Panic Attacks: What Happens and When to Seek Help

Andriy is driving back from a meeting when he notices his heart pounding. There seems to be too little air, his hands are shaking, and the familiar road no longer feels safe. He stops in a permitted parking place and tries to understand what is happening. Minutes earlier he was thinking about work; now he wonders whether he will make it home.

This is an illustrative fictional story, not an account of a particular patient. Andriy has a management job, a wife named Olena, a house and plans for the future, even a small yacht. None of these circumstances makes him immune to anxiety. Nor can the cause of his symptoms be determined from the story alone.

New or severe chest pain or pressure, marked difficulty breathing, fainting, sudden weakness or other unusual severe symptoms require urgent medical assessment. Do not decide for yourself that they are panic, even if you have had panic attacks before. In Ukraine, call 103 for emergency medical assistance; elsewhere, use the local emergency number. If symptoms begin while driving, stop safely and do not continue while it is unsafe to drive. Ukraine’s Ministry of Health: when to call 103.

A panic attack is a sudden episode of intense fear or discomfort with physical and emotional symptoms. These may include a racing heart, sweating, trembling, dizziness, nausea, chills or heat, a choking sensation or tingling. Sometimes the surroundings feel unreal, and the person fears dying, losing their mind or losing control. This description can help someone explain what happened, but counting matches does not establish a diagnosis. NIMH: panic symptoms.

An isolated attack does not automatically mean panic disorder. Assessment considers recurrent and unexpected attacks, subsequent worry about another episode, changes in behaviour and effects on everyday life. A clinician also considers other conditions and possible physical causes. “I have four symptoms, so this must be panic disorder” can therefore be a misleading conclusion. NHS: panic disorder.

Following an assessment, Andriy might be told that his episode was consistent with a panic attack. Yet the following morning he is already checking his pulse before getting into the car. He changes his route to stay closer to a hospital, postpones meetings and asks Olena to accompany him everywhere. He feels better briefly, but more activities begin to seem dangerous.

A cycle can develop: a bodily sensation receives a threatening interpretation, fear grows, and the person monitors their body more closely. Anticipating another attack becomes an additional burden. This does not demonstrate weak character or mean someone deliberately creates their condition. Fear and avoidance themselves become part of the difficulty. NIMH: panic and anticipation.

Fear can help us act during genuine danger. However, symptoms do not always make it easy to distinguish an actual threat, panic and another condition. Assessment and an understandable plan agreed with a professional are more useful than repeatedly demanding proof of personal strength.

If a clinician has already assessed similar symptoms and there are no new danger signs, follow the plan previously agreed. Where possible, sit somewhere safe, notice the support beneath your feet and name a few objects nearby. Breathing can be gentle and comfortable, without forcing large breaths or holding them. If focusing on breathing increases anxiety, attention can return to nearby objects or another person’s voice. NHS: gentle breathing without forcing it.

Olena might ask, “Would you like me to stay? Who should we call?” “Pull yourself together” or “but your life is fine” is unlikely to help someone describe their condition. Explanations do not need to be demanded in the middle of intense fear. A conversation about work, exhaustion and relationships can wait.

Research-supported treatments for panic disorder are available. Cognitive behavioural therapy is one of them. It helps people examine connections between sensations, interpretations and behaviour, and gradually address avoidance. Planning such steps with a professional differs from advising someone to test themselves through unsafe driving or deliberately provoke severe symptoms on their own. NICE: psychological treatment for panic disorder.

Medication can also be an appropriate part of treatment. A clinician chooses it in discussion with the person, considering likely benefits, side effects and how it should be taken. Prescribed treatment does not make someone less independent. Do not change doses or stop abruptly on your own; discuss questions about medication with the prescriber. NICE: medication and follow-up.

Once an acute episode has passed, a brief note can prepare a conversation with a professional: where it happened, which sensations appeared first, approximately how long it lasted, what you did and what you began avoiding afterwards. Sleep, caffeine and other circumstances can be noted without promising to uncover one hidden cause. Constant pulse-checking and detailed monitoring of every sensation are a different activity; if writing increases checking, reconsider its format.

An ordinary notebook or the MriyaRun online diary can hold these notes. The Acceptance Journal can also provide a place for written reflection on the experience. Acceptance here does not mean agreeing to endless suffering or refusing treatment.

As Andriy returns to his usual schedule, he might discover that he has accepted every demand for years and felt embarrassed to say he was tired. That is a reason to review working conditions, but not proof that all panic attacks arise from violated boundaries. The Diary of the Owner of Her Borders can be used to explore requests, refusals and responsibility separately.

Metaphorical cards sometimes offer an image that makes a conversation easier to begin, for example about what pressure or support looks like. They do not determine the causes of panic or replace assessment. For Andriy, a meaningful result may be an ordinary journey following his agreed plan or a meeting he used to avoid, rather than a promise never to feel fear again.