Causes of Panic Attacks

Panic attacks and their causes

A panic attack is a frightening feeling of fear that appears “out of the blue ” in a normally non-threatening situation. By definition, panic attacks occur without an identifiable triggering factor. Anxiety attacks triggered by a particular situation or place are called ‘phobias’. The intense fear and associated physical symptoms in phobias, such as sweating, heart racing, chest pain, and breathing difficulties, are the same as those seen in panic attacks. Although panic attacks seem to occur randomly, there are deeper rooted “emotional complexes” causing them. But they are not recognizable at first glance. It may take hours of psychotherapy with an experienced psychologist to find the “Ariadne’s Thread” that descends into the depths of the psyche to find the hidden problem, the cause of the panic attack. This article describes different approaches towards the origin of the panic disorder.

Panic attack versus common anxiety

Panic attacks are different from the “physiological” anxiety experienced in dangerous situations. Such anxiety doesn’t influence rational thinking; on the contrary, thinking speed and the level of concentration are increased, preparing the individual for the “fight or flight” reaction. In such cases the people are simply afraid of an expected dangerous situation and the allows them to anticipate their reactions and to consider ways of avoiding danger. We can think even when we feel anxious. During a panic attack the activation happens “out of the blue” without any visible causes. Once a panic attack starts, it will progress automatically in not can uncontrollable way paralyzing thinking and not allowing for interventions based on rational decisions.

Evolutionary adaptation theory

Anxiety is a natural and universal experience, which human beings share with all mammals. Since it is ubiquitous, it serves a biological function. The biological function of anxiety is crucial for the survival in the world full of dangerous situations, preparing the individual to meet whatever emergencies may arise.

The actual experience of anxiety is directly associated with physiological changes that prepare the body for violent action: the heart rate increases, the blood pressure rises, adrenaline is secreted, the energy stores are mobilized in the liver and released into the bloodstream, blood is redistributed from the internal organs to carry oxygen and energy the muscles and the brain will use to master the danger. Those changes are caused by activation of the sympathetic nervous system preparing the organism for the fight or flight response.

Frustration of evolutionary development

The anxiety disorders are caused by the modern lifestyle. Only a small percentage of the population develops anxiety which requires a treatment. In the environment of evolutionary adaptedness anxiety is essential for survival. In the modern world, however, the physiological function of anxiety is often “misguided” or exaggerated. A crucial question is why a natural response (anxiety) reaches the level of a psychiatric disorder. The answer could be following: the species Homo sapiens was “designed” to live in stable social groups.

The group and its members struggled to survive dealing with hunger and dangerous situations. However, they lived in balance with the nature. Their life was matching the basic human needs. The group protected the individual and integrated him into a clearly defined social structure. We will not find any anxiety disorders in hunters and gatherers of the Kalahari Desert living a very similar life to those of our remote ancestors.

Living in “the human zoo”

Contrary to the evolutionary developed model of life, modern man lives in large, dense and overcrowded cities that Desmond Morris called the “Human Zoo”.

In the mentioned book we can read:

“Under normal conditions, in their natural habitats, wild animals do not mutilate themselves, attack their offspring, develop stomach ulcers, become fetishists, suffer from obesity, or commit murder. Among human city dwellers, needless to say, all of these things occur… Other animals do behave in these ways under certain circumstances, namely when they are confined in the unnatural conditions of captivity. The zoo animal in a cage exhibits all these abnormalities that we know so well from our human companions. Clearly, then, the city is not a concrete jungle, it is a human zoo.”

Biological factors

Genetics: Various twin studies where one identical twin has an anxiety disorder have reported around 50% incidence of the other twin also having an anxiety disorder diagnosis.

Neurophysiological factors like certain changes in the brain pathways. According to neuroscientific hypotheses, somatic (bodily) anxiety causing a multitude of physical and psychological symptoms derives from an improper activation, through the limbic system, of primitive neurobiological or neurochemical mechanisms that start from the amygdala and cause a short circuit of psychosomatic responses.

Environmental factors

Environmental factors such as major stress, an overly cautious view of the world expressed by parents and cumulative stress over time have been found to be correlated with panic attacks. Other factors are significant personal loss, life transitions and major life changes.

Although the evidence for neurophysiological factors in panic disorder is impressive, these observations are more persuasive regarding the vulnerability for panic attacks than their onset.

Psychological factors

A few major psychological theories try to account for aetiology (root cause) of panic disorder. They rest on explanations based on several lines of evidence. Some of them revolve around the influence of recent life events within the home environment, separation anxiety, or loss of a loved one. Patients with panic disorder have been found to have a higher incidence of stressful live events, particularly loss.

The other explanations point to childhood trauma as the origin of panic attacks. Understanding the pathogenesis of panic disorder from the attachment theory perspective is also helpful in a psychodynamic approach to the treatment.

The other aspect is the impact of temperament and predisposition.

Psychodynamic viewpoint

The psychodynamic approach is based on the idea that panic attacks are the expression of an intrapsychic conflict and that the patients could benefit from a psychotherapeutic process exploring the unconscious. An in-depth analysis of people suffering from panic attacks shows that the anxiety is caused by unconscious worries related to a developmental changes and milestone if the individual feels unprepared for. For example, panic attacks can appear in an 18 years old women while living at home during her studies. She might develop a panic attack before getting married, especially if the marriage of her parents ended in a divorce. She could also have panic attacks after discovering her pregnancy feeling unprepared for her mother role. At the mature age the panic can appear after her children left home and she is facing the big “unknown”.

Panic, narcissistic collapse

In less complex cases, panic attacks signal the collapse of a person’s narcissistic organization. For this reason, panic attacks are particularly common during the mid-life transition or mid-life crisis. The anxieties appear along the realization of the limitations of one’s existence. A person can face it by crossing the age when the myth of one’s own efficiency, beauty or success can no longer be maintained.

Cognitive approach

For cognitivism, panic derives from a perceptive distortion of the fear signals. The recommended therapy approach is based on a combination of cognitive reconstruction and gradual exposures of the patient to the terror-inducing stimuli.