One night seven years ago, I completely lost it. I was lying in bed, staring at the ceiling, trying to fall asleep. Suddenly, my nerves seemed to catch on fire, my muscles became as stiff as steel rods, and my heart felt like it would explode. I clutched the mattress to steady the spinning room. I had three thoughts: I'm going crazy. I'm going to do something crazy. I'm dying. I was overcome by the urge to get the hell out of there--to jump out of bed and run out the door or crash through the window. But I couldn't move. I was paralyzed with fear--the same feeling you get when you step off a curb and realize a car is heading straight toward you. Only there was no car. The danger was all in my head.

Forty-five minutes later, it was over. At the time, I was convinced I'd gone temporarily insane, but a little research revealed a more probable diagnosis: panic attack. A panic attack is clinically defined as a powerful, inexplicable sense of terror that comes on without warning, peaks within 10 minutes, and is marked by at least four of the following symptoms: racing heart; sweating; shaking; shortness of breath; chest pain; a sensation of choking, nausea, dizziness, or numbness; chills or hot flashes; fear you're going nuts, losing control, or dying; and the feeling that the world isn't real or that you're detached from your body. I had experienced at least half a dozen of these feelings. No wonder I was ready to check myself into a psych ward.

Bring Out the Dread

Panic attacks aren't as rare as you might think -- experts estimate that more than a quarter of all people will experience at least one in their lifetimes. They often come on suddenly and without warning, though studies have shown that attacks are sometimes precipitated by highly stressful events. "In patients who have panic disorder [see "Uh-oh, Not Again," page 164, for more on the chronic condition], six to eight months before the first attack we tend to see not merely stress but stress caused by loss, whether it's due to a job change, a move, a divorce, or even marriage or pregnancy, which is a loss of your former life," says Reid Wilson, Ph.D., a clinical psychologist in Chapel Hill, North Carolina, and the author of Don't Panic: Taking Control of Anxiety Attacks.

"When you experience a loss or too many changes too fast, it's easy to lose your grounding," says Pauline Boss, Ph.D., a stress researcher and therapist and the author of Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss. "You can't fix the problem, you feel out of control, and at some primitive level you can become panicked." If you're prone to panic attacks, your internal distress may continue to build as you go about your normal life until finally it overflows, sending your mind and body into a tailspin.

Given that, my own freak-out wasn't as random as it seemed. The seeds of my attack had been planted six months earlier, when I moved to Spain to study abroad, then later returned to the States only to transfer to a new university. Add an on-again, off-again relationship to the mix and I was a panic attack waiting to happen.

But everyone gets stressed and experiences loss. Why do some of us end up hyperventilating into a paper bag while others can decompress with a few Mike's Hard Lemonades and a round of PlayStation 3? Experts still don't know exactly why or how stress sets off an attack, but some believe it's a result of faulty neural wiring. "One theory is that in some people the brain circuitry responsible for processing emotion and fear is in a state of hyperexcitability," Wilson says. "This may cause the brain to mislabel nonthreatening, everyday stress as highly dangerous and set off a false alarm that sends your body into Defcon 1 status." Sometimes this irrational response is genetic. Call it an inherited proclivity toward panicking.

Brain scans show that many of the same stress hormones that are activated during the body's instinctive fight-or-flight response are triggered during a panic attack. Two possible culprits: adrenaline and noradrenaline. "Evolutionarily speaking, these hormones would be released when you're faced with a lion or a bear," says Lindsay Kiriakos, M.D., a clinical instructor in psychiatry at the UCLA Neuropsychiatric Institute and the author of Panic Disorder: How to Fight Back and Win. Both hormones shift your respiratory and circulatory systems into overdrive to prepare you for action. With massive amounts of oxygen pumping into your muscles and brain, you can react quickly to a killer grizzly. "The problem is that, during a panic attack, this extreme response occurs without the presence of any real outside threat," Kiriakos says. Without a real enemy to respond to, whether it's the snarling beast our ancestors had to contend with or a modern-day carjacker, the rapid breathing and muscle tension that would otherwise help us can translate into hyperventilation and trembling. "Sufferers can't figure out what's happening to them, and the confusion can be terrifying," Kiriakos says.

Some scientists theorize that noradrenaline may be to blame for much of that confusion. When this hormone hits the frontal lobe, which is associated with judgment and reasoning, among other things, your ability to think clearly may get jammed up. Unable to comprehend the ensuing cyclone of negative sensations, people assume the worst: that they're dying or having a heart attack. In fact, according to a 2003 study in the Canadian Journal of Emergency Medicine, people with panic disorder are significantly more likely than people without the disorder to head for the ER due to chest pain.

Other than being convinced that I had boarded a one-way train to Reaperville, what scared me most about my panic attack was that I wasn't doing anything strenuous or out of the ordinary when it hit. There was no obvious trigger--I was just lying in bed. That's common during what's called a spontaneous panic attack--one that isn't clearly connected to any fear-­inducing situation, says Jordan W. Smoller, M.D., Sc.D., associate professor of psychiatry at Harvard Medical School. Though it's true I had been under a fair amount of pressure in the months leading up to the attack, because it didn't arise as an immediate reaction to my stress, I didn't make the link until later on.

In other cases, it's easier to connect the dots. A panic attack may strike when a person encounters something that trips a specific phobia, as when a claustrophobe enters a confined space. Asthmatics--who, researchers have found, are about twice as likely as people without asthma to have panic attacks--may experience one at the first sign of shortness of breath. Or a chemical trip could shove you over the edge: Substances such as caffeine, nicotine, and other drugs can spark a panic attack because they induce arousing symptoms (like the jitters you get after a few rounds of espresso) that people who are vulnerable to attacks interpret as dangerous. "About a third to half of my patients report that their first panic attack occurred while they were taking a drug like marijuana," Kiriakos says.





Issue date: July/August 2006

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