About Panic Attacks

I recently read Cracked Up To Be, by Courtney Summers. It's a truly fabulous book, an intense psychological portrait of a young woman, Parker, who is dealing with the aftermath of A MAJOR THING that gets revealed as the book progresses. I'm going to devote another post to discussing this book, which was recommended to me by the always-thoughtful aspiring_x, who wrote, "I'd love to know what's going on with Parker." I'll give you my theories and a potential diagnosis (or two) next week.

Today, I'll keep my scope narrow and focus on one thing that Parker has to deal with in the book: panic attacks.

She has several of them, some worse than others. Here's an example of the start of one of them:

I inhale. How can the auditorium be only half full and have all the air gone from it like that? I'm not getting any air. As students continue to mill into the auditorium, it gets smaller and smaller and my heart beats this insane rhythm in my chest. I rub my palms on my skirt. They're sweaty. I really can't breathe. No, I can.

I just think I can't.

Everyone's in. The teachers line up on either side of the walls, ready to shush us should the need arise. The lights overhead dim, but the stage remains bathed in an eerie golden glow. I take a few short breaths in and bring my hand to my chest because I'm afraid my heart is going to pop out of it. The tips of my fingers are tingling.

According to the DSM-IV (the diagnostic manual for psychological disorders) a Panic Attack is a period of intense fear or discomfort, during which at least four of the following symptoms develop abruptly and reach a peak within ten minutes:

1. accelerated heart rate, pounding heart, or palpitations
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pains or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded, or faint
9. feelings of unreality or being detached from oneself
10. fear of losing control or going crazy
11. fear of dying
12. numbness or tingling sensations
13. chills or hot flushes

As you see in the above passage from Cracked Up To Be, poor Parker experiences symptoms 1, 2, 4, and 12 in just a paragraph or two. After some of her panic attacks, she ends up in the nurse's office.

And during at least two of them ... she faints.

Now here was where I had to take a little pause, and I'll tell you why: people having panic attacks almost never faint*.

Fainting only occurs if there's some underlying medical problem or if something else is wrong. A person having a panic attack might FEEL like she is going to faint. It usually occurs because the person is hyperventilating, which fills the body with too much oxygen and too little carbon dioxide, and that results in a feeling of lightheadedness.

Hyperventilating is part of the body's natural fight-or-flight response, but if you're not doing one of those two things, all that oxygen has nowhere to go. So it builds up in your blood and makes you dizzy. Feeling faint is one of the common symptoms of panic attacks, and fainting is something many people with panic attacks fear (which causes even more anxiety).  But it basically never happens.

Actual fainting occurs with a sudden drop in blood pressure. During a panic attack, a person's blood pressure usually increases a bit. So ... no fainting.

The lifetime prevalence of panic attacks is about 1 in 20. In other words, A LOT of people have them! They're so frightening, and sometimes people are certain they're having a heart attack. People who have this type of episode should, of course, get checked out by a doctor, but the vast, vast majority of panic attacks are NOT medical problems.

And how do you deal with them? Live through them.

There are drugs you can take, and research shows some of them are effective. Research also shows that cognitive-behavioral therapy (CBT) is effective, and that its results are longer-lasting (and without side effects). Part of CBT would be learning to understand exactly what goes on during a panic attack (things like even though it feels like you're going to faint, you WON'T). Another part involves living through the episode without trying to escape the situation. The therapist might even ask you to intentionally cause some of the physical sensations of a panic attack. In fact, I've been in a training on treating panic where I had to hyperventilate, breathe through a tiny coffee straw, shake my head back and forth for a full minute, jog in place, etc. (now imagine a room full of mental health professionals doing it ... I'm surprised something like that hasn't ended up on YouTube). But I digress.

So ... how important is it to you that a novel represents mental health/psychological disorders completely accurately? What if that inaccuracy serves the plot?

*please note I said "almost never", because there are exceptions to every rule, and anyone with panic attacks who faints (or who has chest pain) should be examined by a physician.