From the Docs

Feeling like you are going to die

Many years ago, I worked in an emergency room (ER) at a large hospital. It was a very common occurrence for me to conduct suicidal assessments and inpatient hospitalizations for the severest situations. Surprisingly, it was even more common to be asked by the ER physician to provide education to ER patients on coping with panic attacks. These ER patients were experiencing intense physical symptoms that were actually psychological in nature. In other words, there was nothing wrong with them medically, but they felt as though they were “going to die.” These patients would describe their experiences as heart-attack-like or near-death-like in nature. Their symptoms included typical physical symptoms, such as tightness and/or pain in their chest, shortness of breath, pounding or racing heart, sweating, weakness or dizziness, hot or cold chills, tingling/numbness in hands and stomach pain. After the ER physicians finished assuring the ER patients that medically there was nothing wrong, it was my job to tell the patients that what they experienced was a panic attack and that our minds can be powerful enough to mimic the same symptoms as a heart attack.

Most of the ER patients stated that their symptoms began “suddenly” and “out of the blue” without any preceding signs or triggers. They were often not doing anything particularly stressful or strenuous, sometimes just sitting watching TV. Because of this, they had difficulty believing their symptoms were psychological, since they were not able to link them to some type of emotional distress. Some of them even requested further testing to see if their physician missed a diagnosis, or they would try to convince me that what they experienced was completely physical and became upset when I told them their symptoms were completely psychological.

Once I was able to help them understand that our mind is the most powerful organ in our body, controlling all aspects of our physical responses, they were better able to accept their experience as psychological and began to feel relieved that they did not have a life-threatening event. This is when they were able to reflect on their thought processes and coping skills to control their physical symptoms.

Additionally, since this experience was highly unpleasant and at the time quite real and scary, they would often have an intense fear of another panic attack. They would often avoid places and situations where past panic attacks occurred, and anything in their lives that might cause anxiety. They might even stop exercising, since the normal response to physical exertion can be similar to symptoms of a panic attack. Spiraling further, the more panic attacks they experienced, the more intense their fear of additional attacks became over time. Consequently, for some people, panic attacks can become so debilitating that they may avoid going outside of their home altogether.

People often experience their first “attack” in late adolescence or early adulthood. Women are twice as likely as men to experience them. When these panic attacks occur repeatedly and interfere with a person’s level of functioning, it can be indicative diagnosis of panic disorder, which benefits from short-term treatment.

It is unclear what causes panic attacks, but researchers have found that it usually runs in families and has some genetic component discovered in twin studies. In addition, some stress researchers have discovered that a significant level of stress, such as recent loss, may trigger panic attacks.

Panic attacks may also have other implications. Research shows that people who struggle with a panic disorder are more likely to abuse alcohol and drugs, are at greater risk for suicidal attempts, make frequent visits to the ER and spend less time pursuing pleasurable activities. Overall, they are feeling handicapped by their fear.

Having one or two panic attacks during the course of your life may be considered normal, and you may never experience one again. However, if you experience them repeatedly and it is affecting your functioning at home or work, it is highly recommended that you seek counseling and/or medical advice. If you have a history of panic attacks, you can lead a normal life if you are willing to address the irrational fear rooted in these attacks, and if indicated, are willing to take prescribed medications that can balance the chemistry in your brain. Researchers have found that appropriate treatment, such as cognitive-behavioral therapy and certain types of medication, can prevent panic attacks by 70 to 90 percent.

If anything in this article hits home with you or a loved one, don’t hesitate to seek help. There are effective treatments available for panic attacks/disorders. All psychologists at PSB are highly trained to evaluate and treat panic attacks/disorders. If you would like to talk to one of us, please contact Psychological Services Bureau at (213) 738-3500 to schedule an appointment. Your appointments and all consultations will be confidential. To obtain additional information, you may visit our intranet site (http://intranet/intranet/PSB/Index.htm).