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The Panic Attack
It is as though the symptoms jump you from behind. With little warning the heart begins its rapid pumping, a cold perspiration beads the forehead, trembling hands want to hide from view. The throat attempts in vain to swallow as any moisture remaining in the mouth disappears.
Your mind races to retain some semblance of control. "Just relax! Stay calm!" is the silent command. But you place little faith in such words. And why should you? They have always failed to relieve the anarchy of the body in the past.
The more you grip to keep control, the less control you feel. Panic! Seconds pass like minutes as your mind is pulled in two directions. First, to the past: "This is like last month, when I became so weak that I almost fainted." Then, to the body with a mind of its own: "I can't catch my breath. I'm trying. I can't!" The future rushes to the present: "What if this keeps up? I could pass out. If my heart beats any faster I could have a heart attack."
At that moment the fear of humiliation crowds the noise of the mind. "Everyone's going to see me collapse. I've got to get out of here." With the same suddenness that this attack started, you make your escape out of the door of the conference room or the movie theater, the doctor's office or the grocery store. The farther you get from the scene, the more comfortable you feel.
This scenario is what I call the moment of panic: an internal experience, supported by physical sensations, that one has immediately and dangerously lost control of one's circumstances. The changes in the body and mind take place so rapidly and unconsciously that they are experiencedas an "attack" of panic or anxiety.
All of us have experienced the physical sensations of anxiety. We get butterflies in the stomach before we give a speech, or sore, tense muscles after driving for an hour through a rainstorm. But the experience of general anxiety is quite distinct from the overwhelming sensations of a panic attack.
An example may clarify the difference. Have you ever faced a physical emergency alone, one that you were ill prepared to deal with? Imagine opening your cellar door to the sound of water splashing onto the concrete floor. You run down the stairs, half guided by your feet, half carried by your arms pushing off the hand rails. How fast do you size up the situation? How many options do you rule out in the first thirty seconds? "Can I stop it with my hand? No . . . How about tying it with a rag? Is there a rag around? Won't work! Where's this pipe coming from? Where's the main valve?" Your eyes move rapidly, absorbing every detail that might play a role in reducing the damage caused by a flooding basement. "Grandma's chest of drawers, it's getting ruined! Should I move it? Stop the water first. Where is that valve?! There's the trash can. No use, it's spraying too broadly. Whom can I call?"
If you freeze the action of the scene at this precise moment, you would recognize in yourself many of the physical symptoms found in what we call a panic attack or anxiety attack. The muscles are tense, ready to respond immediately to any directions from the brain ("Get down those stairs--now!"). The blood is rushing to the brain to stimulate the thought processes. The heart and the respiration rates both rapidly increase to produce the shifting of blood throughout the body essential to energetic action.
Each of us should be thankful for the incredible ability of our minds instantly and automatically to respond in such an emergency. How many of us have been saved from injury or death on the highway because our right foot slammed on the brake while our hands pulled on the steering wheel--all this before we had time even to think the command "Watch out for that car!"
Brilliant as this built-in emergency system is, sometimes things can go awry. During panic, the body responds with many of the same psychological changes that take place during an emergency. However, panic is an exaggeration of our emergency response. Instead of taking advantage of the body's rapidly increased strength, the individual experiencing panic becomes overwhelmed by a variety of physical symptoms. The more he focuses his attention on these internal changes, the more anxious he becomes and the less able he is to reassure himself.
A panic attack causes the fastest and most complex reaction known within the human body. It immediately alters the functioning of the eyes, several major glands, the brain, heart, lungs, stomach, intestines, pancreas, kidneys and bladder, and the major muscle groups. Within the cardiovascular system, the heart increases its rates of contractions, the amount of blood it pumps with each contraction, and the pressure it exerts as blood is pumped into the arteries. The vessels that channel blood into the vital organs and skeletal muscles expand, increasing their blood flow, while the blood vessels in the arms, legs, and other less vital parts of the body begin to constrict, reducing blood flow in those areas.
While this is taking place, your rate of respiration increases. The pupils dilate to improve distance vision. Within the gastrointestinal system, all digestive activity is diminished. Metabolism, the conversion of foods into energy, is enhanced, and increased amounts of sugars and fatty acids are secreted into the bloodstream.
Your subjective experience during a panic attack can vary greatly. Certain sensations (such as noticing your heart rate) are directly related to the physiological changes I have just mentioned. Others (such as the fear that you are dying) are produced by your mental and emotional response to these sensations. Listed below are a variety of symptoms associated with different parts of the body during a panic attack. Generally speaking, the more symptoms you have during the attack and the greater the intensity of each symptom, the more devastated you feel by this assault.
The head. Decreased blood flow to the brain, caused by hyperventilation, may result in a feeling of lightheadedness or dizziness, as though your head is "swimming." You may feel faint.