Panic attacks: causes and what triggers them

A panic attack comes on suddenly: the heart races, there is not enough air, fear overwhelms you. After the first episode, many people look for an explanation — what exactly caused it and why it happened to them. A calm look at how panic works helps to make sense of the causes.

What a panic attack is

It is a sudden episode of severe anxiety with physical sensations: palpitations, a feeling of suffocation, chest pain, dizziness, nausea. The attack develops quickly and most often does not last long, although some drag on for up to an hour. A person may feel that they are losing control, going mad, or dying. Panic attacks are not fatal and do not lead to life-threatening diseases. According to various estimates, between 35.9 and 46% of people have experienced at least one such attack in their lifetime, and panic disorder occurs in approximately 1–5% of adults.

What causes panic attacks: main causes

The exact cause of panic disorder is unknown. Researchers name several factors that may play a role:

• severe or traumatic life experiences, such as loss;
• a close relative with panic disorder;
• features of brain function and chemistry, an imbalance of neurotransmitters;
• severe stress and trauma, especially those experienced in childhood.

Attacks are more common in women and often begin in late adolescence or in adults under 44. Episodes can also occur with other conditions — post-traumatic stress, depression, bipolar disorder.

Stress, anxiety and psychosomatics

During an attack, physical symptoms occur: palpitations, shortness of breath, trembling. The person becomes frightened by these sensations, takes them for signs of a heart attack or stroke, and fear intensifies the panic. This closes the "fear of fear" loop: anticipating an attack becomes more agonizing than the attack itself, and sometimes leads to avoiding places and situations where an attack has already occurred.

Panic attack after alcohol

According to medical reference books, alcohol, caffeine and smoking can make attacks more severe. In men, a panic attack may go unnoticed: it more often leads to alcohol dependence as a way to reduce anxiety, and the person consults a doctor about alcohol rather than panic attacks.

Why panic occurs without an obvious cause

An attack can come on suddenly and without an obvious cause. An episode can happen in a calm setting, without danger or warning, sometimes during sleep. In panic disorder, attacks are not caused by external factors, and the exact cause of the disorder is unknown. Internal panic without a cause is especially frightening precisely because there is nothing to link it to.

When to see a doctor

If episodes recur and anticipatory anxiety persists for a month or longer, this is a reason to talk to a doctor. They will ask about the symptoms, their frequency and duration, may perform an examination and order tests to rule out other causes: blood tests for thyroid problems, a check of heart function. If necessary, they will refer you to a psychiatrist or clinical psychologist.

A panic attack in itself is not a reason to call an ambulance. Call 103 or 112 if there are life-threatening signs: severe chest pain that does not go away, or suspected stroke.

This material is for reference and does not replace a doctor's consultation: only a specialist can assess your condition and discuss possible steps with you.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer