For those suffering with Panic Disorder, anxiety attacks feel like they are coming from out of the blue. In reality, there is always a panic trigger, no matter how small. There are two types of stimuli that trigger panic attacks: internal and external. Internal stimuli include:
- thoughts;
- memories;
- emotions;
- bodily sensations such as a skipped heartbeat, a stomach ache.
External stimuli include anything in the environment that the senses can perceive:
- a smell;
- a sudden change in temperature in the room;
- a change in lighting;
- noises or a change in the way things sound;
The Panic Disorder patient might be so unaware of these triggers that it would seem hard to believe they are causing panic attacks. It takes a bit of work to understand how and why these types of events do, in fact, trigger panic attacks.
First, a working understanding of the causes of Panic Disorder is necessary. In short, the Panic Disorder patient may have inherited a highly sensitive nervous system. Then, chronic stressors over time have over-stimulated the nervous system, making it hyper-active and ready to fire at the slightest trigger. When the nervous system goes on hyper-alert like this, it is called a “sensitized” nervous system.
So instead of say, getting butterflies in the stomach over a minor stressor, the sensitized person will get a full-blown panic attack. A panic attack is the body’s fight or flight response, that causes physiological changes in the body to help you fight or flee from danger. In people without anxiety disorders, the fight or flight response is triggered only in response to danger. In a sensitized person with Panic Disorder, it is triggered even when there is no danger present.
How a Seemingly Out-of-the-Blue Panic Attack Is Triggered
Here is an example of how an extremely minor stimulus can trigger panic in the sensitized person. A person is alone at home, folding the laundry. Her heart, for who knows what reason, skips a beat. It is a minor thing, almost imperceptible. But somewhere in the person’s consciousness she notices it and it immediately reminds her of the last time she had a panic attack because skipped heart beats were a symptom.
Once reminded of the attack, she wonders if she is about to have another one. She realizes that she is home alone and wonders if help will be available if she needs it. She wonders what is wrong with her and if she will have a heart attack and die or maybe go a bit crazy. Her mind senses danger. Her sensitized nervous system overreacts and her body activates the fight or flight response in order to protect itself. Suddenly, she is having a full-blown panic attack.
The thought processes that occur in response to the skipped heartbeat are not unconscious, but they are “out of awareness”. They happen in a split second, and the person may not be readily aware of them. It feels like the panic attack was out of the blue because the person was simply folding laundry and the next thing she knew she was having a full-blown panic attack.
The Cycle of Panic
The panic response is activated in the body when a person thinks they are in danger. Because the symptoms of panic attacks feel so awful, the panic victim believes that his symptoms mean that he is in danger. When a person fears for his safety the fight or flight response – the very thing the person in this case fears – gets activated. This is the cycle of panic. This is how fear of a panic attack can actually cause a panic attack that is triggered by some minor stimulus. Thus, the panic attack seems “out of the blue” but it is not.
Cognitive-behavioral treatment for Panic Disorder helps people identify these triggers and thoughts and stop them in their tracks. In addition, it teaches patients how to desensitize their nervous systems so their bodies stop overreacting to minor stimuli. The National Institute for Mental Health offers advice on finding treatment.
This article is for general information purposes only. It is not intended to be personal, medical or mental health advice. People experiencing troubling symptoms should consult their physician or mental health professional.
©Lisa C. DeLuca, all rights reserved. It is a violation of copyright law to reproduce this work on the web or for profit without written permission from the author. This article was originally published on the web in 2008. Please contact the author with your reprint request.