By James Vizza, M.Div., Psy.D.

Each year, millions of Americans experience episodes of sudden and intense fear that seem out of all proportion to the situations around them. A situation as simple as riding an elevator, eating in a restaurant, or sitting in a meeting might trigger an experience of absolute terror and an irresistible urge to flee. These experiences, known as panic or anxiety attacks, often cause people to wonder if they are having a heart attack or a "nervous breakdown." Their intensity leaves a lasting impression.

We don't yet know for certain what causes panic attacks. As with so many other disorders, there seem to be elements of genetic predisposition, biological malfunction, and situational factors. Although the person often experiences the panic as having come out of nowhere, it can sometimes be associated with recent major life events that have contributed to gradually increasing levels of stress.

The panic occurs when the mind/body alarm system goes off for no readily apparent reason. This alarm triggers the "fight or flight response," a series of physical events which exist to help the individual prepare to either fight or flee from some external threat. The heart beats faster, breathing becomes more rapid, and muscle tension increases. The individual might experience a variety of symptoms that include rapid heart rate, sweating, shaking, a sensation of shortness of breath, chest pain, lightheadedness, a fear of losing control, chills, hot flashes, and other equally unpleasant sensations. Typically, these symptoms are far more terrifying than they are harmful.

Most people respond by trying to either fight or flee. Unfortunately, the more they try to fight the sensations, the more they add to them. And if they flee, they make it more difficult to return to the situation in which the panic occurred. Fleeing will ease the immediate anxiety but can lead to a pattern of apprehension and avoidance. Individuals begin to fear situations similar to the one in which they felt that terror, but, more importantly, they come to fear the terror itself. They begin to live at a high level of alert, fearing always that the panic will return.

Various treatments exist to help individuals manage their anxiety. It is usually a good idea to begin with a physical examination by a primary care physician to rule out any medical cause for the symptoms. Sometimes the physician will prescribe anti-anxiety or antidepressant medication to provide temporary relief from the distressing symptoms of a panic attack. Psychologists and other mental health professionals can help people to develop skills and learn strategies for the more long-term management of anxiety. In many cases, people benefit most from a combination of counseling and medication. Self-help books can provide valuable information about panic attacks and how to control them. In some areas, support groups offer an opportunity to share resources and lessons learned from experience.

The bad news about panic attacks is that they are intensely terrifying. The good news is that they are treatable.

Talk to someone who can help. If you would like the name of a qualified psychologist in your area, please try our Psychologist Locator.