Under Attack

Panic attacks affect millions of Americans each year, yet remain highly misunderstood. Learn what triggers these waves of overwhelming terror and how to cope when an episode suddenly strikes

WRITTEN BY Kinsey Gidick

PHOTOGRAPHS BY (jogger) Scott Henderson; (Dr. Coker) by Niki Nero

“I was sitting at a friend’s house, and all of a sudden, I was absolutely convinced that the house was on fire.” That’s how Emma Stone described a panic attack on Good Morning America in 2018. “Obviously, the house wasn’t on fire, but there was nothing in me that didn’t think I was going to die.”

Stone’s story may sound like Hollywood hyperbole, but the actress isn’t simply being dramatic. These waves of intense, unfounded fear strike more people than you might think. The National Institute of Mental Health reports that nearly five percent of American adults experience panic attacks at some point in their lives, women twice as often as men. In fact, panic disorder, which is characterized by repeated panic attacks, affects 2.4-million U.S. adults annually, according to the Anxiety and Depression Association of America. Roughly half of those face the condition before the age of 24.

Over the past year, the COVID-19 pandemic has taken its toll on our mental wellness, and as a result, experts believe the incidence of panic attacks is on the rise. “Acute anxiety queries”—in other words, Google searches on issues of mental health—reached an all-time high between mid-March and early May of last year, growing by 11 percent. This increased push for information underscores just how prevalent—and misunderstood—panic attacks can be, so we reached out to Dr. Sarah Coker, a Roper St. Francis Healthcare affiliated psychiatrist, for clarification.

“A panic attack is an intense emotional episode. This feeling of extreme anxiety or worry can manifest for just a second or last minutes with severe physical symptoms.” —Dr. Sarah Coker

What is a panic attack?

“A panic attack is an intense emotional episode,” Dr. Coker explains. “This feeling of extreme anxiety or worry can manifest for just a second or last minutes with severe physical symptoms including shortness of breath, blurred vision, chest tightness and an overwhelming feeling of lack of control. In short, extreme stress.” Other symptoms may include sweating, trembling, feeling hot or cold, dizziness, a racing heart, a choking sensation, nausea or an unusual out-of-body feeling. Sometimes confused with a heart attack, a panic attack can be extremely frightening both for those affected and those around them.

Even more uncomfortable? There’s no telling where or when a panic attack will take place, as these involuntary surges of fear almost always come out of the blue. “You could be driving a car or even sleeping when a panic attack suddenly takes hold,” says Dr. Coker. While some patients can pinpoint a specific trigger (for example, a stressful event, mental illness or change in environment) and then predict the onset of a panic attack, often sufferers don’t know what sparked an incident.

Why do people get panic attacks?

Psychiatrists have long studied the cause of panic attacks, and they’ve found that genetics plays a big role. “People who have a history of trauma or anxiety disorder might be more predisposed to acute episodes,” says Dr. Coker. “Anxiety does follow pretty closely with the family, so if a family member has a severe anxiety disorder or a history of panic attacks, there’s a higher likelihood of you having them as well.”

Genetics gives us one clue as to why someone might have panic attacks. Understanding the actual catalyst is another issue altogether. Fortunately, science has come a long way in explaining what sets off an extreme anxiety episode. Lifestyle factors such as lack of exercise, poor nutrition, alcohol and caffeine intake, too much media, too little sleep, and stress at work can all lay the groundwork for a panic attack.

“Poor physical health is a significant trigger for anxiety,” explains Dr. Coker. “The first questions a doctor usually asks a patient are ‘How is your sleep?’ and ‘How is your diet?’ While those may seem inconsequential, they really do matter.” Processed and unhealthy foods can worsen depression, which may translate into anxiety in some people. “Poor sleep might also leave people feeling more anxious, a huge risk factor for having a panic attack at some point later that day,” continues the psychiatrist.

The excess strain that anxiety places on the body can lead to other health issues, especially for patients in the age range for cardiac risks and events. Not only can a panic attack feel like a heart attack, some really do involve a coronary event. If an episode is ever accompanied by newly onset cardiac symptoms or chest pain that doesn’t resolve, seek immediate medical attention. “A lot of people keep anxiety to themselves and don’t say anything, which can cause short-term and long-term health problems, as well as relationship or work issues,” says Dr. Coker. “At its worst, untreated anxiety can feel disabling.”

Can panic attacks be stopped?

There’s no quick fix for panic attacks. “People can work with mental health professionals to develop a treatment plan that may involve counseling, lifestyle changes and medication,” advises Dr. Coker. Regular exercise can help diminish anxiety, which may lessen the number or severity of panic attacks. Physical activity also pumps up endorphins (feel-good chemicals in the brain) and improves our quality of sleep, which in turn reduces stress. Just five minutes of aerobic exercise such as brisk walking or biking can kick start anti-anxiety effects on the body.

“If a patient suffers frequent panic attacks, a doctor may prescribe a preventative or an abortive medicine, or sometimes both,” says Dr. Coker. A preventative medication helps avoid a panic attack altogether, while an abortive drug stops the episode as it’s happening. “If somebody is having disabling panic attacks every day, they need to be on a daily preventative medicine,” she continues.

What help is available?

Mental health professionals are working to normalize mental health illnesses and remove the shame once associated with anxiety disorders. With better treatment options, access to affordable counseling and global campaigns to encourage people to consider their mental health, those who have a history of panic attacks no longer need to suffer alone. “Rather than live in fear of an outdated stigma,” Dr. Coker says, “seek help from a mental health professional.” Compassionate support of those who struggle with anxiety is the medical community’s goal, and open conversations about mental health in popular culture are heralding a new dawn for those who struggle with panic attacks. “There’s no reason to stay silent,” says Dr. Coker. “Anxiety is nothing to be ashamed of.”

Ease a Panic Attack

If you find yourself in the midst of a panic attack, these strategies can help you reset:

• Take controlled, deep breaths through your mouth
• Close your eyes to reduce stimuli
• Focus on one object and try to notice every detail about it
• Consciously try to relax one muscle at a time, beginning with your fingers
• Picture yourself in a calm, quiet, happy place
• Move to a peaceful place, if you can do so safely
• Engage in light exercise like walking to flood the body with endorphins
• Drink lavender tea or rub lavender oil on your wrists to relax
• Repeat a reassuring mantra in your head
• Remind yourself that this feeling will pass and you are not in immediate danger

If a friend or family member has a panic attack, ask directly what they need and how you can best support them. Avoid telling them over and over to “just relax.” If symptoms last longer than 20 minutes, shortness of breath doesn’t improve or chest pressure lasts more than a couple of minutes, call 9-1-1.