Panic attacks and panic disorder are usually associated with anxiety. However, a panic attack should not be mixed with anxiety, even though they will most often present themselves together.
Clients presenting with social anxiety are likely to report experiencing panic attacks. Such attacks are also common with obsessive-compulsive disorder (OCD) and obsessive-compulsive personality structure. But they can also be experienced outside these mental health conditions.
What is a panic attack?
If we talk about panic attacks in symptomatic terms, we can describe them on bodily level, as well as on cognitive (thinking) level, and on the level of feelings.
They are usually felt as uncomfortable attacks that seem to incapacitate the person experiencing it by fear, strong bodily reactions and overwhelming thoughts. Some experience them as a form of overwhelming anxiety, however, we should be careful when mixing anxiety and panic attacks as terms.
Because panic attacks have this bodily, or better, physiological nature to them, they are often misinterpreted as physical illness and, hence, often misdiagnosed—especially if they are new to the person that is experiencing them.
It is a good practice to rule out any physical illness before addressing panic attacks in therapy. After any physiological cause has been ruled out, psychotherapy or counselling can be considered as suitable form of therapy and hence treatment.
A common trait of panic attacks is that the person experiencing them has the tendency to catastrophise whatever they are feeling. A panic attack is hence a result of the thought of impeding catastrophe—of something catastrophic and horrible happening to the person and the feeling they will not be able to escape it.
Symptoms of a panic attack
As far as bodily sensations are concerned, a panic attack will usually manifest itself similar to flight and fight response. This involves increased and stronger heart rate and alertness. It will usually be accompanied by feelings of light-headedness, nausea, feelings of ground moving under the feet and agitation.
On cognitive level, a panic attack can also involve thoughts of needing to escape from a certain space, feeling as though a person is having a heart attack or that they will lose consciousness or even die on the spot.
Panic attacks can be accompanied by feelings of moderate to severe fear of dying, losing consciousness or having a heart attack. The thought of losing consciousness can also be accompanied by feelings of shame and embarrassment. The latter is particularly present in the case of social anxiety, which can be complemented by panic disorder.
Dynamics of panic attacks and panic disorder
As we have already indicated, the psychological and cognitive dynamics of panic attacks originate in the person’s fear of something catastrophic happening to them. This sense of impeding danger can result in terror-like fear.
This can be fear of something physical and health-related happening—i.e. heart attack, fainting, stroke, death. But it can also be of obsessive nature, resulting in fear of going crazy or fear of losing control, going into rage, becoming violent, doing something dangerous or in any way hurting self or others. This can also be accompanied by visual intrusive thoughts which often have “foreign” nature to them and hence make the experience even more fearful for the person.
The fear of panic attacks makes panic disorder worse
When a person has a panic disorder or is experiencing panic attacks on reoccurring basis for any other reason, what will commonly happen is that the fear and anticipation of having a panic attack will actually stimulate one to occur. Once this happens, the fear of having a panic attack will come on top of the fear which is the basis of the attack itself and make it even worse.
This fear will often cause the person to avoid situations that they think might cause panic attacks, thinking that this is the best way to avoid them. In reality, unfortunately, this will only deepen the problem.
Panic attacks and panic disorder in therapy
When dealing with panic attacks and panic disorder in therapy, either through psychotherapy or counselling, it is important to look into the underlying causes of their occurrence. These are different for each individual and, therefore, demand a case-by-case approach.
Also, panic attacks should be dealt with along with addressing other mental health conditions, for example anxiety, that might be accompanying panic disorder itself. Hidden psychological rationale that the attacks are the result of will often times lie in psychological content that is not directly clear to the person, or even in the unconscious.