I’m writing a health article aimed at explaining panic attacks to a general audience. While most people have heard of them, many don’t understand the specific physiological processes involved. I need to break down what’s happening internally in a way that’s both accurate and easy to understand, avoiding jargon where possible. I want to be able to describe not just the general symptoms, but the reasons behind those symptoms.

So, instead of just saying "your heart races," I want to explain why the heart races. What chemicals are being released? What systems are being activated? How do these changes lead to feelings like shortness of breath, dizziness, and tingling sensations? I need a comprehensive explanation of the biological cascade that unfolds during a panic attack, from the initial trigger (real or perceived) all the way to the manifestation of physical symptoms.

Therefore: What exactly happens in the body during a panic attack, detailing the specific biological processes, hormonal changes, and system activations that cause the various physical symptoms experienced?

Answer

During a panic attack, the body undergoes a cascade of physiological and psychological changes triggered by the perception of intense fear or threat, even in the absence of real danger. Here’s a breakdown of what happens:

Neurological Changes:

• Amygdala Activation: The amygdala, the brain’s fear center, is intensely activated. It interprets a perceived threat and sends distress signals to other brain regions.
• Hypothalamus Activation: The hypothalamus, a control center in the brain, is stimulated. It triggers the "fight-or-flight" response, preparing the body to either confront or escape the perceived threat.
• Autonomic Nervous System (ANS) Activation: The hypothalamus activates the sympathetic nervous system (SNS), the branch of the ANS responsible for the "fight-or-flight" response. Simultaneously, it can suppress the parasympathetic nervous system (PNS), the branch responsible for "rest and digest" functions.
• Neurotransmitter Release: The brain releases neurotransmitters, including norepinephrine (noradrenaline), epinephrine (adrenaline), and cortisol. These hormones amplify the body’s stress response.

Cardiovascular System Changes:

• Increased Heart Rate (Tachycardia): Epinephrine and norepinephrine increase the heart rate to pump blood more rapidly to muscles and vital organs. This can feel like a racing or pounding heart.
• Increased Blood Pressure: Blood vessels constrict, raising blood pressure to ensure adequate blood flow to muscles. This can contribute to feelings of tension and pressure.
• Palpitations: Irregular or forceful heartbeats may be felt due to the heightened activity of the heart and changes in blood flow.

Respiratory System Changes:

• Rapid Breathing (Hyperventilation): The body increases the rate and depth of breathing to provide more oxygen to muscles. However, this often leads to breathing too fast, disrupting the balance of oxygen and carbon dioxide in the blood.
• Shortness of Breath (Dyspnea): The feeling of not being able to get enough air can result from rapid breathing, tightening of chest muscles, and a sensation of constriction in the airways.
• Chest Pain or Discomfort: Tightening of chest muscles, increased heart rate, and changes in blood flow can cause chest pain or discomfort.

Musculoskeletal System Changes:

• Muscle Tension: Muscles tense up in preparation for action, leading to feelings of tightness, stiffness, and aches, particularly in the neck, shoulders, and back.
• Trembling or Shaking: Muscle tremors can occur as a result of the nervous system’s heightened activity and the release of adrenaline.
• Weakness or Numbness: Blood flow can be diverted from the extremities to vital organs, leading to feelings of weakness, numbness, or tingling in the hands, feet, or face.

Gastrointestinal System Changes:

• Nausea: The stress response can disrupt normal digestive processes, leading to nausea or an upset stomach.
• Stomach Cramps: Muscle tension in the abdomen can cause stomach cramps.
• Dry Mouth: The sympathetic nervous system reduces saliva production, leading to a dry mouth.
• Butterflies in Stomach: A feeling of unease in the stomach, as a result of nervous activity.

Other Physical Symptoms:

• Sweating: The body sweats to cool itself down due to the increased metabolic activity.
• Dizziness or Lightheadedness: Hyperventilation and changes in blood pressure can cause dizziness or lightheadedness.
• Hot Flashes or Chills: Vasoconstriction and vasodilation can cause fluctuations in body temperature, leading to feelings of hot flashes or chills.
• Blurred Vision: Pupils dilate as part of the "fight-or-flight" response, which can temporarily blur vision.

Psychological Changes:

• Fear of Dying: The intense physical symptoms can lead to the feeling of impending doom or a fear of dying.
• Fear of Losing Control: The overwhelming physical and emotional sensations can create a fear of losing control, going crazy, or having a heart attack.
• Derealization: A feeling of unreality, as if the surroundings are not real.
• Depersonalization: A feeling of being detached from oneself, as if observing oneself from outside the body.
• Intense Anxiety and Worry: The experience of a panic attack can trigger intense anxiety and worry about having future attacks.

The combination of these physical and psychological symptoms creates the overwhelming and frightening experience of a panic attack. The duration of a panic attack varies, but it typically peaks within a few minutes and subsides within 20-30 minutes.