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What Is a Panic Attack?

  • Published16 Jul 2018
  • Reviewed16 Jul 2018
  • Author Clinton Parks
  • Source BrainFacts/SfN

Image of a woman on a train having a panic attack

Feeling panic is an adaptive response to danger. The related increase in breathing rate and blood flow provides what's needed to fight off — or escape from — the threat. But feeling panic can be a problem when there is no threat. Heide Klumpp, associate professor of psychiatry at the University of Illinois at Chicago explains what can happen when an unexpected panic attack comes out of the blue.

What happens during a panic attack?

While anyone can have a panic attack, the fear of having a panic attack is characteristic of panic disorder. During an attack, people with panic disorder commonly report strong heart palpitations, shortness of breath, feeling lightheaded, and a fear of having a heart attack, dying, or going “crazy.” Panic attacks usually peak within 10 minutes. Whether the physical symptoms cause the fear or the fear causes the symptoms is not understood. Also, people with panic disorder tend to have higher baseline levels of anxiety than those without the disorder, which may make them more sensitive to attended to internal body cues, like their heart rate and changes in breathing — an awareness of mind-body connection called interoception. This oversensitivity may cause them to perceive an internal problem when none exists. Thus, unlike phobias and other anxiety disorders where the source of anxiety is known, panic disorder can develop without a clear trigger. Also, unexpected panic attacks can become expected panic attacks. For instance, the subway can become the cue for an expected panic attack after having an unexpected panic attack on the subway.

What parts of the brain are involved in panic disorder?

Though the circuitry for panic disorder is poorly understood, scientists have a general idea of what parts of the brain are involved. Deeper structures involved in motivational and defensive responses — like the fight or flight response — appear to play a role in panic disorder. These include parts of the hypothalamus and a region in the brain stem called the periaqueductal gray. Stimulating these regions elicits fear symptoms frequently experienced in panic disorder. Normally, signals from these deeper brain regions are moderated by signals from higher brain regions, such as the ventromedial prefrontal cortex. But, in panic disorder, less activity in the higher cortical regions may lead to over-activation of these deeper brain regions. The amygdala, a region that mediates fear and supports emotional processing and learning, is involved in panic disorder but does not seem to play as huge of a role as it does with other anxiety disorders. Given links between panic disorder and interoception, another part of the cortex, the insula, has been identified as a likely culprit in panic disorder as it is critical to interoceptive awareness.

How are panic disorders treated?

Working with the patient's interoception is how psychotherapists treat people with panic disorders. Patients go through what's called interoceptive exposure to replicate the symptoms experienced during a panic attack. The patient works with the psychotherapist to learn how to deal with the discomfort they feel during a panic attack and “ride it out,” which helps refute fears that the patient will die or “go crazy.” While this type of treatment does not work for everyone, it can be highly effective in a relatively short amount of time — within a few weeks.

This Ask an Expert was answered by  Heide Klumpp  as told to Clinton Parks for

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