GUEST POST – A Psych Student Has A Panic Attack
By Justin Matheson
Just last year, I finally got around to taking a full course in abnormal psychology. I’m working towards an academic career in psychiatry, so it seems like a good idea, right? I remember when we covered panic disorder thinking, “Huh, that sounds a lot like me. But I’m not about to fall victim to the med school syndrome!” It turns out in this instance I was wrong to ignore my self-diagnosis.
It would seem to follow logically that since I have an academic understanding of panic attacks, I should feel less fear when I actually have a panic attack. Unfortunately for me, this logic fails. Why? Because a panic attack has nothing to do with logic or rational thinking; those things are under control of the prefrontal cortex, the part of the brain involved in higher order functions. No, panic attacks are largely a function of the limbic system, the evolutionarily older part of the brain responsible for mediating the so-called “fight-or-flight response.”
To illustrate my point, I will walk you through a typical panic attack of mine.
It starts with a very slight sense of discomfort: Uh oh, my heart rate is rising. My adrenal glands must have released some adrenaline into my blood stream. Maybe it’s my amygdala, the fear center of my brain, telling me that I’m in danger? At this point, I can tell that I’m on my way to panic – but not quite there yet.
Then, a few other symptoms kick in. I start hyperventilating, which decreases the relative concentration of carbon dioxide in my blood, sending me into a state of alkalosis (high blood pH) that will slowly reduce the amount of oxygen making its way to my brain. I start to sweat, my body’s way of preparing for excessive heating. My muscles tense in preparation for future action. Now is when I wish I could tell my brain that the check-out line at the supermarket is not the right time for a fight-or-flight response – you know, that age-old mechanism that protected our ancestor from saber-toothed tiger attacks.
In order for it to be considered a panic attack, it must peak within about 10 minutes. So things start moving along at a quicker pace as my sympathetic nervous system prepares my body for action. My heart rate reaches a crescendo, my breathing becomes erratic, and I’m in a state of pure fear. Because blood sugar and oxygen are being sequestered away from my brain to help my muscles, I start feeling all sorts of bizarre things upstairs in my head: dizziness, numbness, tunnel vision, disorientation. To me, the worst part is the dissociation – the feelings of unreality and detachment, like I’m in a dream. Time seems to slow down and speed up at the same time.
The peak hits, and my blood is full of adrenaline (or at least, that’s what I imagine). It’s like a wrecking ball hits me square in the chest. “Run! Run! Run!” shouts my brain. I would love to run, but I know that if I run away from every situation that gives me a panic attack, I’ll develop agoraphobia – the fear of open spaces and inescapable situations that likes to tag along with panic disorder.
As my parasympathetic nervous system kicks in (finally!), I start relaxing a little bit. The adrenaline is cleared from my blood and over time, I return to normal (whatever that means). Except, no, I never do return to normal. Because my tricky brain has decided that the panic attack itself is something to be feared. Where our ancestors took advantage of the fight-or-flight response to avoid being eaten, I’m stuck in constant fear of it. What if I panic while I’m in the car and can’t pull over? What if I panic in front of my coworkers and they think I’m crazy? These thoughts start to become crippling over time.
What causes my panic disorder? While there are many theories, we don’t really know. It probably has to do with dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis which regulates the stress response. It could have to do with a faulty COMT gene, which codes for a protein that clears dopamine and other similar neurotransmitters (brain chemicals involved in helping brain cells talk to each other). The amygdala seems to have a particularly prominent role in panic disorder since it regulates the fear response. One thing we know for certain is that serotonin, the neurotransmitter popularly associated with happiness, is involved in the disorder since antidepressants that increase levels of serotonin can treat most anxiety disorders.
Whatever the cause, the result is the same: me, and millions of other people across the globe, sitting in fear, wondering when the next attack will strike.
Kim, Jieun E., Dager, Stephen R., Lyoo, In Kyoo. (2010). The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies. Biology of Mood & Anxiety Disorders, 2, 20. doi:10.1186/2045-5380-2-20
A Brief Bio of Justin Matheson
Justin studies psychology and biotechnology at McGill University in Montreal, Canada. When he’s not in school, he likes to cook, go for runs, write horror stories, and watch a lot of supernatural dramas. He hopes one day to become a professor of psychiatry and expert on anxiety disorders. He writes a blog called Anxiety Really Sucks! and can be followed on Twitter @justinrmatheson.