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What Causes Panic Attacks? An Extensive List of Possibilities

Panic attacks can strike at anytime and turn a seemingly normal situation into sheer terror. Unless you’ve personally experienced a panic attack, it may be difficult to understand what it feels like. Many panic attacks are caused by a specific stimulus or “trigger” (i.e. person, event, etc.). In other cases they may occur organically without any sort of trigger. In many cases a person becomes more vulnerable to panic attacks as a result of increased stress.

As a person’s stress level increases, their sympathetic nervous system’s “fight-or-flight” response becomes activated and leads to increased heart rate, increased energy, and stimulation. During sympathetic activation, a person’s physiology (body and brain) become “primed” with a fear response. If this response becomes overwhelming, it can lead a person to experience a panic attack. Unfortunately it can be difficult to pinpoint what exactly causes panic attacks or panic disorder (recurrent panic attacks).

What causes panic attacks?

If you are unsure about what it feels like to panic, it may help to read about some notable panic attack symptoms; this should give you a better understanding of the condition. The causes of panic attacks can range from daily stressors to lack of sleep or something like medication withdrawal.  For other individuals, panic attacks may be a result of a genetic predisposition to overwhelming anxiety. Included below is a compiled list of possible panic attack causes. It is important to realize that what may cause panic attacks in one individual may not be the same cause for another person.

Anxiety: The most common cause of panic attacks is untreated anxiety. When anxiety builds up in your body and brain, it decreases your threshold for stress and activates the sympathetic nervous system. Many people who have panic attacks, also report comorbid anxiety issues. A person will typically need to learn how to deal with anxiety in order to reduce the likelihood of future panic attacks.

  • Anxiety Disorders: Any anxiety disorder can contribute to development of a panic attack. These disorders are characterized by feelings of general nervousness and tension for no apparent reason. If you have an anxiety disorder you are more likely to experience a panic attack than the average person.
  • OCD: Those who experience obsessive-compulsive disorder have uncontrollable thoughts with activities (compulsions) that must be completed to alleviate their anxiety. In some cases if they aren’t able to engage in a compulsion, they may have a panic attack and believe that something awful is going to happen to them.
  • Phobias: Do you have a specific phobia that may have contributed to a panic attack? Dealing with something that you’ve always been afraid of may result in enough anxiety to cause a panic attack. Usually phobias are best addressed in therapy through systematic desensitization with exposure therapy. Once these are addressed, you will likely not be as prone to panic as a result of your specific fear.
  • PTSD: If you suffer from PTSD, memories or reminders of the trauma to which you were exposed can lead to panic attacks. Individuals with PTSD can exhibit hypervigilance to certain sounds, sights, and other triggers that remind them of the trauma. These triggers can elicit a panic response from the body even when there is no longer any danger.

Brain: Those who experience panic attacks are known to have different brain activity than those who don’t. Specifically, brain waves as well as brain activation (as seen on an MRI) will be different among those who have panic disorder compared to those who remain calm. When panic sets in, our brain waves tend to shift from alpha waves (relaxing) to dominant beta waves (stress). Other studies have also found that abnormal theta waves play a significant role in panic attacks and emotional dysfunction.

  • Source: http://www.bpsmedicine.com/content/4/1/9
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/9027932

Body: People that deal with panic attacks usually report feeling physical symptoms of anxiety such as muscle tension, adrenaline, and the fight-or-flight response. These symptoms can be very uncomfortable and tend to occur during an actual panic attack, but may also be prevalent before the panic sets in. When the body is essentially “primed” with heightened sensitivity and arousal (i.e. the “fear” response), vulnerability to panic increases.

Dietary factors: There is evidence that nutrition can play a huge role in influencing mental health and development of mental illness. Although panic attacks aren’t usually a direct result of nutrition, in some cases the foods that you eat could increase your anxiety. Anything that increases your anxiety theoretically could increase the likelihood that you have a panic attack. Diets high in fat tend to increase anxiety, whereas diets that include lean meats, fish, fruits, veggies, and whole grains tend to improve some cases of anxiety.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362800/

Drug withdrawal: If you are withdrawing from a drug, you are significantly more likely to experience a panic attack. During withdrawal your nervous system is attempting to readjust itself to functioning without the drug and functioning is temporarily chaotic. Your brain is likely scrambling as a result of changes in neurotransmission and it may be low on vital neurotransmitters such as serotonin, GABA, and dopamine, which can easily lead to panic attacks.  It typically takes awhile before your neurotransmitters recover to the level that they were prior to your use of the drug. Therefore it may be awhile before your panic attacks subside or lessen in severity and frequency. Many people experience worse panic attacks and anxiety during withdrawal than they did prior to taking a medication. This is because your brain neurotransmitter levels are deficient as a result of relying on a drug for a time period.

Environmental factors: Do you live in a stressful environment that could be contributing to stress and panic? If you know something in your environment that is triggering your panic attacks, at least you can work to address it. If there is nothing specific in your environment that is directly causing panic, perhaps look at what could be contributing to your feelings of stress. Are there certain things in your environment that really stress you out? Anything that serves to increase stress will naturally increase your susceptibility to panic attacks.

Genetics: If you know that panic attacks, anxiety disorders, and/or other mood disorders run in your family, you may have been born with a genetic predisposition. If you have a first-degree relative who also experiences panic attacks, your chances of a similar problem increase. Nearly all mental illnesses are caused by genetic abnormalities and variations in DNA. If a high degree of general “anxiety” runs in your family, your chances of also experiencing a panic attack increases. People who are genetically predisposed to panic attacks tend to have them from a young age and usually need medication to offset the problems caused by dysfunctional DNA.

Lifestyle choices: Do you make an effort to live as healthy as possible and reduce the possibility of panic attacks? Or are there certain aspects of your life that you neglect? In many cases a variety of unhealthy lifestyle choices may cause anxiety and/or panic attacks. If you neglect physical exercise / are sedentary, overwork yourself, don’t get enough sleep, and/or use stimulants – you may be contributing to the occurrence of panic. Making healthy lifestyle choices such as: exercising (read: psychological benefits of exercise), eating healthy, avoiding excessive work, taking time to relax, and getting adequate sleep can significantly reduce the possibility of panic.

Medical conditions: If you begin experiencing panic attacks randomly with no prior history, it is important to rule out medical conditions. Although the likelihood that panic attacks are specifically triggered by a medical condition is relatively slim, it still very important to consider. Many individuals who experience panic attacks with no family history tend to report panic to their doctors without investigating possible medical causes. Things like thyroid abnormalities and low blood sugar (as in diabetes) are known to cause panic.

  • Hyperthyroidism: An overactive thyroid caused by hyperthyroidism can lead a person to experience panic attacks. This is the opposite of an underactive thyroid or hypothyroid which can lead to depression. An overactive thyroid releases an excess in T3 and/or T4 hormone. Once this condition is treated, the panic attacks tend to completely subside within a couple months.
  • Inner ear problems: Various inner ear disturbances such as labyrinthitis have also been associated with panic. Inner ear problems are associated with a variety of psychiatric symptoms such as depression, anxiety, and panic attacks.
  • Low blood sugar (Hypoglycemia): When a person has low blood sugar, they are significantly more prone to panic and other types of mental illness. Usually people who experience low blood sugar have diabetes or dysfunction of the pancreas. In the event that hypoglycemia is causing your panic attacks, fixing the blood sugar should reduce the panic.
  • Mitral valve prolapse: This is a type of heart disease in which one of the valves between chambers of the heart does not close properly. This can lead to a variety of symptoms similar to various types of anxiety, but panic attacks are also commonly reported.
  • Wilson’s disease: This disease is caused by copper accumulating in tissues within the liver. It is considered a genetic disorder and a variety of psychiatric symptoms are usually present, including anxiety and panic attacks.

Nervous system: When the parasympathetic nervous system is overridden by the sympathetic nervous system, the stress response occurs. This stress response is what causes a person to feel stimulated, nervous, tense, and on-edge. If the sympathetic nervous system dominates overall functioning, you essentially won’t be able to feel relaxed – you will be too stimulated. In order to increase parasympathetic functioning, you will need to practice consistent, proven relaxation exercises.

Relationships: Anyone who’s caught up in an abusive or dysfunctional relationship may experience panic attacks, anxiety, and a variety of mental health problems. The emotional toll that poor relationships take on certain people can manifest as a variety of psychiatric conditions. Typically panic sets in when one of the individuals in a relationship feels “trapped” or lacks assertiveness to express themselves. Research has linked a lack of assertiveness in social functioning to panic attacks. Lacking assertiveness can lead a person to feel as if they have no control, and panic ultimately sets in.

Side effects: If you are taking a medication and notice that you began to experience panic attacks after you started it, the panic may be a side effect. It is most commonly reported with medications that stimulate the CNS such as psychostimulants (e.g. Adderall, Vyvanse, etc.). If you are taking stimulants and think that they may be causing your panic attacks, talk to your doctor about how to mitigate this side effect. In other cases, panic attacks may be a result of antidepressant side effects. Although many antidepressants are used specifically to help treat panic attacks, they can make the problem worse in certain people – especially if the antidepressant has stimulating properties (e.g. Wellbutrin). If you suspect that panic may be a side effect from taking your medication, talk to your doctor about switching or withdrawing.

Social isolation: Being isolated from social contact is known to be detrimental for both physical and mental health. Many people with agoraphobia (fear of leaving the house) tend to have increased vulnerability to panic. This may be a result of their initial fear, but it could also be a result of the brain receiving no stimulation during isolation, and then becoming overwhelmed when faced with social contact. Consistent, long-term isolation is associated with a variety of mental illnesses and could also be a result of experiencing an initial panic attack. If you consistently isolate yourself from others, it may make worsen the prognosis of panic disorder.

Stimulants: There are a variety of drugs that carry stimulating properties. Anything from the caffeine in coffee and energy drinks to prescription psychostimulant drugs like Adderall tend to increase arousal. Other examples of stimulants include: cocaine, amphetamines, and even antidepressants like Wellbutrin. If you are taking any stimulants, these could be single-handedly responsible for causing panic attacks. Obviously if you started using a stimulant and noticed your anxiety and panic increased, stopping it will likely decrease the panic. On the same token, if you have panic attacks, in most cases it is recommended to avoid stimulants. Only in very rare cases can stimulants be used as a counterintuitive treatment option for anxiety. Read: Adderall for anxiety disorders for further information.

Stimulus: You may have a panic attack that is caused by a certain stimulus. This could be an environmental stimulus that causes your nervous system to become increasingly aroused. For example, someone who has hyperacusis or sensitivity to loud sounds may experience a panic attack if they happen to be exposed to a loud noise or music without hearing protection.

Stressors: Anything that stresses you out such as death of a loved one, break-up, increased workload, relationship troubles, financial problems, etc. can contribute to heightened anxiety and lead to panic. Most stressors need to be addressed before people will experience a reduction in panic attacks. Usually by finding ways to reduce our total level of stress will help significantly towards reducing panic.

  • Source: http://www.sciencedirect.com/science/article/pii/0887618587900119

Triggers: A variety of things could trigger a panic attack – but many times people are able to come up with something specific that they know is causing their panic. For example, if every time a person sees a clown they have a panic attack, it may be due to an association of a clown with a fear-response. In some cases a person will know why they have a certain fear that leads to panic, such as a negative experience in childhood seeing a clown. In other cases, identifying a specific trigger can be very difficult and/or there may not be one. If there is a trigger that happens to be causing your panic, it would be best addressed in CBT (cognitive behavioral therapy).

Determining panic attack causes

Keep in mind that one specific factor from the list above could be causing your panic or multiple factors could be working simultaneously to cause a panic attack. In most cases panic is caused by a variety of factors that all contribute towards increasing the possibility of experiencing an “attack.” One of the reasons that it can be tough to pin down a specific root cause for their panic attacks is because there may not be just one cause.

In many cases there are a variety of “big picture” factors such as unhealthy lifestyle, environmental stress, stimulant use, etc. that are simultaneously leading a person to panic. In other cases there may be specific things that can “trigger” panic attacks such as phobias or things that resemble trauma experienced in PTSD. When trying to figure out what is causing your panic, it may be beneficial to work with a professional as they may be able to provide some insight.

Ultimately what most people want is to figure out the cause so that they can address it and reduce or diminish the likelihood of experiencing another panic attack in the future. Since everyone is different, one person may make some lifestyle changes, reduce stress, increase relaxation, and they may never have another panic attack in their life. For others with panic rooted in genetics, therapy and medication may be the only treatment that works.

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