Panic Attacks

Let's call him "Tony," a seasoned officer, of formidable size and a strong command presence. Tony works the second watch in a medium-sized department and is considered one of the most squared away guys on the team. If it is hitting the fan, you want Tony covering you. He has been with the department for nine years, and at 34 years old is in overall excellent health. On a fall night Tony is dispatched to a routine disturbance call in the middle of a generally quiet residential neighborhood. He waives cover. In route, Tony pulls to a curb, without any other reason than basic cop instinct; he senses imminent danger and is suddenly overwhelmed with anxiety. Things quickly go from bad to worse for Tony. He feels nauseated, dizzy, hot and sweaty. His vision becomes blurry and his ears burn. His fingers and toes feel numb. Tony has severe pain and tightness in his chest and can feel his heart beating way too fast; breathing is almost too difficult to accomplish. Tony is certain that he dying and things begin to happen in slow motion as an intolerable sense of dread immobilizes him. When Tony didn't answer up to the dispatcher's request for a status update, his beat partner headed to the call, finding Tony's patrol car haphazardly parked two blocks away. Paramedics were called and Tony was rushed to the hospital. After an extensive examination, x-rays, EKGs, and lab work, the emergency room doctor advises Tony that he had not had a heart attack, but had suffered a panic attack. She instructs Tony to follow up with his primary care physician and a mental health professional, and gives him a prescription for Xanax. Tony takes a few days off, telling the department the incident was related to food poisoning, and jokes with his peers. He tells himself it was a fluke occurrence and makes no follow-up appointments.

Panic Attacks

Panic attacks are very common and can happen to anyone, given the circumstances. Conservatively, more than one in ten people experience at least one panic attack during their lifetime. Some researchers estimate that about 35% of the general population has a panic attack in the course of a year. Attacks often happen at times of stress/strain, after an unpleasant or traumatic experience, or may occur unexpectedly. An attack can last from minutes to hours; most typically symptoms peak in approximately ten minutes and subside in under an hour.

Panic attacks are also very real. Paramedics respond frequently to suspected, and later unfounded, heart attack calls. True attacks are nearly impossible to fake. Those who suffer from panic are not hypochondriacs. The housewife with two kids in the backseat who freaks out when you pull her over for a minor traffic violation, may indeed be in the throngs of a panic attack. Your probable cause stop has just become a living nightmare.

What happens during a panic attack? The body is equipped with an automatic nervous system response to fear, commonly known as the "fight or flight" response. An individual either copes with a real or perceived danger, or runs from it. Law enforcement officers are trained to safely confront all types of danger. A panic attack results when the nervous system reacts as if it is facing a life-threatening situation, even if no actual danger exists. The response triggers a silent alarm that screams danger. People experiencing panic attacks often fear they are dying, suffocating, having a stroke or heart attack, or are simply going crazy. Anyone with these symptoms needs to first be assessed as a medical emergency. The diagnosis of a panic attack is based on the exclusion of medical diagnosis that may manifest with same symptoms.

Tony returns to work, and things seem to be going fine. Within a week, he is back at the top of his game. However, on an extra patrol call a mile from his previous incident, he begins to feel funny. Going by that fateful intersection, he realizes that he is hyperventilating and white-knuckling the steering wheel. He can't seem to focus, and he senses severe indigestion, but much lower in his gut. There is a feeling of dread, of impending doom, but it passes. Tony learns to avoid the neighborhood as much as possible, and tries alternate routes when he has to respond to a call. Luckily for Tony, two weeks later there is a beat rotation, and he feels free.

Seventeen days later, Tony awakens in his bed three hours after a long shift. His eyes pop open, it is still dark. He is chilled, sweating profusely, with a familiar crushing pain in his chest. Nothing feels real, he senses he is detached from himself and is looking down at himself from the ceiling. He has no control over his body or thoughts, he is virtually paralyzed. He wonders if he should call 911; he wonders if he can. He waits, eventually the symptoms subside, and Tony secretly believes he has gone over the edge, and that he is in fact going crazy. Embarrassment prevents him from talking to his family, supervisors or friends. He takes some comp time to regroup. The mere thought of leaving the house stresses him out.

Panic Disorder and Agoraphobia

A panic disorder is diagnosed when an individual suffers at least two unexpected panic attacks, followed by at least a month of concern over having another attack, as well as avoidance of places that may trigger an attack. A person with a panic disorder increasingly senses an intense feeling of foreboding, followed by raw fear, he/she knows that something terrible is about to happen. When another attack does come, the individual naturally begins to search for a cause. They may suffer phobic avoidance. He/she will begin to avoid situations or places where episodes have occurred. If the panic attack occurred at a mobbed concert, the sufferer makes sure to avoid crowds (enochlophobia). If the attack was during an airline flight, he/she will now drive everywhere and exclude distant locations they still may want to visit (pteromerhanophobia or acrophobia). The individual may even become reclusive. It's better to suffer alone than to endure the attacks in the public, where there's no escape from the fear and humiliation. However the attacks continue, making normal work or home life virtually impossible.

Agoraphobia, an intense and irrational fear of being in public places, often occurs in people who have a panic disorder. People who have agoraphobia are afraid of being in any place or situation which may trigger a panic attack, or from which it might be hard for them to escape--crowds, standing in line, shopping malls, public transportation, etc. Individuals with severe agoraphobia may never leave their homes.

Treatment

Sometimes, panic attacks just go away. Some people have one and never have another, while others are plagued for years or a lifetime. Some sufferers learn coping strategies; others rearrange their lives and may eventually become totally isolated and alienated.

Treatments for panic attacks and panic disorder are very effective and include both medications and counseling. The most commonly prescribed medication for a panic disorder is an SSRI antidepressant, such as Zoloft, Prozac, Paxil or Luvox. Trials have shown that these medications reduce the frequency of panic attacks by up to 75-85%. Unfortunately, it takes from three to six weeks for a SSRI to be effective in treating a panic disorder. Benzodiazepines or diazepam (Xanax, Klonopin, Ativan, and Valium) can decrease panic attacks by up to 70-75% almost immediately, but these tranquilizers have some major drawbacks, including sedation, memory loss, decreased reaction times, increased tolerance, the possibility of addiction, and withdrawal symptoms.

Therapy for panic attacks includes education about the disorder, as well as learning how to differentiate a panic attack from life-threatening disorders such as a heart attack or stroke. Therapy can help an individual realize the first signs of a panic disorder, to initiate muscle relaxation and breathing techniques. Sufferers are taught to calm their thoughts and reactions by reminding themselves that the attack will be time-limited. Behavioral therapy may be another component of the treatment plan, related to gradual exposure to feared situations. A panic attack sufferer will tend to avoid perceived trigger situations at all costs. With behavior therapy, an individual practices being in a trigger situation while she/she is in a safer environment. The goal is to make small strides towards confronting and overcoming a trigger. For example, if your trigger situation is shopping at the grocery store, all you may be able to at first is make a shopping list. The next goal may be to sit in your car in the driveway and think about shopping for five minutes. Eventually you may drive a block, then perhaps two, then drive and park in the parking lot, followed by making a one-item purchase on your next attempt.

What Can You Do If You Experience A Panic Attack?

  • Don't be frightened; a panic attack cannot harm you.
  • Flow with, rather than fight, the experience. The attack will pass sooner.
  • Tell yourself, "I will not die," "I will not lose control," "I will not faint," "I am not going crazy," "I can breathe," "This will pass." Repeat.
  • Breathe deeply in through your nose, hold it, and forcefully exhale through your mouth (like you are blowing out candles).
  • Be cognizant of muscle tension. Relax your shoulders first, next progressively tense and hold, then relax each of your major muscle groups one by one, working downwards. Re-evaluate and notice where you are still tense; rework those areas.
  • Write down everything you can remember about the attack after it passes. It will help you and your therapist understand the circumstances in which your attacks occur.
  • Watch out for those frightening trigger thoughts. You have a better chance of winning the lottery than having a plane fall from the sky onto your patrol car.
  • Call a hotline: 800-64-PANIC.

By the way, Tony received effective treatment, and will be testing soon for a promotion. He has learned to make physical and mental health a priority in his life. Tony was able to talk to others about his panic attacks, and is now on the department's peer support team.

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