What causes panic attacks?
Physical v.s. psychological causes of panic attacks
Panic attacks can be caused by physical as well as psychological problems.
Psychogenic
When panic attacks are caused by our minds, we refer to that as “Psychogenic”. “Psycho” refers to our minds, and “genic” means “beginning.” Therefore, Psychogenic refers to psychological causes of panic attacks.
About half of the U.S. population knows what it is to experience a panic attack. Panic attacks are a rather common human experience. The reason why they happen is because when we experience an extreme level of fear, and there is no actual threat that we physically need to respond to, we end up “cooking” in our own stress response. Under natural circumstances, whenever a person would experience that level of stress, they would be either running away at full sprint, or fighting for their lives with everything they’ve got. They would be burning through all of that fearful energy. This does not happen during a panic attack. Instead, we might pace back forth, or worse yet, sit or stand still.
When our thinks that there is a physical threat, it gets our body ready to act. It gets ready for powerful motion like hitting or sprinting. It fires up all of our musculature so that if we have to move quickly, our muscles are already half-flexed which allows them to react faster than normal. This is why sometimes anxious people have an exaggerated reflex response: Their musculature is already primed to fire, and all it takes is a little tap. Under natural circumstances (a bad guy, a tiger, etc.), you would then take your muscles through a full range of contraction and relaxation by running or fighting. You would “burn up the adrenaline”, so to speak. However, with panic attacks, we experience that same level of terror, but with no physical expression to it. Instead, we just sit in that muscle tightness. Those muscles get tighter and tighter, and eventually begin to cause us physical symptoms. For example, chest tightness can make it feel like it’s harder to breath. During an elevated state of fear, this can easily be misinterpreted as another sign of danger. Many people assume that this is a sign that they might suffocate, which causes panic to escalate further.
That was just an example and there are many ways that symptoms of panic can show up. For example, the symptoms of hyperventilation alone cover a whole swath of common panicky sensations. Symptoms of hyperventilation include lightheadedness, dizziness, weakness, difficulty thinking, shortness of breath, pounding heartbeat, dry mouth, muscle spasms in hands and feet, numbness and tingling in arms or around mouth, and difficulty sleeping. These physical symptoms become overwhelming and unbearable, and we eventually start to become afraid of them. Essentially, we become afraid of the symptoms of fear.
As soon as we become afraid of our own symptoms of fear, the fear of a panic attack begins. Fear of panic attacks underpins many psychiatric disorders.
Book your free consultation.
Psychiatric disorders that cause panic attacks
Below is a list of all of the psychiatric disorders that often present with panic attacks. Click on each one to expand it and learn more about it.
-
Isolated panic attacks do happen, and they are a normal part of human experience. Over half of the US population has experienced a panic attack at some point in their lives. A single panic attack is often times nothing to be worried about.
-
A defining and required feature of a panic disorder are recurrent and unexpected panic attacks.
However, there is one additional requirement. In order to be diagnosed with a panic disorder, a panic attack must be followed by at least 1 month of:
1) Persistent concern about additional attacks or their consequences
AND/OR
2) A significant maladaptive change in behavior related to the attacks
AND/OR
3) The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition
*Panic disorder can occur with or without agoraphobia. See “Agoraphobia” below to learn what agoraphobia is.
-
Agoraphobia refers to an intense fear of specific places or scenarios. If you have agoraphobia, then you’ll find yourself avoiding those places or situations. The DSM 5 defines agoraphobia as:
A marked fear or anxiety about two (or more) of the following five situations:
1) Using public transportation
2) Being in open spaces
3) Being in enclosed spaces (e.g., shops, theaters, cinemas)
4) Standing in line or being in a crowd
5) Being outside the home alone.The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
-
A phobia is a marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Similarly to agoraphobia, other phobias can elicit the same strong physiological response that can escalate into a panic attack. Furthermore, the fear of the object or situation may blend with the fear of having to deal with a panic attack.
Phobias can be broken down into 5 categories based on the phobic trigger:
1) Animal Type (e.g., spiders, insects, dogs)
2) Natural Environment Type (e.g., heights, storms, water)
3) Blood-Injection-Injury Type (e.g., needles, invasive medical procedures)
4) Situational Type (e.g., airplanes, elevators, enclosed places)
5) Other Type (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters) -
Obsessive-Compulsive Disorder is marked by the presence of obsessions and compulsions.
OBSESSIONS are defined as:
1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
And..
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).
COMPULSIONS are defined as:
1. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.
And…
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
Furthermore, the obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
-
PTSD is a serious condition that can trigger panic attacks or experiences similar to it. It develops following exposure to actual or threatened death, serious injury, or sexual violence. Further below, you’ll find more detailed list of symptoms. These symptoms do not necessarily have to develop immediately after the traumatic event. PTSD has a subtype called “With delayed expression”, where the full expression of the disorder does not take place until 6 months or longer.
MENTAL INTRUSIVNESS:
PTSD presents with intrusive memories, dreams, re-experiencing of trauma, and distress as a result of external or internal cues related to the trauma (phobic-like responses).
AVOIDANCE BEHAVIOR:
There is also a pattern of persistent avoidance of stimuli associated with the traumatic event(s), such as: Memories, thoughts, feelings, people, places, conversations, activities, objects, or situations. Often times people will self-medicate with alcohol in order to escape the memories, thoughts or feelings, which unfortunately causes more problems.
NEGATIVE THOUGHTS AND MOOD:
PTSD is marked by negative changes in thoughts and mood. Some examples are: Inability to recall specific details of the trauma, negative self and world beliefs (“I am bad”, “No one can be trusted”, “the world is completely dangerous”, “my whole nervous system is permanently ruined”), negative mood, feelings of detachment or estrangement from others, and persistent inability to experience positive emotion.
FREQUENTLY IN FIGHT-OR-FLIGHT:
Lastly, changes in arousal and reactivity can be seen, such as: Hypervigilance, exaggerated startle response, irritability, reckless behavior, and/or sleep disturbances.
-
Separation anxiety disorder refers to excessive fear or anxiety concerning separation from those to whom the individual is attached. Individuals with separation anxiety may experience panic attacks at the thought or actual separation from their attachment figure (Typically a parent, sibling, or romantic partner).
Someone with separation anxiety will experience excessive distress when anticipating or experiencing separation from home or from major attachment figures. They’ll worry about losing them and about what harm could come to them (such as illness, injury, disasters, or death.) They might experience excessive worry about things that could separate them from a major attachment figure (events like: Getting lost, being kidnapped, having an accident, becoming ill). Generally, there is a preoccupation with separation.
-
Social anxiety disorder refers to fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. The fear may get so intense that it can cause panic attacks. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). The person will also avoid social situations or endured them with intense fear and anxiety.
Somatogenic
The word “somato” means “relating to body”, and “genic” means “beginning”. Therefore, Somatogenic refers to a physical cause of panic attacks.
Below is a sample list of physical conditions known to induce panic attacks.
Hyperthyroidism and hypothyroidism refers to an overactive thyroid gland, and an underactive thyroid gland. Both can cause panic attacks.
Pheochromocytoma is a type of adrenal gland cancer that can cause panic attacks.
Temporal-lobe epilepsy can create symptoms similar to panic attacks.
Asthma can cause panic attacks. The individual’s nervous anticipation of an asthmatic attack can cause a panic attack.
Cardiac arrhythmias can cause and trigger panic attacks.
Excessive intake of caffeine or other stimulants can cause panic attacks.
Withdrawal from alcohol can cause panic attacks.
Treatment with high doses of corticosteroids can mimic or cause panic attacks.
This is just a sample list of causes and there may be others. Please visit your primary care doctor to get more information.
“I used to have panic…”
Adam J. Biec, LMHC/LPC
“My name is Adam J. Biec. I am Licensed Mental Health Counselor and a Licensed Professional Counselor, and I used to have a panic disorder. I learned how to eliminate them and became passionate about helping others get rid of their panic attacks as well.
My clients often say that talking to me about their panic attacks is like a breath of fresh air, because it’s so hard for most people to understand their experience. I understand the experience because I lived it. Having that personal experience with panic also made it easier for me to help others, because I know how to navigate the problem.
Right now, the most important thing I need you to know is that it is absolutely possible to get rid of your panic attacks. I did it, I’ve seen my clients do it, scientific research suggests it, and I know that it’s possible for you to do it as well.”
What People Are Saying
“Adam has been very helpful to me. I went to him for help with panic attacks, but he helped me overcome them. What he said made sense from the start. It was hard for me to describe what I was going through w other people, but he knew what I was going through and could relate, which made me feel comfortable. Most of my panic attacks have stopped. I have a lot more to go, but I know what I have to do now! I definitely recommend him!”
— ZocDoc Reviewer
“After suffering from anxiety and panic attacks for most of my life, and as it got increasingly worse this past year, I sought out a therapist and was lucky to find Adam through Zocdoc. I tried a therapist once in the past, but I had a horrible experience so I was definitely hesitant about going in. But after coming highly-recommended, I met with Adam who provided a very safe environment to talk. He has significantly helped me cope with my anxiety and provided extremely useful techniques when it comes to approaching and overcoming it. He is very personable and just a pleasure to talk to about anything. I wish I could give him more than 5-Stars. I can't thank him enough for everything he has done for me!”
— ZocDoc Reviewer
“Adam is above all a wonderful person, who truly cares about improving the life of his patients. I am so glad I found Adam: he is a rare gem, an incredibly smart and approachable person. If you are lucky enough to work with him, I am certain you'll see rapid improvements, whatever your goals may be. I highly recommend Adam's practice.”
— Google Reviewer