Anxiety explained

One in every 10 people is bound to experience a panic attack at some point in their life. Could you be next?

We are often told to ‘stop panicking’ during difficult times in our life. As simple this might sound, for some of us, the words are a nightmare. Kamran Ali*, a student of Biomedical Sciences at the University of Sheffield, for instance, has battled panic attacks for most of his adult life. “Anxiety trickled in with full force and I felt like I wasn’t going to make it through,” he says of his first experience. “There was a detachment from reality and visions of the future I had planned looked bleak.”

Such traumatic experiences are often categorised as a surge of fear but just like other mental disorders, anxiety and panic disorders also come with their fair share of stigmas, aggravating the situation further. Therefore, understanding the science behind them becomes even more crucial in order to combat the condition effectively.

What is a panic attack?

Medically speaking, a panic attack involves a sudden onset of palpitations, dizziness and shortness of breath coupled with intense fear. According to Dr Yusra Hanif, a psychiatrist at the Aga Khan University Hospital in Karachi, people often get paranoid and thoughts of a heart attack, loss of sanity, chest suffocation, perspiration, nervous breakdowns and even impending death alters their behaviour. Many patients also live in constant fear of a panic attack recurring. In a span of 10 to 20 minutes, the symptoms loft up to their extreme and then recede gradually. In some severe cases, the attack can carry on for hours without anything beyond the usual taking place.

“Diagnostically, four such episodes in one month or one episode followed by constant fear of an impending episode classifies it as a panic disorder,” she adds. Most individuals learn about the condition and acknowledge their episode to be a panic attack but a few cases show that an attack can occur without any cues, usually dependent on the context of their disorder. In fact, a panic attack might arise whilst a person sleeps! According to Anxiety Disorders Association of America’s research in 2005, women are twice as likely to experience anxiety as men. Also, people with an above-average intelligence quotient are also more vulnerable to the condition as stated in the journal Frontiers in Evolutionary Neuroscience in 2011.

Internal and external triggers

There is a diverse range of reasons that can trigger panic attacks but anxiety stemming from immense fear is the lynchpin. To put it simply, when one is frightened, their body releases a surge of adrenaline which expedites the heart rate and a physiological reaction known as ‘the fight or flight response’ builds up. Due to this, breathing immediately increases and incurs more oxygen for energy. “When fear is strong, it paves the way for a panic attack and the body reacts erroneously to unreal danger,” explains Dr Amanat Mohsin, a psychiatrist at the Gulshan Psychiatric Hospital, Karachi.

However, it must be noted that ‘fear’ is a blanket term which holds different meaning for different people. When attributed to the following classifications, understanding the reasons behind a panic attack becomes easier:

1. The loss of a loved one.

2. Difficulty in dealing with life transitions and mistaken beliefs.

3. Negative self-talking, such as ‘what if’ scenarios.

4. Phobias, such as fear of height or flying.

5. Disorders that aggravate panic attacks, such as hypoglycaemia or obsessive compulsive disorder (OCD).

Ironically, one of the leading causes of panic attacks is the fear of having a panic attack itself or perhaps, the fear of embarrassment from having the attack in public. For Kamran, it was a sense of alienation that he felt upon beginning student life abroad that gave way to anxiety. For others, anxiety arises due to instantaneous trauma from a specific situation. School teacher Rubina Ahmed* for example, has been afraid of heavily crowded places ever since an episode from a few years ago wherein her hair got stuck in the spokes of a bicycle wheel, pinning her down to a jam-packed road. Mirror the e-paper, reported on April 13, 2015 that a mother of seven hasn’t left her house in 17 years owing to the fear of having a panic attack in public.

Diagnosis and treatment

A number of treatment options are available to counter irrational fears, anxiety and panic attacks but getting the best possible treatment becomes difficult as according to the book The Oxford Handbook of Depression and Comorbidity published last year, 40% to 80% of patients develop severe depression. “Patients suffering from the condition have clouded rationality, and family members and close friends must push the patients towards attaining a medical professional’s help,” informs Dr Amanat. Some of the main treatments include:

1. Cognitive behavioural therapy (CBT), which involves a series of relaxation techniques administered by a professional. According to the American Psychologist Association, CBT is an effective and holistic approach which ensures drastic improvement within the first eight to 10 sessions.

2. Medication prescribed by professionals, usually a mild sedative taken on the onset of an attack.

3. Group therapy sessions and support groups which provide an opportunity for patients to meet others and realise that they are not alone. This form of therapy is highly recommended by doctors.

4. Short term strategies that offer quick first aid techniques to help patients calm themselves down at home. These can include breathing in and out of a paper bag or lifting their legs up to increase blood flow to the brain.

Dr Amanat also states that harmful habits like smoking, too much caffeine and a high intake of sugar should be strictly avoided as they tend to aggravate the condition.

Towards a better future

The negative stigma attached to mental disorders often leaves family members, friends and co-workers of patients at a loss. They deem patients to be overreacting and fragile as they do not comprehend what the latter is feeling. This can, ultimately, cause a hindrance towards rehabilitating the patient as crude judgements can take a toll upon their self-esteem and perpetrate negative thoughts. Therefore, it is very important to raise awareness about such issues and actively help patients towards a better future. “Patience is virtue in terms of treating anxiety and panic disorders; treating them isn’t an overnight phenomenon,” says Dr Amanat. “It depends on the diligence and commitment of the patient towards treatment,” he adds.

*Names have been changed to protect privacy

Bio: Zohaib Amjad is a scienet with a major in molecular pathology. He tweets at @infectiousuni

Did you know ?

Did you know that a lot of your favourite A-list celebrities also suffer from panic disorders?

Oprah Winfrey



The ever-engaging talk show guru experienced anxiety for many years, resulting from her traumatic childhood. Being sexually abused at a young age and a teenage pregnancy that resulted in a dead baby caused Oprah to feel severe nervousness and difficulty in relating to others during the early years of her career.

Princess Diana



The princess was reported to experience panic attacks and depression for many years. In fact, after her death, her bodyguards reported that during her first royal tour, she would often cry uncontrollably while travelling to different destinations.

Johnny Depp



It may be hard to believe that the street-smart and confident Captain Jack Sparrow could have a grave social phobia but it’s true. The actor of Pirates of the Caribbean fame openly states that he is shy in person and hates being famous. He even played fearful social misfit in the movie Edward Scissorhands, a role which reflected his real life struggles.

Scarlett Johansson



A gorgeous movie star and singer, Scarlett Johansson surprises a lot of people by sharing her experience of social anxiety and panic. She has confessed that she often gets panic attacks before coming in front of the camera.

Published in The Express Tribune, Ms T, May 31^st, 2015.