Panic disorder is a type of anxiety disorder characterized by sudden, unexpected panic attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
People with panic disorder experience recurrent, unexpected panic attacks and also worry persistently about having more attacks or the consequences of the attacks. This worry causes significant anxiety and interferes with daily functioning.
What Triggers Panic Attacks?
Panic attacks can occur spontaneously without an obvious trigger or in response to a stressful or anxiety-provoking event or situation. However, research has identified some common triggers that can set off a panic attack in people with panic disorder:
Stress
Stress is one of the most frequently reported triggers of panic attacks. Major life stressors such as a death in the family, divorce, job loss, financial difficulties, or medical issues can trigger panic attacks. Even small daily stressors can set off an attack in some people with panic disorder who may be more sensitive to stress.
Anxiety and Worry
Anxiety, apprehension, rumination, and excessive worry about real problems or perceived threats can also trigger panic attacks. People with panic disorder often worry persistently about when their next attack will happen, how bad it will be, or what the consequences might be. This anxiety and worry creates a hypervigilant state that makes them more prone to experiencing panic attacks.
Physical Sensations
In some cases, just becoming aware of physical sensations like an accelerated heart rate, dizziness, shortness of breath, or gastrointestinal discomfort can trigger panic attacks. People with panic disorder may misinterpret these normal bodily sensations as dangerous or catastrophic, triggering an attack.
Phobias
Having phobias of certain places, situations, or objects can predispose people to panic attacks. Common phobias linked to panic disorder include agoraphobia (fear of open spaces), claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), and driving phobia. Exposure to, or even thinking about, the feared situation or object can instantly trigger an attack.
Interoceptive Exposure
Interoceptive exposure involves purposefully inducing physical sensations like dizziness, rapid breathing, increased heart rate, or shortness of breath in a safe, controlled setting. This technique is sometimes used in cognitive behavioral therapy for panic disorder. However, interoceptive exposure can also inadvertently trigger panic attacks in people with panic disorder if they become frightened by the physical sensations.
Medication Withdrawal
Some medications like antidepressants or benzodiazepines have anti-anxiety and calming effects. If people abruptly stop taking these medications, it can precipitate rebound anxiety and panic attacks.
Caffeine and Other Stimulants
Consuming large amounts of caffeine or other stimulants found in coffee, energy drinks, some sodas, chocolate, or medications can induce feelings of anxiety, rapid heartbeat, jitteriness, and insomnia that may lead to panic attacks in those with panic disorder.
Hypoglycemia
Allowing blood sugar levels to get too low by not eating regularly can cause hypoglycemia. The shakiness, sweating, irritability, confusion, and palpitations associated with hypoglycemia may be misinterpreted as an impending panic attack by those with panic disorder.
Hyperventilation
Rapid, deep breathing known as hyperventilation blows off too much carbon dioxide from the bloodstream. This can cause many sensations like dizziness, lightheadedness, and tingling that may trigger panic attacks in people prone to them.
Exercise
The increased heart rate, sweating, and shortness of breath that occurs with intense or prolonged exercise can elicit panic attacks in some people. This is sometimes called exercise-induced panic disorder.
Situations That Commonly Trigger Panic Attacks
In addition to the triggers above, there are certain situations that commonly provoke panic attacks in people with panic disorder:
Driving
Many people have driving-related phobias and being in a car can trigger panic attacks, especially if they get stuck in traffic or on a bridge where escape seems difficult. The fear may stem from worrying about having an attack while driving.
Being in Crowds
Crowds, queues, audiences, and public gathering places like malls, theaters, or stadiums can trigger panic attacks. There may be a fear of having an embarrassing attack in public, or not being able to escape in the crowd.
Riding on Public Transport
Buses, subways, trains, and planes may trigger panic attacks due to a fear of being trapped, stuck in traffic, or not being able to get off if having a panic attack. In particular, traveling through tunnels on subways can induce panic.
Being Home Alone
Some people are conditioned to experience panic attacks when home alone because there will be no one to help them if they start to feel panicky or have an attack. The comfort of having others around helps keep panic at bay.
Shopping Centers
Shopping centers, supermarkets, or department stores can trigger attacks – especially during busy sales when stores are crowded and noisy. As with other public places, the fear of losing control and embarrassing oneself can cause panic.
Doctor or Dentist Appointments
Fear of medical procedures, dislike of hospitals, or worries about hearing bad news can cause panic attacks around doctor or dentist appointments.
Traveling
Some people experience panic attacks while traveling. This may be related to fears about health problems being far from home, getting stuck at an airport, or worries about flying, driving, or taking trains or buses.
Narrow or Enclosed Spaces
Claustrophobic places like elevators, small rooms, MRI or scanning machines, tunnels, or even tight clothing can trigger panic attacks in some people with claustrophobia or agoraphobia.
Bridges
Driving over bridges can induce panic because of a fear of heights or feeling trapped on the bridge with no escape. Some people also worry the bridge may collapse, keeping them from getting to safety.
Being Far From Home
Being too far from home or somewhere comfortable and familiar can cause panic attacks due to agoraphobia, the fear of being trapped with no means of escape or going crazy. There may also be a fear of health problems occurring far from help.
Risk Factors for Panic Disorder
Research has uncovered various risk factors that may increase a person’s chance of developing panic disorder:
- Family history – Panic disorder appears to run in families and may have a genetic component. Those with a first-degree relative with the disorder have a higher risk.
- Major stressful or traumatic life event – Stressful events like childhood abuse or neglect, death of a loved one, divorce, or job loss increase the risk for panic disorder.
- Substance abuse – Use of alcohol, marijuana, cocaine, amphetamines, or caffeine has been linked to increased risk of panic attacks or disorder.
- Medical conditions – Some illnesses like thyroid abnormalities, seizure disorders, or COPD may increase the chance of experiencing panic attacks.
- Personality traits – People with anxiety sensitivity, introversion, neuroticism, or harm avoidance traits appear more likely to develop panic disorder.
- Female gender – Women are twice as likely as men to have panic disorder.
Treatments for Panic Disorder
Several effective treatments exist for managing and overcoming panic disorder:
Psychotherapy
The main psychotherapy used to treat panic disorder is cognitive behavioral therapy (CBT). CBT helps people identify and change dysfunctional thoughts and behaviors that feed panic. Exposure therapy is also useful for facing and overcoming feared situations or physical sensations that may trigger attacks.
Medications
Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and tricyclic antidepressants are sometimes prescribed for panic disorder. These medications help control panic symptoms.
Relaxation Techniques
Relaxation training, mindfulness meditation, yoga, and deep breathing exercises can help people with panic disorder calm down when they feel panicky or experience attack triggers. Reducing overall stress levels can also minimize panic severity.
Lifestyle Changes
Making positive lifestyle changes like avoiding caffeine, alcohol, and recreational drugs, getting regular exercise, and sticking to a healthy diet can help manage panic disorder. Sufficient sleep, social support from loved ones, and avoiding trigger situations also helps.
Conclusion
In summary, common triggers for panic attacks in those with panic disorder include stress, anxiety, physical sensations, phobias, interoceptive exposure, medication withdrawal, stimulant use, hypoglycemia, and hyperventilation. Situations like driving, being in crowds, doctor visits, traveling, and enclosed spaces often provoke attacks as well. Understanding one’s personal panic attack triggers is key to learning how to prevent attacks and overcome panic disorder.