TL; DR
Five of the most common fears during a panic attack are myths that science simply doesn't support. Rapid heart rate during panic is nowhere near the level required to be dangerous. Fainting actually requires a drop in blood pressure that anxiety prevents. Psychosis develops slowly and genetically rather than suddenly during a spike of fear. Lastly, the nervous system has built-in safeguards that make "wearing out" from anxiety physiologically impossible. These beliefs are the very thing that keeps the panic cycle fed. Understanding that the symptoms aren't dangerous is an important piece of the puzzle, but it's not enough on its own. Panic disorder treatment is what actually builds the tools to break the cycle for good.
Beliefs About Panic That Make Everything Worse
People with panic disorder are afraid of physical symptoms of anxiety that are perceived as dangerous. Ironically, this increases their anxiety, increasing those physical symptoms, and increasing their fear to the point of a panic attack. In this blog, I wish to focus on the mistaken beliefs that the physical symptoms are dangerous, and why those beliefs are not accurate.
Below are 5 of the most common myths about panic attacks that keep panic symptoms going.
Myth 1: A Racing Heart Means You're Having a Heart Attack
People with panic disorder often misinterpret the increased heart rate and pounding heartbeat of anxiety as symptoms of a heart attack. First and foremost, increased heart rate alone is not dangerous. The purpose of the fight-or-flight response, the physical symptoms of anxiety, is to keep us safe or to get ourselves to safety. So, it wouldn’t make sense for those symptoms themselves to be dangerous. The purpose of increased heart rate is to help carry oxygen to the muscles faster to prepare them to fight danger or flee to safety. Heart rate only becomes dangerous if it is VERY high, over 200 bpm for some. Typical heart rate during a panic attack is between 120-130 bpm. Vigorous physical exercise is usually a higher heart rate, around 150-180 bpm. Rapid heart rate is not considered a reliable sign of a heart attack.
Heart attacks happen when blood flow is blocked, usually in the coronary arteries, from returning to the heart. It’s considered a “plumbing” problem. The lack of blood flow can then damage or destroy part of the heart muscle. Overall, the symptoms of a heart attack are not always as dramatic as people usually expect.
How Expert Support Can Help
Some of the symptoms of heart attacks are similar or identical to panic, like chest pain, lightheadedness, nausea, shortness of breath, and, occasionally, heart palpitations. However, heart rate doesn’t always increase with heart attacks. Heart attacks are diagnosed with an electrocardiogram recording (EKG). In panic attacks, the only change is the increased heart rate. However, with heart attacks, it might not be an increased rate, but there will be a clear difference in what the heartbeat looks like.
If you’ve had an EKG and the doctor has told you that it’s not a heart attack, it’s been determined you are not at risk for a heart attack, and you are not having any symptoms that are different from your typical panic attack, it is often safe to assume it is panic. A panic disorder therapist can help you understand the difference between panic symptoms and genuine medical concerns as well.
Myth 2: Feeling Dizzy Will Cause You to Faint
This is another common fear for people with panic disorder, especially those who struggle with feelings of lightheadedness or dizziness during panic. Can panic attacks cause fainting? Usually, the answer is no. For most people, anxiety causes an increase in blood pressure, which is directly the opposite of what is required for fainting to occur. Fainting requires a drop in blood pressure to occur. Some people do experience vasovagal syncope in response to anxiety or stress, but that is rare and usually a known pattern in that individual. For most of us, it’s basically impossible to faint during a panic attack.
Myth 3: Panic Attacks Are a Sign You're Going Insane
Another common fear is that symptoms of panic mean the person is “going crazy.” Sometimes this fear is related to symptoms of derealization or depersonalization that can occur during panic, which make people feel as if they or the world around them are disconnected or unreal.
Let’s think about what “going crazy” even means. People are typically thinking of disorders involving psychosis, which is a mental state of losing contact with reality. It is different from dissociative symptoms such as depersonalization and derealization, where you feel removed from reality. Forms of psychosis include hallucinations (sensing things that aren’t there) and delusions (strong, fixed, false beliefs for which there is no evidence or contradictory evidence).
A commonly known disorder involving psychosis is schizophrenia, so let’s take a look at it. Schizophrenia develops slowly and gradually, not suddenly like during a panic attack. People typically experience prodromal symptoms prior to developing the disorder. It also has a strong genetic component, so it is unlikely to develop in people with no family history of it. Schizophrenia also usually first appears in the late teens to early 20s, so most people over about the age of 25 will be unlikely to develop it.
Myth 4: You Can't Control Yourself During a Panic Attack
Since panic attacks make people feel so out of control, many folks fear losing control during panic. They fear not being able to control their own body, which could mean not being able to move at all or their body will move on its own accord, causing them to yell and scream, run and jump around inappropriately, or otherwise embarrass themselves.
Although panic attacks definitely make it more difficult to think clearly and there is often a strong urge to escape, neither of those things equates to losing control of your own body. At Leap Counseling, I often ask my clients to test this the next time they have a panic attack:
Think to yourself, “scream, scream right now, yell out obscenities and run around and cluck like a chicken,” and then, don’t do those things. So far, no one has actually done those actions.
Next, tell yourself to raise your hand, then do it. Scratch your nose. If you can do those things on purpose, then I don’t see how you have lost control.
Myth 5: Panic Attacks Will Wear Out Your Nervous System
For some people, there is a fear that their nervous system will just wear out and they will collapse or even die from this. Panic is based on activation of the sympathetic nervous system, and it is regulated by the body and counteracted by the parasympathetic nervous system. The latter is a safeguard to make sure our bodies can go back to rest.
Furthermore, there is no evidence to suggest that anxiety can “wear out,” damage, or “use up” nerves. Continuous anxiety can cause some negative effects on the body over time, but not in that way. Some people might be thinking about a “nervous breakdown,” which clinicians would usually describe as a mental health crisis. This, too, will not cause any kind of damage to the nerves. It just doesn’t work that way.
Bringing it All Together
Panic disorder involves fear of the physical symptoms of anxiety, which are interpreted as dangerous. They may even be misinterpreted as signs of a serious medical emergency. The myths that panic can cause a heart attack, fainting, “going insane,” losing control, or a nervous collapse are beliefs that keep the panic cycle going. Hopefully this information helped to explain why panic attacks do not cause these issues (for most people, most of the time).
If a person is medically cleared and is known to have panic attacks, there is no reason to suggest that the next panic attack will be something different, as long as the symptoms are consistent with previous panic attacks. Knowing this is not enough to recover from panic disorder, so it's important to seek panic disorder treatment to fully address the problem.
SOURCE: Information adapted from Mastery of Your Anxiety and Panic, Fifth Edition, by David Barlow and Michelle Craske.
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