Panic attacks can feel like imminent death, insanity, fainting, or some other terrible loss of control. So it's helpful to know something about what a panic attack can, and can't, do to you.
If you have anxiety attacks and phobias, it can be very hard to believe that you're not in danger. Panic is an effective Trick, and is very good at convincing you that you are in danger.
Don't struggle to be sure. That's not the way out of the panic problem. If you try to be 100% sure, with no doubts or "what if..." thoughts in your mind, you will never get there. Panic attacks create worry within you, but just because you worry, doesn't mean you're in danger.
Read through this material and keep an open mind. Compare it to your history with panic. Don't struggle with it. If you find it hard to believe, leave room for your doubts. Browse through other parts of the site, and come back to have another look in the near future.
Let's consider the typical fears of a person having an anxiety attack.
You think you are dying of a heart attack, or perhaps from lack of air. It feels that way, as best you can tell, since you haven't died before, but neither one happens. This is what makes a visit to the Emergency Room with a panic attack such an unsatisfactory experience. It's not a life threatening emergency, just an imitation of one.
The chest pain you experience during an anxiety attack is real, not imagined. But it's pain in your chest muscles, not your heart. Those muscles hurt because you've been breathing in a way which makes them tight and tense.
The sensation of not getting enough air is also due to the shallow breathing. It's uncomfortable, but not dangerous. You have ample air to live on, and even to talk.
The way to soothe these symptoms is by switching to belly breathing.
Many people think that, if you get afraid or anxious enough, you will "go crazy". But you won't. Veterans of hundreds of attacks can tell you, they believed it each time and it never happened.
If you have an anxiety disorder, you will experience recurrent episodes of anxiety until you've found a solution. But that's what you will have, anxiety. You don't graduate and move on to something else. It doesn't matter how many anxiety attacks you have, you don't accumulate enough credits to trade up to psychosis. You won't "get promoted" to schizophrenia!
This is a very common fear among people suffering from panic attacks. First, here's a little background.
People think of fainting as belonging to the same category as heart attacks - a terrible physical calamity. But fainting is actually a valuable way the body protects itself.
Do you know what causes a person to faint?
It's caused by a sudden, significant drop in blood pressure. When blood pressure drops this way, there is a chance the brain won't get enough blood, because it's at the highest point of the body. That's no good - your brain needs a steady supply of the oxygen the blood carries. So when your body can't get enough blood to your brain because of low blood pressure, it protects you by bringing your brain down to the blood. The faint ensures a blood supply to the brain by bringing your head down to the ground.
If we had our brains in our feet, there wouldn't be any such thing as fainting, but tap dancing would probably be banned.
Here's the key point: What do you think is happening to your blood pressure during a panic attack?
It's going up. Probably not a lot, but it's doing the opposite of what you need to faint. So it's extremely difficult to faint during a panic attack. In order to faint during a panic attack, you need to have some other physical circumstance or condition which lowers your blood pressure to such a degree that it overcomes the increase.
It's not impossible, but extremely rare. Some people have a condition, called a syncope, which can result in a faint during panic. If you have such a condition, you would probably have a history of actual faints (not "almost fainting", actual faints) by the time you're in your thirties. Some people have what's called a Blood Phobia, and they can faint when they see blood. That's not an uncommon condition, but it's very different from Panic Disorder.
In more than 20 years of treating patients with Panic Disorder, I've seen four who had actual fainting episodes. Certainly it was of little comfort to them that it was so rare and, if you have a history of actual fainting episodes, you have to learn how to manage them and protect yourself. But if what you have is a history of fearing a faint, of feeling like you were about to faint, of thinking you just narrowly dodged a faint, and so on, in the absence of any actual fainting episodes, then what you are troubled by is a fear of fainting in the absence of any actual fainting.
While fainting almost never occurs, the fear of fainting is extremely common among people with Panic Disorder. This is because people often feel dizzy and lightheaded during a panic attack, and mistakenly associate this with fainting. People who have never fainted in their lives will say "it feels like fainting". That's part of the Panic Trick. These sensations are the result of shallow, labored breathing, and have nothing to do with fainting. A good belly breathing exercise will quickly clear up these sensations of feeling lightheaded and dizzy.
People with Panic Disorder often fear that they will act in such a crazy, "out of control" manner that others will fear and loathe them, and avoid them thereafter.
However, there's usually very little about a panic attack that's visible. While you may feel like you're "out of control", you're probably still walking in an ordinary way toward the exit of the supermarket, or the theater, or wherever you happen to be.
In my experience, most people having a panic attack continue to act in an ordinary and amiable way, showing no particular sign of external distress, even as the panic rages within them. It's usually hard to tell when a person is having a panic attack. If they don't tell you, you probably won't notice.
This often causes conflict in the family, when loved ones say things like "You look okay to me", but this is why these fears of public displays typically don't come to pass. You may well feel embarrassed. You may feel sure that others are secretly laughing at you, or thinking that you're weird. You may worry that you will look, and act, so bizarrely as to be driven out of society and left to live with wolves. But this is another part of the Panic Trick.
They scare you. You get scared, real scared. They fill you with Discomfort, and trick you into reacting as if you're in Danger.
And if you don't get some good information about Panic Disorder shortly after the first attack, you're likely to start developing ongoing fears of having more attacks, and to develop phobias.
That's the real danger of Panic Disorder. It can lead you to become so fearful and phobic that you give up many ordinary and enjoyable parts of life.