Anxiety disorders are the most prevalent mental disorder seen in the U.S., affecting 40 million adults in the United States or roughly 18% of the population. When that anxiety escalates to a panic attack, sometimes seemingly out of nowhere, it can turn your world, your life, upside down.
What my clients know for sure is how they feel when the mounting anxiety and swiftly rising panic takes over. Oftentimes it feels as if they are suffering a heart attack. What they don’t always know is what is causing the anxiety and panic. Let’s take a closer look.
Severe anxiety is common to both PTSD (Post Traumatic Stress Disorder) and Panic Disorder, but what separates the two is cause and the cause is found in trauma.
At the age of 24, I developed PTSD after nearly dying in a severe automobile accident. Afterwards, I experienced severe anxiety whenever I was riding in a car and much later when I tried to once again drive a car on my own. The driving of the car was a known stressor brought on by the trauma of the car accident. Those with clinical PTSD have experienced something truly horrific. They have seen, heard, felt, smelled something that caused their autonomic nervous system (ANS) to be triggered. That “fight or flight” system is then continuously on hyper-alert, scanning their environment for any new potential dangers. Trauma can be any number of things from war to accidents, to natural disasters, to assault and abuse. Trauma can also occur from simply witnessing something horrific; the person need not be physically hurt themselves. What felt like panic attacks to me at the time, I later learned were explicit and implicit flashbacks. More on this later in the article…
Panic disorder (PD), by definition is recurrent unexpected panic attacks, that cannot be explained or accounted for by another mental disorder, such as social phobia, specified phobias, PTSD, separation anxiety, or obsessive-compulsive disorder (OCD). So PD is brought on by one too many panic attacks. Let’s say you were traveling when you happened to experience a panic attack, not severe enough to keep you from travel yet, but what if the next attack also occurred while traveling? You could then become so frightened of having another panic attack that you decide to avoid travel all together.
In both examples, travel is being avoided, but with my PTSD I was traumatized by the car accident. In the second example, there was no known trauma, nothing real to be frightened by, yet the person would have be traumatized by the experience of the panic attacks themselves.
The “trauma” of having a panic attack is vastly different from the “trauma” of war or a horrific accident but the effects from a brain mechanics point of view is similar. The hyper-vigilance experienced by someone suffering with PTSD is much like the severe anxiety experienced by one who is fearing the effects of yet another panic attack. Both disorders can cause avoidance as a means of survival and both can also create agoraphobia.
With PTSD, sufferers are not having panic attacks (though again it feels quite similar); the anxiety is brought on by repeatedly re-experiencing their trauma in the form of dreams and flashbacks. Flashbacks can be both explicit and implicit (also termed emotional flashback). More specifically, flashbacks come from explicit and implicit memory. Explicit memories are memories that are conscious and remembered as memories, such as “I remember going on my first camping trip in boy scouts.” Therefore, in an explicit flashback, there is a known trigger like helicopters flying overhead or the sound of a car backfiring to the war veteran or the subtle scent of cologne to a sexual assault victim. Implicit memories come from the subconscious and are not recognized as memories. Implicit or emotional flashbacks flood the person with intense emotions such as pain, fear, shame, and anger, but because there is no known memory tied to these emotional reactions, they are experienced as if they are happening in the present moment.
Emotional flashbacks, termed “amygdala hijackings” by Pete Walker and described as “sudden and often prolonged regressions to the frightening and abandoned feeling-states of childhood” are considered part of Complex PTSD. This can be seen by those whose childhoods were characterized by emotional abuse, neglect and abandonment as well as with those with more severe physical and sexual abuse. Emotional flashbacks occur when one is triggered by something in the present moment that reminds our primitive brain of past pain. As a result we become flooded with intense, painful emotions often reacting disproportionately and inappropriately to the present situation.
Implicit memories of pain and shame can be disruptive, affecting relationships, careers as well as one’s own emotional stability. Patients are either unaware that they are having one because they attribute their feelings to the present moment or they are confused and fearful, not understanding what caused the anxiety and panic that seems to hit them seemingly out of the blue!
For example, let’s take John who had a childhood marked with shame from a highly critical, alcoholic father. No matter how many good grades or soccer goals scored, his father only saw the mistakes and he was never good enough. Jump ahead 30 years later, John is repainting his home office and his wife walks in remarking, “Oh honey, I think you missed a spot.” John instantly blows up at his wife in anger, because the pain detector in his primitive brain reacted to her constructive criticism from the filter of his implicit memories of never doing anything right or being good enough and he becomes flooded with shame, pain and anger.
Or the example of young Julia, who is walking in the mall one day when suddenly a choking, overwhelming fear and panic overtakes her and she runs from the mall to escape. What Julia isn’t consciously aware of is that her primitive brain recognized the smell of a particular cigar smoke from the man who molested her as a child.
In addition to flashbacks, PTSD sufferers are also subject during sleep to the rise of explicit and implicit memories in the form of nightmares and night terrors. These too, can cause significant distress. Psychotherapy with a trained professional can help the individual to not only safely process the trauma but also teach them coping skills such as relaxation, grounding and dual awareness techniques.
So by now, some of you are asking, “OK, we understand that trauma creates PTSD, what then creates panic attacks?” Good question. Remember, panic disorder is created by one too many or recurrent panic attacks. However, initial panic attacks are more of a mystery. Scientists and researchers are still searching, but as of yet, the exact cause of panic attacks remain unclear. Here are some factors they believe play a role:
- Genetics (Panic attacks do have a tendency to run in families)
- Major Stress (ex: loss of a loved one, major life transitions)
- Temperament that is more sensitive to stress or prone to negative emotions
- Certain changes in the way parts of your brain function
Panic attacks often strike when you’re away from home, but they can happen anywhere, anytime including while you are relaxing or even sleeping. Panic attacks arise quickly and usually reach their peak in 10 minutes, lasting 20 to 30 minutes (rarely lasting more than an hour). According to the the DSM, a full blown panic attack includes a combination of the following signs and symptoms:
- Shortness of breath, hyperventilation, smothering feelings
- Heart palpitations or a racing heart
- Chest pain or discomfort
- Trembling or shaking
- Choking feeling
- Feeling unreal or detached from your surroundings
- Sweating
- Nausea or upset stomach
- Feeling dizzy, light-headed, or faint
- Numbness or tingling sensations
- Hot or cold flashes
- Fear of dying, losing control, or going crazy
If you are suffering from PTSD or PD, you are not alone. According to the Anxiety and Depression Association of America, 6 million people in the U.S. are affected by PD, with women being twice as likely as men to be affected. 7.7 million in the U.S. will be affected by PTSD, again women more likely to be affected than men. Rape is the most likely trigger of PTSD; 65% of men and 45.9% of women who are raped will develop PTSD.
Psychotherapy, specifically a combination of cognitive behavior therapy and exposure therapy are extremely helpful, as well as mindfulness and relaxation techniques. Prescription medications are also often prescribed to treat PTSD and PD, but are recommended in combination with psychotherapy. Prescription medicines, even anti-anxiety and depression supplements will only treat symptoms; they do not help the client in identifying and treating underlying causes nor creating lasting coping skills.
~Currently dealing with an Anxiety Disorder? Interested in exploring the thoughts and ideas in this article further? Please feel free to contact me at 314-502-9072 or kelly@happy-brain.com
Kelly Locker is a Licensed Professional Counselor and Certified Hypnotherapist at Happy Brain Counseling, LLC.
References:
Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. W.W. Norton & Company: New York.
Walker, P. “Emotional Flashback Management in the Treatment of Complex PTSD.” Psychotherapy.net. 2009, 27 June 2016.