomic nervous system has two branches, called the sympathetic nervous system and the parasympathetic nervous system. It is these two branches of the nervous system that are directly involved in controlling the body's energy levels in preparation for action.

Simply put, the sympathetic nervous system is the emergency fight/flight response system that releases energy to prepare the body for action. In contrast, the parasympathetic nervous system, is the restoring system, which returns the body to a normal state.

The “alarm” reaction or “fight/flight” response is the initial reaction of the body to any stress. It is actually a complex of reactions initiated by the stimulation of the sympathetic nervous system. It suspends all non-essential activity in the body and increases activity in any system that would be used to either fight or flee.

The responses are immediate and are designed to counteract a danger by mobilizing the body's resources for immediate physical activity. The alarm reaction brings tremendous amounts of glucose and oxygen to the organs that are most active in warding off danger. These are the brain, which must become highly alert; the skeletal muscles, which may have to fight off a stronger attacker; and the heart, which must work furiously to pump enough blood and oxygen to the brain and the muscles.

In addition, it constricts the peripheral blood vessels near the surface of the body, raising the blood pressure and makes the skin appear pale; suspends digestive activity (including the flow of saliva) and in stopping this activity rechannels the blood used in this process to provide additional blood for the motor muscles; triggers the emptying of the bladder and bowels to free the body for strenuous activity.

One of the major effects of the sympathetic nervous system is that it releases two chemicals called adrenaline and noradrenaline from the adrenal glands on the kidneys. These chemicals are used as messengers to continue activity, so that once activity in the sympathetic nervous system begins, it often continues and increases for a period of time.

However, it is important to note that this activity is stopped in two ways. First, the chemical messengers, adrenaline and noradrenaline, are eventually destroyed by other chemicals in the body. Second, the parasympathetic nervous system, which generally has opposing effects to the sympathetic nervous system, becomes activated and restores a relaxed state. It is important to realize that eventually the body will have enough of the emergency response and will activate the parasympathetic nervous system to restore a state of relaxation.

Panic chemistry

In other words, sympathetic fight/flight arousal cannot continue forever. Nor can it spiral to ever increasing and possibly damaging levels. The parasympathetic nervous system is a built-in protector that stops the sympathetic nervous system from getting carried away.

Another important point is that the chemical messengers, adrenalin and noradrenaline, take some time to be completely destroyed. Thus, even after the immediate danger and accompanying surge of emotion has passed and your sympathetic nervous system has stopped responding, you are likely to feel keyed up or apprehensive for some time because the chemicals are still floating around in your system.

As a result, his fight/flight response triggers the release of increased amounts of adrenaline (epinephrine) and related chemicals into the bloodstream. They provide additional strength, stamina, and the ability to respond rapidly. These chemicals aid soldiers to survive in battle, athletes to perform better, and all individuals to respond more effectively when faced with dangerous situations.

Because such provocations generally do “not” trigger panic attacks in people who do not have the disorder, scientists have inferred that individuals who have panic disorder are somehow biologically different from people who do not. Also, people that have experienced panic attacks eventually become fightened of the physical sensations of the emergency response itself.

False alarm?

In essence, panic attacks represent fear of fear. So, panic attacks are akin to phobias, but in this case the phobic object is internal instead of external.

In contrast, an external phobic object, such as an animal, is usually predictable and escapable. Being afraid of something that is relatively unpredictable and inescapable creates a lot of anxiety about when it will recur and how to deal with it when it does recur.

It probably isn't important which of these biological factors are at the physiological root of panic disorder. It is sufficient to know that in some individuals such an overly reactive brain chemistry is sending out a false alarm. The message the body is sending probably isn't accurate and just this knowledge, that there may be some biological basis for the disorder, should be comforting to many.

Coping mechanisms

What can one do to aleviate this disorder? Some use medication, some use alcohol and some relearn breathing techniques, muscle relaxation and general behavior of eating, sleeping, exercise and thought patterns.

The first two methods are extremely dangerous because they lead to addiction, which then leads to a vicious cycle of withdrawl . . . increased panic attacks . . . increased medication/alcohol.

Researchers estimate that of all patients hospitalized for treatment of alcoholism, between 18 to 32 percent may be suffering with panic disorder. Alcohol is the quickest way to stop a panic attack, however, the consequences can become so severe that the alcohol becomes the problem and not the disorder.

Problem solving primer

When the startle response is triggered, it sends out signals to prepare the body for the fight/flight response. More oxygen is required and the muscles are tensed for action. For this reason it is important to understand breathing and muscle relaxtion techniques.

The body needs oxygen to survive. When you inhale, oxygen is taken into the lungs where it is picked up by the hemoglobin (the “oxygen sticky” chemical in the blood). The hemoglobin carries the oxygen around the body where it is released for use by the cells. The cells use the oxygen in their energy reactions, producing a by-product called carbon dioxide (CO2), which, in turn, is released back into the blood, transported to the lungs, and exhaled.

Efficient control of the body's energy reactions depends on a balance between oxygen and CO2. This balance is maintained chiefly through the rate and depth of breathing.

Breathing too much will increase levels of oxygen in the blood and decrease levels of CO2, because the oxygen is not used at the same rate that it is taken in. Breathing too little will decrease levels of oxygen and increase levels of CO2. The appropriate rate of breathing, at rest, is about 10-14 breaths per minute.

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Next month: We will publish an outline of a case in point and the techniques he used to control panic.