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Panic Attacks

Spontaneous/ Uncued

This type of attack is associated to Panic Disorder. This attack comes without any warning, day or night, irrespective of what the person is doing. The spontaneous attack is not related to, and is not induced by, any particular situation or place.

Many people diagnosed with Panic Disorder report that the panic attacks happen 'out of the blue'. They may be woken up from sleep by a spontaneous panic attack, which is said to occur between stage two and stage three of rem sleep. Many people report that the panic attacks happen when they are relatively 'calm' or 'relaxed,' eg., when they are watching TV or relaxing. In fact, a study we undertook in 1993 on the uncued/ spontaneous panic attack showed that 78% of Panic Disorder participants reported experiencing panic attack energy when relatively 'calm'. 69% of Panic Disorder participants report they experience the panic attack energy while going to sleep and 86% report that the panic attack wakes them from sleep at night.

The symptoms of a panic attack are described in the DSM-4 as a "discrete period of intense fear or discomfort in which four (or more) of the following symptoms developed abruptly and reached a peak within ten minutes:

1. Palpitations-pounding heart or accelerated heart rate;
2. Sweating, trembling or shaking;
3. Sensations of shortness of breath or smothering, feeling of chocking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lightheadedness or faint; and
4. Derealisation or depersonalization, fear of losing control or going crazy, fear of dying, numbness or tingling sensations, chills or hot flushes.

Three internationally recognized experts in Panic Disorder describe a panic attack as follows:

"Intense recurring spasms of panic that start just below the breastbone and seem to spread like a white hot flame passing through the chest, up the spine, into the face, down the arms and even down into the groin to the tips of the toes" C.Weekes.

"The attacks start with a tingling feeling going up my spine which enters my head and causes a sensation of faintness and nausea" J.Hafner.

"A rushing sensation of a hot flash through the body sometimes associated with a sick feeling and a sensation of fading out from the world, but this faintness is more like a 'white out' than a 'black out' in that the head may literally feel light." Sheehan

1. C. Weekes (1962): Self Help for your Nerves. London: Angus & Robertson pp33.
2. J. Hafner (1986). Marriage and Mental Illness. New York: The Guildford Press pp 39
3. Sheehan (1983). The Anxiety Disease. Charles Scribner's Son N-1.

In our research into the subjective experience of the spontaneous panic attack, we found that many people with Panic Disorder experienced a panic attack as 'energy' moving through their body - either before or during the actual panic attack. The 'energy' descriptors are as follows:

• "unusual" intense flows of energy throughout the body
• rushes of 'energy' shaking the body
• electric current moving through the body
• tingly sensation moving through the body
• creeping sensation moving through the body
• hot prickly sensation moving through the body
• intense heat or burning pain moving through the body
• wave-like motion of energy moving through the body
• vibration moving through the body
• white hot flame through the body
• ice cold sensation through the body
• "ants crawling" sensation over the body

For more info: Research- Energy descriptors; Research - Energy descriptor severity

It was also found that there were dissociation experiences that were linked with the uncued panic attack. These can include a feeling of being the 'witness' of what is happening to you, a feeling of falling into a void, a feeling of being "outside of body;" either situated alongside, above or behind it; feel as if you are floating; feel as if you and your surroundings do not seem real; experience your surroundings through a diffused light, fog or mist; or experience a visual sensation where stationary objects appear to move. These Dissociative experiences may occur before or during the actual panic attack. Refer to Dissociation for more details.

A summary of the experience of the panic attack (as seen in our research) is as follows:

Prior-

• Energy felt... May experience one, or more, of the following: 'Unusual' intense flows of 'energy' throughout the body, electric current moving through the body, wave-like motion of energy moving through the body, vibration moving through the body, white hot flame through the body, rushes of energy shaking the body, intense heat or burning pain moving through the body and less predominantly, ice cold sensation through the body. Energies may be moving in one of the 6 energy movement models defined.
• Dissociation... May experience one, or more, of the following: your body feels expanded, so that you feel huge/larger than normal. Your body feels shrunk to minute proportions/smaller than usual. Your eyes are closed and you are unable to open them and your feel as if your are floating, 'witness' of what is happening to you, feel as if you are falling into a void. You, and your surroundings. You do not seem real, experience surroundings through a diffused light, fog or mist; and experience a visual sensation where stationary objects appear to move; whole body enveloped in light.
• Physical symptoms... May experience one, or more, of the following: Sensitivity to light, tunnel vision, diminished vision, tightening of throat, indigestion, burning sensations in the stomach, digestive problems, eyes burning, intolerance to noise.
• Breathing... One of the following: shallow breathing (either at a normal rate of inhalation or very rapid [2-3 breaths/sec]; normal rate/normal inhalation; or almost stopped - barely noticeable.
• Other... May experience one or more of the following: seeing of 'inner' lights, hearing of 'inner' sounds, spontaneous physical jerking.

Breathing... One of the following: shallow breathing, rapid [2-3 breaths/sec].

Other... May experience one or more of the following: seeing of 'inner' lights, hearing of 'inner' sounds, spontaneous physical jerking.

After

Physical symptoms... May experience one or more of the following: nausea, shaking/trembling, headaches, depression, sensitivity to light, diminished vision, diarrhea, cold flushes.

Breathing... One of the following: long, slow and deep or shallow (either normal rate of inhalation or very rapid [2-3 breaths/sec]).

Continual

Energy felt... "ants crawling" sensation over the body; ice cold sensation through the body; itching sensation through the body; rippling sensation through the body; tingly sensation; creeping sensation.

Dissociation... May experience one or more of the following: 'witness' of what is happening to you; "outside" of body either situated alongside, above or behind it; you and your surroundings do not seem real; experience a visual sensation where stationary objects appear to move; you feel as if your are floating.

Physical symptoms... May experience one or more of the following: difficulty sleeping, lack of concentration, neck aches, extreme exhaustion, appetite swings, depression, abdominal pain, digestive problems, hot flashes, giddiness, feeling faint, lightheadedness, localized pressure, night sweats, shaking/trembling, headaches, lower back pain, backaches, sciatica, numbness of the hands and feet, migratory unexplainable body pains, recurrent pelvic pains, unexplainable rashes, chronic/temporary pains all over the body.

Other... May experience one or more of the following: sensory sensitivities.

For more detail of the study: Research

No one particular cause for the uncued panic attack has been found.

Cued Panic Attacks

These occur in relation to specific feared situations or places. For example, social situations for people with Social Phobia. Revisiting the scene or scenes reminiscent of the traumatic events in Post-Traumatic Stress Disorder or exposure to a particular anxiety-producing situation in Obsessive Compulsive Disorder. These panic attacks are also associated with Specific Phobia, ie., people may experience a panic attack when in contact with a spider (if they have of fear of spiders) or panic while traveling by air, if they have a fear of flying.

The subjective experience of the panic attack is similar to the uncued panic attack. The 'cued' attack is rarely experienced in Panic Disorder.

Situational Predisposed Panic Attacks

People with Panic Disorder may experience this type of attack. Some people with Panic Disorder can be predisposed to having panic attacks in certain situations or places, although they are not frightened of the situation or place. For example, someone may experience panic attacks while driving their car. Sometimes they will have them, other times they won't. They are predisposed to having attacks while driving, but the attacks are not a response to a fear of driving.

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