My heart is stuck! I’m going to have a heart attack! I can’t take the bus or the elevator! If I eat too much, my heart will tighten! I have to move slowly so I don’t have a heart attack!
At the basis of all these complaints, if there is no organic problem (cardiovascular problems), the concepts of fear, panic, panic attack and panic disorder are located. Therefore, it is necessary to begin to define these concepts through fear.
What is Fear?
Imagine that you are in a forest and immerse yourself in the beauty of nature. You started walking. Then you come across something undesirable. A snake! As with most living things, we get scared in such a dangerous situation. The occurrence of fear is normal. In fact, it has a very important function in terms of survival. Because it prepares us for the fight or flight response. So how does fear do this?
During fear, adrenaline is released. When adrenaline is secreted, the sugar level in the blood increases. Oxygen is needed to burn this sugar. In order to increase oxygen intake, we begin to breathe rapidly. As a result, the heart rate increases and blood begins to circulate rapidly throughout the body. What happened in the process up to this point explains the so-called palpitation. Adrenaline doesn’t stop there. It constricts blood vessels to the skin and digestive system, where most blood goes in the body. It pumps most of the blood to the muscles to keep us on the alert. Having more blood in the muscles means increased energy. However, the withdrawal of blood on the skin brings with it coldness. The increase in energy in the muscles causes sweating on the cold skin. This is exactly what we call cold sweating. What about nausea and intestinal motility? We said that adrenaline constricts the veins on the digestive system. As a result of these, the stomach and intestinal system, which receives less blood, reacts in this way. Then we have also explained the nausea and the strange condition of the intestines. All these abnormal reactions take place during the effect of adrenaline in the body. This is very important attention! Adrenaline reaches its maximum effect after 15 minutes. It continues at maximum level for about 15 more minutes. Then, in a 15-minute period, its effect decreases to the initial level.
So what is a panic attack?
Panic attacks are very similar to fear. Symptoms such as adrenaline, nausea, sweating, rapid breathing are similar. However, in fear, which is different, there is a stimulus that appears at that moment. In a panic attack, there is no fear object. It works through dangerous situations that may arise in the future. There is no situation that can be functional, on the contrary, it can disrupt the function in daily life. It develops unexpectedly. It occurs at home, watching TV, eating, anywhere. The first panic attack comes unexpectedly, its cause cannot be known, its meaning cannot be understood, and it evokes danger. Therefore, it creates a situation that will create fear. However, this is a false alarm situation. In the first panic attack, the person thinks, “I’m dying, I’m having a heart attack, I can’t breathe”. Therefore, he calls the ambulance, his wife-friend-taxi, and goes to the hospital… Let’s think about it. In the case of a panic attack, how many minutes passed when the person arrived at the hospital? I think he’ll be at the hospital in an hour or so at the most. This indicates that the effect of adrenaline has begun to decrease. But one cannot know this. And “I went to the hospital and there was relief, I didn’t get it either.” says. He sees the doctor, he has nothing left! Adrenaline is now at a normal level. In this case, the hospital has become a negative reinforcer for that person. In other words, the behavior of going to the hospital will be reinforced for the person. The person will then go to the hospital for each attack. If he is going to go somewhere, he will go through the hospital routes. What if he didn’t go to the hospital in this panic attack situation, would the symptoms continue? If there was no other reason, if it was just a panic attack situation, no, he wouldn’t. He wouldn’t have learned if he didn’t see negative reinforcement.
What is panic disorder?
Panic disorder, which is often confused with panic attacks, is a much broader condition.
According to DSM 5 panic disorder criteria;
A) Persistent anxiety about having other panic attacks for at least 1 month (anticipatory anxiety)
B) Concern about the possible consequences of a panic attack (such as loss of control, heart attack) for at least 1 month
C) Significant behavioral change.
If the person has at least one of these 3 conditions, there is a possibility of having panic disorder.
The thought that panic attacks will recur anticipation anxiety significantly affect people’s lives. It causes behavioral changes such as not leaving his house, which he sees as safer, instead of doing the things he always does. If we want to give another example, we can say that they want to move to a new house close to the hospital. The person takes various precautions so that a panic attack does not start; does not carry heavy, does not watch the news. In short, dysfunction arises in your life. If the person has had a panic attack related to the intestines, the person does not eat or even drink water.
Shedding light on the path to panic disorder is a very important way to help these patients. The most critical point in the treatment of this disorder is anticipatory anxiety and avoidance. For this reason, cognitive behavioral therapies are offered as the first choice in the treatment of this disorder. If you are having trouble with panic attacks etc., you can contact us.