Image Credit: Getty Images / SimonSkafar
Woman running away from the office having a panic attack at work

"Like a Sledgehammer to the Gut": Recognising Panic Attacks

Reading time | 7 mins
“Anxiety feels like a series of paper cuts. The panic attack was like a sledgehammer to the gut.”
In November 2012, Claire Eastham had her first panic attack during a work meeting. Now a self-made “panic attack expert,” she shares her strategies for coping with the sudden, unpleasant symptoms.

***

Something’s wrong.

Your heart is beating too fast. You're sweating, your stomach is cramping, and your mouth is dry. What's happening? Why can't you take a deep breath? Oh God - is this a heart attack, or are you going crazy? Something is VERY wrong. You need to get out of here NOW.

In November 2012, I had my first ever panic attack. It happened during a meeting with several of my colleagues. As the episode reached its peak, I gave in to the urge to flee and ran from the room as fast as my legs could carry me.

The whole experience was as distressing as it sounds. After the "hump," I was left feeling confused and embarrassed (after all, it's not every day you're convinced you're going to die in front of half the office!).

As soon as the working day was done, I rushed over to my GP, convinced I had a heart issue or something equally serious. I stammered out my symptoms and waited for the worst.

So, imagine how perplexed I was when my GP's reaction was along the lines of, "Oh, I see," and not much more. In my head, I'd totally lost control. I'd run from a room of people relying on me, I hadn't been able to breathe, and I'd felt inches away from death's door. To my ever-pragmatic doctor, however, I'd had a textbook panic attack. "There's nothing to be alarmed about," she said.

NOTHING TO BE ALARMED ABOUT?!

At this point in my life, I was used to riding the waves of my (at that point, still undiagnosed) anxiety disorder. I had learned, mostly, to self-soothe. I could read my mind and body like a book and take necessary precautions on a bad day.

This "panic attack", on the other hand, had come out of nowhere. I'd gone from 0 to 100 in no time, and I didn’t understand why. How could I have felt so threatened in mere seconds when there wasn't a perceivable threat that had set it off?

Was my brain faulty? Was I going mad?

Fast forward to the present day, and I now consider myself a self-made "panic attack expert" and the author of two books on the subject.

So, take this from someone "in the know" - while panic attacks can be unpredictable and illogical, they can also be managed.

Anxiety doesn't act like this... does it?

Before that first panic attack, I'd lived with high-functioning anxiety for over a decade. Over the years, I'd learned to recognise the "warning signals" all on my own. Bouts of insomnia? Used to them. Stomach cramps, sweating, and a hand tremor that never left? All part of the furniture.

However, although I acknowledged and accepted these "quirks" of mine, I did my best to completely ignore my anxiety. "Everyone worries," I told myself. "I bet everyone goes through stuff like this. Don't draw attention to it!"

Honestly, it never occurred to me that all my overthinking and physical symptoms weren't the norm.

So, what is a panic attack?

A panic attack is "a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause" (Mayoclinic, 2018).

Since 2012, many therapists have suggested I had a panic attack that day because I'd overstressed my amygdala. The amygdala is "a cluster of almond-shaped cells near the base of the brain" (Healthline, 2021). Everyone has two sets of these cell groups, one in each of the brain’s hemispheres. These cells help us regulate our emotions - including fear, anxiety, and aggression - process memories, and make decisions.

In November 2012, my amygdala detected danger (talking in a group) and triggered my "fight or flight" response. My body became flooded with adrenaline, my heart went crazy, and it seemed like my only choice was to run away.

How are panic attacks different to anxiety?

It's easy to see why panic attacks and anxiety get confused, as they share many symptoms. In my case, the sweating wasn't anything new. Other signs like nausea, trembling, and an upset stomach were also part of my anxiety's usual regimen.

But while anxiety produces more of a gnawing worry, a panic attack is rapid and violent. It's absolutely impossible to ignore.

My symptoms looked like these:

  • A pounding heart (quick to the point of being painful)
  • Hyperventilating (unable to take a satisfying breath)
  • Feeling the need to void my bowels
  • Blurry vision
  • Dry mouth
  • Heavy/numb limbs
  • Dizziness
  • Excessive sweating (that was actually visible to others)

Anxiety feels more like a series of paper cuts. It causes damage with each slice, but there isn't enough pain to grind things to a halt. Whereas my first panic attack was like a sledgehammer to the gut.

I've also learned that my anxiety usually has an identifiable trigger and lingers. I may be dwelling on something (past or future) that causes pressure to gradually ramp up. Or I'm expected to do something I'm not comfortable with (a presentation at work, for example) and dread piles up in anticipation. Acute periods of anxiety can last for months.

Panic attacks, on the other hand, swoop in and only last a few minutes.

Can you get different types of panic attack?

Yes. Clinical Professional Counsellor Sheryl Ankrom, MS, LCPC, explores how different triggers may affect how panic attacks manifest.

In my case, panic attacks are brought on by prolonged periods of anxiety.

Back in 2012, when I was doing everything possible to ignore my anxiety symptoms, the panic attack represented an "explosion" of bottled-up emotions. Although I didn't technically see the attack coming, the reason was obvious once my therapists and I had done some digging.

For others, panic attacks may have causes like overtiredness, illness, or a hangover (“hangxiety" is now considered an actual condition and is reasonably common).

Other people may have sporadic panic attacks caused by medication, too much coffee, over-exercising, smoking, or long periods of stress.

Finally, the most extreme cause of panic attacks is a panic disorder. Usually, a panic disorder develops in someone with a history of panic attacks. They are distressed by the symptoms of an attack, so they become overcautious of triggering another.

Some people with a panic disorder may find it difficult to leave their homes, talk to anyone outside of their household, or go to work. However, a significant percentage of people with panic disorder say their attacks have no apparent trigger.

How I deal with panic attacks

Panic attacks can feel overwhelming, but there are ways to manage them.

Here's how I deal with panic attacks when they occur:

1. I accept the attack is happening 

I accept the attack rather than exhaust myself by ignoring or fighting it. Although I feel afraid and the symptoms are uncomfortable, nothing terrible will happen, and the episode will stop in time.

Australian physician Claire Weeks famously referred to this approach as "masterly inactivity." Meaning that a person should float through panic and stop trying to control their fear. I accept the attack like a wave crashing over me and make myself as comfortable as I can while I wait.

2. I take deep breaths from my belly

I deploy breathing techniques that can soothe many of the physical symptoms of panic. David Carbonell’s "belly breathing" strategy encourages breathing from the stomach, thereby increasing the amount of oxygen in the body and easing the tension.

He says, "Comfortable, deep breathing is the key to relaxation. All the traditional relaxation methods (yoga, meditation, hypnosis) place a central emphasis on breathing."

3. I try some light exercise

If I'm able (i.e., my heart's beating fast, but I'm not totally incapacitated), I do some gentle exercise, such as walking. This helps burn off the additional adrenaline triggered by the fight or flight response. If I'm stuck indoors, I might roll my shoulders or stretch my arms. On one occasion, I even tried star jumps! (I was alone).

Once the attack is over its peak, I watch something on YouTube that might make me laugh. I've become quite a fan of cute-but-naughty puppy videos! This is a mini-distraction, with the benefits of laughter producing endorphins with both euphoric and calming effects. 

4. I go to talking therapy

Many different types of therapy can help with panic attacks and anxiety. I like having someone I trust who's on "the outside" of my daily life. Together, we can talk about what's going on at work, in my relationship, and within my friendship and familial groups. Sometimes, it helps get certain niggles, worries, or even complaints off your chest.

Therapists aren't there to judge or give advice. Sometimes, they can make suggestions, but they won't get offended if I don't want to tackle an issue in a certain way.

While I love getting advice from family and friends, they can sometimes expect you to do something exactly how they told you. If it doesn't work for me (or I don't think it'll work), I don't want to offend them by saying so. Talking therapy cuts out a lot of unsaid expectations and sticky dynamics.

The takeaway

Panic attacks are highly unpleasant, and I don't think I'll ever "get used" to them. However, I can accept them when they come and use strategies to help me get through the worst faster.

Anxiety and panic aren't the same, though they're definitely linked. If you have any anxiety or panic symptoms, I recommend seeing your doctor or healthcare team. While there's no "cure" for anxiety or panic, treatments, therapies, and expert techniques can help make your life as comfortable as it should be.

NPS-IE-NP-00432 May 2022