A panic or anxiety attack is like a siren or fire alarm going off. It is unexpected and scary. We
experience many of the same emotions and feelings that we would have if we were in a fearful
situation, especially one that we felt we had little control over—a plane tumbling from the sky or
a fire in a building.

But, where’s the fire? What is the alarm for? When we have these feelings and there is no fire,
we naturally feel that there must be something terribly wrong with us.  

We might rush to the emergency room or our family doctor. We tell the doctor that we think
something is terribly wrong. “Maybe I’m having a heart attack?” (After all, my heart is beating
out of control.) Or, “I must be having a stroke!” (After all, I feel dizzy.) Or we think, “I must be
going crazy," or "I’m dying!”

The doctor examines us and does not find anything—no heart attack, no stroke. As far as
going crazy, since we are not pushing a shopping cart, talking incoherently to imaginary people
and are not suicidal, the doctor is not impressed by concerns of going crazy. Nor is the doctor
very impressed about the possibility that death is imminent.

Then the doctor might ask about stressors in our lives and might suggest seeing a
psychologist. Sometimes to re-assure us or to eliminate other possibilities, we might find
ourselves undergoing a series of expensive medical tests that in most cases do not detect
anything significant. Then we might wonder if we are suffering from a disorder that has not yet
been discovered.

DSM IV (The Diagnostic and Statistical Manual of Mental Disorders, 4th edition) defines a panic
attack as “a discrete period in which there is the sudden onset of intense apprehension,
fearfulness, or terror, often associated with feelings of impending doom. During these attacks,
symptoms such as shortness of breath, palpitations, chest pains or discomfort, choking, or
smothering sensations, and fear of 'going crazy' or losing control are present.”

DSM IV goes on to list thirteen symptoms and defines an attack as a discrete period of intense
fear or discomfort in which four or more of the following symptoms develop rapidly and reach a
peak within about ten minutes. These symptoms are:

1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. nausea or abdominal distress
6. chest pain or discomfort
7. feeling of choking
8. feeling dizzy, unsteady, lightheaded, or faint
9. derealization (feelings of unreality) or depersonalization
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flushes

Number 9, derealization has been described as an X-Files or Twilight Zone experience. You
feel as if you are not your normal self.

You only need four of these symptoms to classify the experience as a panic attack. I have had
clients who have suffered from all thirteen symptoms. In other words, they are gifted in having
panic attacks.

Funny, when I work out, I may have a number of these symptoms. If I am working out really
hard, I will experience an accelerated heart rate. I will be sweating. I may even tremble or shake
on the last few repetitions of a heavy weight. If I have been running hard on the elliptical
trainer, I may have shortness of breath. When I step off the treadmill or trainer, I might feel
dizzy. After an intense and long workout, I may feel as if I am dying or at least complain that I’m
dying.  

However, I don’t feel panicky or anxious. I feel good because I know that working out is good for
me and that feeling all the above, like sweating and accelerated heart rate, means I have had a
successful workout. I know that I’m supposed to feel that way. So, why don’t we feel good when
we have a panic attack? It is in part because we don’t expect to have these feelings at that
particular time.

Remember that old saying, “Every cloud has a silver lining.” It surely does not seem as if there
is a silver lining in having a fire alarm go off unexpectantly. At least when we were kids and the
school had a fire drill, we got out of whatever boring class we were in, got to go outside and
maybe catch a glimpse of our friends or that new girl we had a crush on.

However, I find an amazing number of silver linings in panic attacks when I look for them. These
panic attacks are often a valuable wake up call telling us that we need to make some changes
in our lives. These changes might mean that something needs to be done about problems in a
relationship or problems at work.

Unfortunately, since the message is delivered by physical sensations (racing heart rate, etc.)  
rather than verbally ("Wake up and smell the coffee; your partner is cheating on you"), we
focus on the physical sensations and conclude that we have a major medical catastrophe
rather than the realization that we need to make changes in our lives.

Too often we seek a pill to calm the anxiety or the panic. In the long run, medications like Xanax
may be addicting and we still suffer from panic attacks. Over the years, I have had a number of
referrals from medical doctors concerned that their patients will not give up medications like
Xanax; yet, the patients are still having panic attacks. Psychotherapy can be very effective in
teaching us both how to manage the anxiety or panic that we feel and explore ways to work the
problems in our relationships or career that are contributing to panic attacks.
Panic Attacks
The Scream
by Munch
Panic attacks are
scary experiences;
however, they are
common, do no real
physical damage
and often contain an
important message
for us from our
psyche or
unconscious.