Panic Attack Triggers
What Causes Out of the Blue Anxiety Attacks in Panic Disorder?
For those suffering with Panic Disorder, anxiety attacks feel like they are coming from out of the blue. In reality, there is always a panic trigger, no matter how small.
There are two types of stimuli that trigger panic attacks: internal and external. Internal stimuli include:
- thoughts;
- memories;
- emotions;
- bodily sensations such as a skipped heartbeat, a stomach ache.
External stimuli include anything in the environment that the senses can perceive:
- a smell;
- a sudden change in temperature in the room;
- a change in lighting;
- noises or a change in the way things sound;
- a funny taste in the mouth.
The Panic Disorder patient might be so unaware of these triggers that it would seem hard to believe that they are causing panic attacks. It takes a bit of work to understand how and why these types of events do, in fact, trigger panic attacks in the Panic Disorder patient.
First, a working understanding of the causes of Panic Disorder is necessary. In short, the Panic Disorder patient may have inherited a highly sensitive nervous system. Then, chronic stressors over time have over-stimulated the nervous system, making it hyper-active and ready to fire at the slightest trigger. When the nervous system goes on hyper-alert like this, it is called a "sensitized" nervous system.
The Sensitized Nervous System
Once the nervous system is sensitized, a tiny stimulus that might cause a minor moment of worry in another person, would trigger the fight or flight response - which is another word for a full blown panic attack - in the sensitized person. Since panic attack symptoms can be frightening, people may fear having another panic attack. This creates a "cycle of panic" and actually results in more panic attacks.
The Cycle of Panic
The fight or flight response is activated in the body when a person thinks they are in danger. Because the symptoms of panic attacks feel so awful, the panic victim believes that his symptoms mean that he is in danger. When a person fears for his safety the fight or flight response – the very thing the person in this case fears – gets activated. This is the cycle of panic. This is how fear of a panic attack can actually cause a panic attack. But this doesn't happen "out of the blue." Usually there is some trigger that causes the fear which then leads to the panic attack.
How a Seemingly Out-of-the-Blue Panic Attack is Triggered
Here is an example of how an extremely minor stimulus can trigger panic in the sensitized person. A person is alone at home, folding the laundry. Her heart, for who knows what reason, skips a beat. It is a minor thing, almost imperceptible. But somewhere in the person's consciousness she notices it and it immediately reminds her of the last time she had a panic attack because skipped heart beats were a symptom.
Once reminded of the attack, she wonders if she is about to have another one. She realizes that she is home alone and wonders if help will be available if she needs it. She wonders what is wrong and whether she will have a heart attack and die or go crazy. Her mind senses danger. Her sensitized nervous system over reacts and her body activates the fight or flight response in order to protect itself. Suddenly, she is having a full blown panic attack.
The thought processes that occur in response to the skipped heartbeat are not unconscious, but they are described as “out of awareness”. They happen in a split second, and the person may not be readily aware of them. It feels like the panic attack was out of the blue because the person was simply folding laundry and the next thing she knew she was having a full blown panic attack.
Cognitive-behavioral treatment for Panic Disorder helps people identify these triggers and thoughts and stop them in their tracks. In addition, it teaches patients how to de-sensitize their nervous systems so their bodies stop overreacting to minor stimuli. The National Institute for Mental Health offers advice on finding treatment.
This article is for general information purposes only. It is not intended to be personal, medical or mental health advice. People experiencing troubling symptoms should consult their physician or mental health professional.
