Phobias and panic attacks, what is its mechanism?

Phobias and panic attacks, what is its mechanism?

Many people suffer, suddenly, from a true crisis of anguish, with a feeling of terror and impending catastrophe. It's a panic attack ...

During these minutes (it rarely lasts for more than an hour) symptoms such as tachycardia, chest pain, rapid and short breathing, choking sensation, instability, unreality usually occur. There are also waves of heat and cold, profuse perspiration, and fear of dying or losing your mind.


  • 1 Prevalence and consequences of panic attacks
  • 2 What is the mechanism of panic attacks
  • 3 Neither so abandoned nor so protected
  • 4 Aoraphobia and panic attack
  • 5 Treatment of panic disorders

Prevalence and consequences of panic attacks

It is estimated that this problem is suffered by 5% of the general population and almost 14 percent of heart patients. It is more frequent in women and often begins at the end of adolescence.

One of the most common complications is the development of a anticipated fear: person fears losing control during those attacks. And since you don't know when they will arise, avoid being alone or going out to public places.

When there are at least three panic attacks in a period of three weeks, without intense physical efforts or real life-threatening situations, it is estimated that the problem should be treated clinically since we are in the presence of a phobic disorder .

What is the mechanism of panic attacks

There are objective physiological factors that activate panic attacks. Among them, hypoglycemic reaction (low blood sugar), mitral valve prolapse (heart problem), orthostatic hypotension, (low blood pressure), hyperventilation (short and rapid breathing) and excessive consumption of drugs like caffeine, LSD, or other stimulants.

The variety and intensity of symptoms differ from one person to another. Some compare the attack with a nightmare or a strong adverse reaction to some medication, although probably the most frightening is tremendous anxiety and the impression of losing control.

Many have expressed it saying: "I feel that I am not here, that I am different, that I am dying or going crazy. It is the worst thing that can happen to one"All of the above can lead to hopelessness: the person tends to believe that his disorder exceeds the possibilities of control.

The fear of their own vulnerability interacts with psychological and emotional responses, producing a vicious circle. Suppose a patient experiences an abdominal disorder after overeating. Think: "Something terrible can happen to me." Then comes a physiological response, such as tachycardia, fatigue, perspiration.

In the affective aspect there is anxiety. And in the "mental", blocking, confusion. At that point there is a cognitive - physiological and behavioral escalation: "Something awful is happening to me. I can't control myself. I'm dying. I need help."

Not so abandoned, nor so protected

The phobic They experience anxiety crises only in two ways: one, which can be experienced by the person, such as feeling abandoned and unprotected in a threatening and dangerous world, with their own perception of vulnerability and weakness. Accompanied by the feeling that very "terrible" things can happen to him and with the anguish of "not being able to control the situation."

The basic symptomatology is asthenic. This means that the 'loss of control' experience is lived in terms of fainting, losing consciousness or dying. The other form that the anxiety attack takes is of a constrictive type.

That is, the person lives the fear as if I was imprisoned, as if it could not be released physically, as a restriction to its physical freedom, and the symptomatology is always located in the thoracic region, as a difficulty in breathing, for feeling the chest as tight and almost always in a tachycardia crisis. The person has a heart attack and perceives himself without any possibility of "control" of what is happening to him.

These two forms alternate in the same person.

These conclusions reached the psychiatrist Vittorio Guidano, after 20 years of research in this type of disorders.

Aoraphobia and panic attack

Another important feature is that the anxiety crisis is always associated with the course it takes.the person's relationship with their partner. And that the appearance of attacks are a consequence of what the person perceives in the other.

That is, if the other is seen as distant, disinterested in the relationship, the agoraphobic will begin to have unprotective crises; if on the contrary, if the other is seen as restrictive, the person suffers a constrictive panic attack.

For example, if the person suffers a panic attack when he arrives at the office, he is likely to feel asymptomatic as a symptom, as it is perceived abandoned and unprotected by his spouse.

If the attack occurs when arriving at home, after work, the attack is most likely of a constrictive type, since the experience will be to feel imprisoned and trapped by your partner. Most notably, the person has no awareness of this, that is, of the association between their attacks and how they perceive that their partner is interacting with him or her now.

The agoraphobic He only pays attention to his physical symptoms, he is not able to discriminate in his feelings. All his emotional life is experienced in terms of physical symptoms. These people are always involved in the control of their feelings and in the control of the other, in such a way that they never feel abandoned, nor imprisoned or trapped by their partner.

This is the predominant affective style. The goal for the agoraphobic will be to find the right balance in these two polarities. Any life situation that destabilizes it will trigger panic attacks.

Treatment of panic disorders

As anecdotal, a patient had his first panic attack at the wedding ceremony, and of course it was a constrictive type. With the perception of feeling "trapped" for a lifetime. This current understanding of agoraphobia, a product of Guidano's research, has now allowed the development of a highly effective therapy in the treatment of a refractory disorder.

Basically The therapy is that the patient becomes aware of their emotions and feelings of vulnerability in "restrictive" and "unprotective" situations in relation to his partner and that he can elaborate his emotional life and "break" with the habit of living his emotions of physical sensations, which make him perceive himself as a chronic patient of somatic ailments.

Author: Angela Puglia Barceló


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National Institute of Mental Health (NIMH). (1997) Anxiety Disorders "Panic Disorder" Psychiatry. Com - Vol 1. No. 1 September 1997

Marks, I. M. & Lader, M. (1973). Anxiety states (anxiety neurosis): A review. Journal of Nervous and Mental Disease, 156, 3-16

Miguel-Tobal, J. J., & Casado M. I. (1999). Anxiety: Basic and intervention aspects. In G. G. Fernández-Abascal & F. Palmero (Eds.), Emotions and health (pp. 91-124). Barcelona: Ariel

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