What are Panic Attacks: Symptoms, Distorted Thoughts, and Behavioral Responses

Dr. Tracey Marks defines panic attacks as a sudden onset of intense anxiety, characterized by a surge of intense fear or physical symptoms that peak within minutes. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a panic attack involves at least four specific symptoms, including palpitations, sweating, shortness of breath, chest pain, dizziness, derealization, depersonalization, and fears of losing control, going crazy, or dying. She differentiates panic attacks from general anxiety, highlighting their acute and overwhelming nature, and explains that panic disorder occurs when recurrent panic attacks become a primary problem, often leading to avoidance behaviors. Panic attacks can be either expected, with an obvious trigger, or unexpected, occurring without a clear cause, even during sleep.

The episode delves into the psychological mechanisms underlying panic, introducing the concept of "body vigilance" – a hypersensitivity to bodily sensations, leading to misinterpretation of normal physical feelings as signs of serious medical issues. Dr. Marks identifies three types of distorted thoughts common in anxiety and panic: catastrophizing, fortune-telling, and jumping to conclusions. She debunks common fears associated with panic, such as the belief one can hyperventilate into suffocation (as breathing is involuntary) or worry oneself into psychosis (a distinct mental illness). A key distinction is made between the internal, silent suffering of a panic attack and the misconception of external, wild behavior, emphasizing that panic typically manifests as internal distress rather than outward loss of control.

Practical insights are offered by examining the interplay between thoughts and actions in perpetuating panic. Dr. Marks outlines five common distorted thoughts, such as fearing a heart attack or fainting, and explains their irrationality in the context of panic. She then discusses typical behavioral responses, including escaping the situation, avoidance of triggers, and engaging in "safety behaviors." While these behaviors provide temporary relief, they ultimately maintain the panic cycle by preventing individuals from testing the reality of their fears and learning effective coping strategies, thus hindering genuine management of the situation.

Broader implications include the understanding that panic attacks can co-occur with other conditions like depression or generalized anxiety disorder, or even be triggered by medical conditions or medication side effects. The discussion underscores the self-perpetuating nature of panic when distorted cognitions and maladaptive behaviors reinforce the fear response. By elucidating these "behind the scenes" factors, Dr. Marks sets the foundation for future discussions on non-medication interventions, emphasizing that a comprehensive understanding of these psychological and behavioral mechanisms is crucial for effectively addressing and managing panic. This episode serves as an essential primer for anyone seeking to understand the complexities of panic attacks.

"panic attacks are a sudden onset of intense anxiety sometimes when you get anxious you can feel uptight or on edge or you may even worry about things but panic is different"

"with a panic attack you experience four of the following symptoms and this is as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition"

"body vigilance when you're hypersensitive to every body sensation and then you worry that your physical symptoms are a sign of a serious physical problem"

"people with anxiety and panic tend to have three kinds of distorted thoughts catastrophizing fortune-telling and jumping to conclusions"

"you really can't hyperventilate yourself into not being able to breathe breathing is involuntary and if you stop trying to breathe your brain takes over and breathes for you"

"psychosis that's usually what we associate with the most severe form of mental illness because you have a break from reality but psychosis is a completely different problem and you can't worry yourself into it or hyperventilate yourself into it"

"you may fear that you're going to embarrass yourself with some wild behavior but it just doesn't happen it's more of a silent suffering in your head that causes you to take action"

"these safety behaviors can make you feel better temporarily but they keep the panic response going because when you do the safety behavior you don't get a chance to test how realistic your assumption is and then you don't learn to manage the situation because you avoid dealing with it"

"Panic disorder occurs when you have Ray or panic attacks and this is your main problem and you can get to where you don't want to leave the house or be around people because you fear having a panic attack and not being able to escape"