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The mysterious [don’t] panic attack

I am embarrassed to admit that I occasionally suffer from panic attacks – another complex, improperly-named collision of biochemical mysteries. Yesterday it was in the movie theater, where half of my attacks have occurred. The movies have not been consistent in theme, and I am not agoraphobic. The familiar feeling of terror gripped me without any warning or connection to my surroundings. A bit of nausea waved over me, then a cold sweat – crawling out of my skin and sticking to my clothes. I felt my body stiffen and heard my mind trying to race to the usual conclusions about how I was going to pass out or die. This time I focused on steadying my breathing and controlling thoughts of logic, knowing it was temporary. Minutes passed, but for brief moments I felt the urges to alert my friend, then didn’t want to interrupt the movie and kept focusing. The worst was over in a few minutes, but I was unsettled throughout the movie. Just hours later, I experienced unusual allodynia – painful, hypersensitive skin in my right hand (not far from my aching knuckle and below my tennis elbow). This accompanied a slight headache (PMS) for the rest of the evening. As usual, I am rattled by the cruel experience and determined to learn more about the elusive underpinnings.

I have endured six panic attacks since 2007 – ironically as I have regained my overall health. My very first one was the most intense, as I had no idea what was happening. My family was eating at Downtown Disney in an outdoor patio. I had recently learned about my food allergies and was careful in avoiding wheat and eggs. I just finished my soup sampler when I felt two odd pains in my lower right side. I asked someone at the table if they knew where the appendix was located and was quietly stricken with a vision of appendicitis. Suddenly a wave of nausea and light-headedness came over me. I broke out in a cold sweat with chills and a feeling of intense physical crisis. I kept urgently asking for “medical attention,” fading and feeling like I was going to pass out. Most alarming was the sensation that something horrible was happening, and wondered if I was dying. Thankfully we were at Disneyland where I was shuffled in the back (out of sight) and given prompt (and free) attention by a Disney nurse within a few minutes. Could it have been any easier? I started feeling better right away as they confirmed my vitals were fine, but I went home fearing a repeat performance. I recalled that I had some tingling in my legs on the previous day. Research shows that tingly sensations can be affiliated with 44% of panic attacks, particularly during pre-menopause…great.

In the last few years, the attacks have been sporadic and never clustered, with no common time of year. However, there are some patterns worth noting:

  • Most, if not all, panic attacks have occurred while driving or after driving in our Honda Accord Hybrid. I am not sure if the leather interior or other plastics may be involved in my susceptibility. I do not use this car as much as the family car which has fabric upholstery, so there may be some significance.
  • All panic attacks have occurred during the luteal phase of my cycle (the last half closer to the period) between days 17 and 26. Hormones appear to play a role – no surprise.
  • Many of the panic attacks have occurred between meals when I was hungry or as I was eating a snack or appetizer (after soup at Disneyland and after popcorn in the theaters). I recall two episodes in the Honda when I was starving out of my wits.
  • A few days ago I started short breathing exercises twice a day to improve my fatigue. Wikipedia references a study mentioning that “breathing exercises may actually increase the risk of relapse.” June 2000 study. I will confirm this association if it happens to me again, as I plan to continue my breathing exercise.

What researchers are learning about panic disorder may relate to these observations.

  • Carbon dioxide sensitivity have been detected in panic disorder patients. Research has not determined if respiratory challenges are a result of panic disorder or a cause of panic disorder. I have not experienced as many respiratory symptoms as described by others during episodes, though I do believe I have other underlying symptoms related to hypoxia (lack of oxygen in the tissues – more on this in future posts). July 2009 study
  • Just published last week – first-degree relatives of adults with panic disorder have significantly higher odds of alcohol use disorders. Feb 2011 study. There appears to be strong hereditary factors in panic disorder as well.
  • There is some correlation between poor sleep and panic disorder. Jan 2011 study.
  • Diverse, major or stressful life events prior to age 18 appear to increase susceptibility to panic disorder and carbon dioxide sensitivity. Jan 2011 study.
  • There is association between low pituitary gland volume and severity of panic disorder. Jan 2011 study.
  • Catastrophic associations (as in imagining appendicitis) predicts the anxiety sensitivity in panic. Reducing these associations through biofeedback would likely improve the anxiety and improve the experience. Feb 2008 study.
  • My first and last panic attacks occurred near episodes of allodynia. The risk of skin sensitivity is increased with migraines which are also increased during the luteal phase. These migraines appear to correlate with estrogen ‘withdrawal.’  Sept 2006 news. Hormone swings seem to be part of my panic attack formula as well as many others.

While panic disorder can be a disabling fear that affects daily life, I am thankfully not there. I sympathize with those who are ashamed by the condition and cannot find answers or support from family, friends, and professionals. Careful notes and research continue to reveal influences from hormones, anxiety, and respiratory system – possibly a vicious cycle of physical-psychological helplessness that characterizes the panic. Genetic tendencies and heredity are also linked to susceptibility. It is important for me and others to recognize and prevent the triggers through awareness and action to improve our quality of life.

No fear.


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