Fear was hardwired into our brain long before our ancestors had developed the language to name it. Our great-granddaddy's and great-grandmummy's couldn't afford to miss any stimuli that could be a threat. In order to survive they needed a brain hypersensitivity to ANYTHING that may be a problem. Like a bear, anything that resembled a bear…or anything that suggested a bear may have been nearby. Missing it could mean death. So you were better off over-reacting than under-reacting. A panic attack is that easily spooked brain of ours getting carried away.
When our body is faced with a perceived threat our brain whacks a whopping big red button deep in the primal part of our brain, ordering a spike of chemicals like adrenaline and cortisol, which then prompts a cascade of physiological changes prepping the body to fight or flight. Heart rate and breathing goes up, blood is focused on major muscle groups, sweat is generated to keep the body cool in the predicted physical combat or mad dash for the hills.
Feelings of choking. 6. Chest pain or discomfort.
I have worked with people who have described a mix of most of the above symptoms at some time during a panic attack. The pounding heart, the shortness of breath and the fear that you are dying are all highly prevalent. You want to know this because these are the visceral, physiological responses your character goes through when a panic attack hits them. Capture that and you have an authentic description of what it feels like. Capture it well and your reader will get to experience it right alongside them.
Whether your character experiences one panic attack, or multiple – potentially making them eligible for a diagnosis of Panic Attack Disorder – their history and personality is influential. If your character is a worrier, possibly prone to neuroticism, they are more likely to experience panic attacks. If they were an anxious child, maybe experiencing separation anxiety or 'fearful spells', they are at a higher risk of experiencing panic attacks.
If you dig deep into their backstory you might find a history of trauma – reports of experiences of sexual and physical abuse are more common in panic disorder than in certain other anxiety disorders. If you travel up their timeline you might find a specific trigger – most individuals report identifiable stressors in the months before their first panic attack (e.g., relationship/family stressors, health issues, or death in the family). You could consider their family history – there is an increased risk for panic disorder among children of parents with anxiety, depressive, and bipolar disorder.
It's also worthy of noting, that if your character experiences multiple panic attacks then they are likely to have other mental health issues going on. Panic disorder rarely occurs on its own, and is more likely to occur in individuals that experience other anxiety disorders (especially agoraphobia), major depression, bipolar disorder, and possibly mild alcohol use disorder.
It's not uncommon for panic attacks to go away on their own. If it's a single episode then your character can ride out the unpleasant, frightening symptoms. Alternatively, they (or a helpful secondary character) can focus their attention on something…anything. Sometimes focusing on your breathing can be helpful; counting five in, holding for three, then counting five out. Personally, I don't recommend it because I've found that people experiencing a panic attack are already hypersensitive to their bodily sensations and focusing on their breath can be counterproductive (I encourage clients to focus on wiggling their toes in their shoes).
Even ongoing panic attacks, or panic attack disorder, can wax and wane. In truth, panic disorder is known to go into remission for years, but unfortunately others can experience continuous severe symptomatology. Luckily, treatment can be highly effective (as long as they seek it). Cognitive behavioural therapy, generally viewed as the most effective form of treatment for panic attack and panic disorder, focuses on the thinking patterns and behaviours that sustain or trigger the panic attacks. Alternatively, exposure therapy exposes a person to the physical sensations of panic (by hyperventilating, running on the spot or holding your breath) in a safe and controlled environment, giving them the opportunity to learn healthier ways of coping. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.
What do you think? Do you have a character that's experienced a panic attack? Maybe several? Comments and feedback are always appreciated. Connecting with others is why I write. You can comment below, or connect with me on Facebook, Twitter or Instagram.