Whether you’ve experienced panic attacks personally or not, they tend to be an unseen occurrence and therefore sometimes not validated. People may feel the need to “prove” their anxiety to others because the symptoms are many times not seen from an outside point of view, but more psychological.

Panic attacks usually last only a few minutes, but the experience is always terrifying. Sudden activation of the sympathetic nervous system leads to sweating, a wildly beating heart, and trembling.

Although panic attacks may occur only occasionally, the victim’s dread of another episode can be continual.

Panic disorder is described as recurrent attacks of intense terror that come on without warning and without any apparent relation to external circumstances. The short periods of panic occur suddenly, reach a peak within 10 minutes, and gradually pass.

More than one-quarter of all people have one or more panic attacks at some point in their lives. Some people, however have panic attacks repeatedly and unexpectedly without apparent reason and may be suffering from panic disorder. If symptoms last a month or more it may diagnosed as panic disorder by a licensed mental health professional. These symptoms include persistent worry about having additional attacks, and significant changes in behavior related to the attacks.

People who are diagnosed with panic disorder experience dysfunctional changes in their thinking or behavior as a result of the attacks. An example of this change could be planning their lives around the possibility of future attacks, persistent worry about having additional attacks, and the thought of what the attacks might mean, “Am I losing my mind?”

What Biological Factors Contribute to Panic Disorder?

Anxiety disorders are shown to have a clear biological link. In 31 percent of cases, pairs of identical twins were shown to have panic disorder. Among fraternal twins, who share some but not all of the same genes, only 11 percent of pairs of twins had panic disorder. Researchers found that panic disorder was helped more by antidepressant drugs usually used to reduce symptoms of depression, but different than drugs used for treating generalized anxiety disorder. From there, researchers worked backward, looking at the fact that antidepressant drugs changed the activity of norepinephrine. This struck researchers to study if panic attacks were caused by abnormal norepinephrine, a neurotransmitter chemical released in response to stress.

A monkey study that electrically stimulated the locus ceruleus, rich in neurons using norepinephrine, resulted in a panic- like reaction. This along with other studies suggests that panic reactions may be related to increases in norepinephrine activity in the locus ceruleus. Recent research show it is more complicated than a single neurotransmitter or single brain area. It turns out that panic reactions are produced in part by a brain circuit of the amygdala, central gray matter, locus ceruleus, and ventromedial nucleus of the hypothalamus. In short, when a person confronts a frightening object or situation, the amygdala is stimulated, and from there stimulates the rest of the circuit.

As with much of psychology, the biological factors are only part of the cause of panic attacks. The causes vary from person to person, for some people it may be caused from the biological perspective, some from the cognitive perspective, and some from a combination of both. The cognitive perspective theorizes that panic-prone people may be very sensitive to certain bodily sensations. When they unexpectedly experience such sensations, they misinterpret them as signs of a medical catastrophe. This causes feelings of losing control, fearing the worst, losing all perspective, and quickly falling into panic.

This can be shown as “over breathing” or hyperventilating in stressful situations. The abnormal breathing causes thoughts of being in danger or suffocation and therefore they panic. Individuals further believe that these and other “dangerous” sensations may return at any time and so set themselves up for future panic attacks.

Cognitive-behavioral therapies are used in order to confront fears. It can be used alone or in combination with medication. Benzodiazepines are used to increase GABA’s inhibitory effect and influence neurons in the amygdala in treatment for panic disorder.

All treatments have a general goal to normalize brain activity in the limbic system and to let individuals go about their lives without interference of daily activities.

Comer, Ronald J. ABNORMAL PSYCHOLOGY. Wol. 8, Worth Publishers INC, U.S, 2017.

Kolb, Bryan, et al. An Introduction to Brain and Behavior. Vol. 3, Macmillan Education, 2016.