One of the biggest obstacles that stops people from seeking help for panic attacks is the embarrassment and even shame they feel. Human beings have an instinctive tendency to minimize or conceal illness, especially if it strikes in a public or social situation. When the illness itself is fear, fear multiplies and heightens that instinct. When your heart is pounding, you’ve broken out into a cold sweat, you’re dizzy and feel like passing out—and on top of all that you know that there is no real danger—your first instinct is not to calmly explain to people around you what is happening and how you are feeling. And while the fear that triggers a panic attack is irrational, it is not entirely irrational to be afraid of letting the world at large know you have a condition that is classified as a mental illness. Therefore, it is important for those who are suffering from this condition to understand that getting panic attacks help is available and all they have to do is feel comfortable asking for it.

There is help available for panic attacks, however, and it begins with information. The best first step a person can take is no doubt to educate himself or herself about what is happening. If you are not ready to confide in your doctor or therapist, excellent resources exist on the Internet and in public libraries that provide medically accurate information about panic disorder. In the grip of an attack, fear and physical discomfort can actually make you think you are having a heart attack, going crazy, and even about to die. The first time it happens you have no reason not to think these things. But medical descriptions and accounts of other peoples’ experiences can provide some defense. The next attack is still unpleasant, even overwhelming, when it strikes, but knowing what is happening and that it will stop gives you a start on gaining cognitive control over your experience.

For most people, intellectual knowledge will not be enough to control the disorder. Behavioral therapy is also needed. Behavioral treatment focuses on recognizing, analyzing, and learning to control specific physical elements of a panic episode, one-by-one, step-by-step. An individual symptom (for instance, a hot flash or a rapid heartbeat) and the situational triggers that tend to bring it on (e.g., being at a party or packing for a trip) are deliberately evoked in a controlled manner so that the panic attack sufferer can experience them in isolation and practice dealing with them. This is partly a process of de-sensitization and partly a question of learning some techniques for shutting down the physical reactions. Perhaps planning ahead that you will only stay for 10 minutes or a half-hour at a party will enable you to hold off an attack. Some learned breathing exercises or relaxation techniques may help slow or halt the onset of breathlessness or a racing pulse while you are there.

When behavioral and cognitive therapy together do not bring sufficient relief, medication can modify or even prevent panic attacks for many people. In some cases, knowing that you have an anti-anxiety drug that can shut down some symptoms at the first sign of an episode or before some trigger situation (pre-party or pre-flight), can provide you with a feeling of control that will stop an attack before it starts.

If you suffer from panic attacks, you are not alone. A lot of people understand your experience and can help you deal with it—through live and online support groups and information resources, medical treatment, and behavioral and cognitive therapies. Don’t be afraid to reach out for help.

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If you’ve ever experienced a panic attack, you know what it is—a sudden, apparently unmotivated episode of extreme anxiety accompanied by a whole list of unpleasant physical sensations, such as racing heart, cold sweat, breathlessness, dizziness, etc. In fact, the physical sensations of a panic attack are remarkably like the natural and essential “fight or flight” alarm mechanism, that powerful rush of adrenaline which evolved to enable humans to respond to life-threatening external events. In a panic attack, however, there is no external threat to justify the physical response.

What makes some people susceptible to these debilitating moments? A number of possibilities are at the  root of the panic attacks cause and have been theorized.

Hereditary causes. Because a tendency to panic attacks and panic disorder can run in families, there is a possibility they are influenced by hereditary factors. Certain personality traits are often found in people prone to panic attacks—particularly a lack of assertiveness and tendency to passivity. Heredity doesn’t appear to be a particularly strong predictor, however, and it’s difficult to separate nature from nurture in family histories. The attitudes and atmosphere a person grew up surrounded by could account for a good deal of the coincidence.

Biological causes. A number of diagnosable physical and mental illnesses can apparently bring on associated panic attacks. Vitamin B deficiency, hypoglycemia, and hyperthyroidism have also been linked to panic attacks, suggesting the possible operation of some chemical imbalance in the mechanism underlying panic attacks. Less surprisingly, people who suffer from phobias, OCD and post-traumatic stress disorders are also more prone to panic episodes.

Such genetic and biological factors likely lead to a long-term continuing experience of panic attacks, but there are also a number of causes for a more sudden and possibly temporary susceptibility. These are classified generally as environmental or external causes.

Stress. For instance, it’s recognized that people are more vulnerable to developing panic disorder at peak stress times in their lives. Losing a loved one through death or divorce, and other major life-changing events sometimes precede the onset of panic disorder. Stimulant drugs (legal or illegal) can also act as triggers. A number of medications actually list panic attack among their known side effects, and various drugs (including alcohol and caffeine) can interact to trigger attacks.

In cases where temporary stress or short-term drug use leads to panic attacks, it’s possible the attacks will cease once the external stressor is removed. However, these short-term external causes may simply be activating a pre-existing vulnerability that can be traced to heredity or other illnesses, and once activated the tendency may not pass.

Conditioning. Furthermore, whatever it is that causes the first panic attack—whether internal or external, lasting or temporary—the panic experience itself is so powerful and traumatic that it can easily become self-perpetuating. The situation or circumstances that the victim associates with that episode—where they were, what they were doing, eating, smelling, whatever the very first sensations were—can become triggers for the next attack. The first sensation of dizziness or a quickened heartbeat due to a totally different source can quickly summon up the association and escalate into full-blown panic. Eventually, anticipatory fear alone can bring on an attack.

With so many factors possibly contributing to the onset of panic attacks or panic disorder for any individual, identifying and treating the originating cause is difficult and even impossible in many cases. It may require exploring several different types of therapy to find help. For many, the answer may lie not in controlling the cause, but learning instead to control the symptoms.

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