A panic attack is an acute episode of anxiety accompanied by often very painful physical sensations (such as dizziness, heart palpitations, chills, hot flashes, and feeling as if you are suffocating or have “had the wind knocked out of you”). People experiencing panic attacks may also fear that they are going crazy or even dying.

When a doctor diagnoses a panic disorder in a patient, it means that this person has suffered more than just one isolated panic attack. Panic disorders are characterized by panic attacks that occur repeatedly and unpredictably, with no apparent triggers. Unlike phobias, panic attacks can occur in the absence of any particular external stimuli. Instead, they appear to be triggered by internal psychological reactions.

Patients who suffer from panic disorders thus live with the constant fear that they will suffer an attack despite themselves. They may also experience additional anxiety from thinking about how their attacks may affect the people around them. When someone has panic disorder and is afraid of situations where it might be hard to hide this condition, or flee, or get help if they did suffer a panic attack, then they are said to have panic disorder with agoraphobia. Such peopleconsciously try to avoid situationsthat might cause them to have panic attacks.

At least once in our lives, most of us have suffered a panic attack brought on by some specific event. But people who have panic disorders experience panic attacks suddenly and with no apparent external threat that precipitates them. These attacks peak rapidly, usually in less than 10 minutes, and then subside. But despite their brevity, these attacks are typically described by their victims as terrifying experiences that leave them drained of emotion and anxious about their health.

The fear of having another attack becomes so worrisome that these people quickly learn to avoid the situations that seem to have triggered these episodes. Some people alter their behaviour considerably, thus somewhat relieving their anxiety about having more attacks. But some of the changes they make are so radical that they can cause even more serious problems.

One such problem is panic disorder withagoraphobia. Contrary to what the Greek and Latin roots of this word suggest, agoraphobia is the fear not only of open spaces but also of any situation that can cause anxiety. This anxiety is quite often associated with the fear of losing control in places where it could become embarrassing to do so. These places may include not only open spaces such as public squares or crowds, but also closed spaces such as supermarkets, buses, and airplanes.

In fact, often these will be places where the person has previously experienced a panic attack. The circumstances that precipitated the original attack seem to give way to a lasting association with any environment resembling the one where the attack took place. Thenceforth, such an environment will generate anxiety and possibly further panic attacks, thus potentially creating a positive feedback loop that increases the number of anxiety-producing situations and panic attacks even more.

GENERALIZED ANXIETY DISORDER (GAD)

What generally distinguishes anxiety from fear is the absence of any external stimulus that triggers the anxiety reaction. Actually seeing a snake may trigger fear, while remembering a snake when you pass by a place where you once saw one may trigger anxiety. By keeping us away from potential dangers, both fear and anxiety have significant adaptive value, which is why we have inherited them from our ancestors. But when anxiety becomes so recurrent and persistent that it interferes with someone's normal activities, they may be diagnosed as having generalized anxiety disorder (GAD).

There are probably a number of factors that contribute to this disorder. Since it is more common in certain families, some genetic factors seem to be involved. These factors might make certain individuals biologically predisposed to GAD, which they would then develop if certain kinds of triggering external events occurred in their lives.

In other cases, GAD might be caused by traumatic memories or unresolved internal conflicts. In many cases, these precipitating factors and the disorder itself date back to very early childhood.

Most people who have GAD also experience depression and/or panic attacks. All of these disorders seem to be influenced by certain neurotransmitters, such as serotonin. GABA and norepinephrine may also be involved in anxiety disorders.

Anxiety is a psychological mechanism that can very likely serve useful purposes for human beings. It is closely related to our ability to anticipate and to project into the future. This ability to construct mental scenarios is far more advanced in humans than in other species whose prefrontal cortex is less developed. Hence this faculty is involved in many behaviours that make us uniquely human. But when it gets out of control, it can also be responsible for anxiety that paralyzes us and prevents us from functioning.