In Part 1, I went over my story of dealing with panic attacks.

In this part, I’m going to go over what causes panic attacks.

With every action, there will be a reaction.

In the aftermath of my panic attacks, I started to get angry at how debilitating they were. I refused to be a victim and investigated why I was having panic attacks. 

I looked back on my entire life (from childhood to present), wrote down and analyzed any patterns I saw, and heavily researched what caused panic attacks.

Here’s what I came up with on why panic attacks occur:

Panic Attack Cause 1: Genetics

Scientists have pinpointed the exact gene (NTRK3) that makes people prone to panic disorder1http://www.medicaldaily.com/gene-behind-panic-disorder-discovered-targeting-fear-memories-could-lead-treatment-264015 (i.e. a disorder in which inappropriate, intense apprehension and physical symptoms of fear occur so frequently as to produce significant impairment). Studies also show anxiety sensitivity runs in families and strong familial-genetic influences in panic disorder have been reported2https://www.ncbi.nlm.nih.gov/pubmed/12880648. In other words, you were probably born with genes that made you susceptible to anxiety and panic attacks.

As a child in elementary school, I suffered from OCD (obsessive-compulsive disorder). I don’t use that word casually to describe I was neater and more organized than the average kid. No, I was terrified of germs and things not going exactly the way I wanted.

  • I would refuse to step into my bedroom wearing the socks I had worn that day to school because I would track all the germs into my “clean” bedroom.
  • If I washed my hands, dried them, and then touched something I thought was “dirty” (i.e. the sink counter), I would immediately wash my hands again.
  • I would wear slippers around the house because I didn’t want my feet to touch the “dirty” floor.
  • I wouldn’t relax until I had taken my nightly shower, because then I could go into my bedroom.
  • I would fold my clothes and lay them out exactly in the order I would wear them that week.
  • When I did my homework, I would lay out my papers and pens in the exact some position every single time. Leaving papers and pens strewn around would freak me out.

After doing some more reflection on my childhood, I realized I also had a mild panic attack when I was a kid in elementary school. The details are fuzzy, but I remember sitting down on the couch watching TV. There was a news segment on how kids were suffocating on plastic bags. My older brother had suffered from asthma and had mentioned how there were times it felt like he couldn’t breathe. During the news segment, I remembered what my brother had mentioned and started to feel my throat constrict. I started to feel it was difficult to breathe, and had to consciously inhale then exhale to bring air to my lungs. After the news segment ended, the difficulty breathing left. Since I wasn’t sure what was going on, I wondered if I was developing asthma.

My mother also has a history of anxiety and depression. Her anxiety rubbed off on my brother and I. She would drive us crazy asking us a bunch of questions about scenarios that were never happen. For example, if I were hanging out with a friend, she would ask about the friend, who his / her parents were, and to watch out for getting kidnapped / molested / etc. She also was a helicopter parent who had to monitor every single homework assignment and test grade I received. I had to show her how I did in all my classes for every homework assignment and test. I would get yelled at / punished if I had anything less than an A. Her micromanagement was a manifestation of her anxiety, and it constantly set me on edge because I knew someone was always looking over my shoulder and ready to dole out punishment if I didn’t meet their standards.

It seems I was predisposed to anxiety and panic even as a child. The OCD, panic attack episode, and anxious state of my mom were indicators of what lurked in me.

Panic Attack Cause 2: Drugs

The lights, the music, and the ambience…it was heaven on earth. That’s how I felt about EDC 2015, a rave that takes place in Las Vegas, Nevada annually. I may or may have not dropped E the first night. And, I may or may not have dropped acid on the second night. Let’s just say that whole music festival was a hell of a trip. The massive amounts of people, the lights, and the blasting music made my senses overload. I was super out of it. I almost felt like I was floating along the universe instead of being in the desert heat of Las Vegas.

 

edcmainstage-e1408064124171

The first week after EDC 2015 was strange. I felt out of it and didn’t feel like I was in my body. Coworkers mentioned I was unusually quiet. Then, more symptoms happened after the first week. I grew increasingly claustrophobic and would zone in on things that would start to give my chest a crushing feeling. I became even more dissociated. I could function at work and talk to people, but it didn’t really feel like I was the one doing the actions. I felt like I was floating out of my body. A sense of impending doom loomed in the back of my mind at all times. There was one moment I went into my apartment and started to struggle with breathing. I was terrified to the point I wanted to go tell my roommate to check up on me in case I didn’t come out of my room. I was terrified I was going to die. I ended up running out of the apartment and getting some fresh air, which relieved the symptoms.

After a while, things gradually returned back to normal. I thought the symptoms I experienced were just an effect of taking too many “recreational substances”. So, I shrugged it off. After all, it wasn’t like the symptoms I experienced were a recurring part of my everyday life.

In the aftermath of my panic attacks, I realized that all but one of the panic attacks I experience occurred after I had ingested recreational substances. What a coincidence.

After noticing this linkage, I researched ecstasy’s link to panic disorder and found the following:

  • Ecstasy / MDMA causes selective and persistent neurotoxic damage towards serotonin in laboratory animals3https://www.ncbi.nlm.nih.gov/pubmed/23660456.
  • People with panic disorder have consistently been shown to to have reduced serotonin receptor binding4https://www.ncbi.nlm.nih.gov/pubmed/15598551. This is even applicable to abstinent ecstasy users5https://www.ncbi.nlm.nih.gov/pubmed/23660456.
  • Decreased serotonin levels make it more difficult to restrain panic6https://www.researchgate.net/publication/227580688_The_role_of_serotonin_in_panic_Evidence_from_tryptophan_depletion_studies.

Although I specifically researched ecstasy and its link to panic attacks, I did anecdotally notice there were a considerable number of questions from drug users (whether they were recreational or heavy users) about whether or not the drug they took started their panic attacks.

Panic Attack Cause 3: Past Experiences 

Sometimes demons from the past come back to haunt you and rear their ugly head.

I grew up in an extremely de-validating household. My worth felt like it was based on achievement, whether it was the grades I got or the seat I placed in Orchestra. If I ever got a B+ / A- or didn’t place in the best seat in Orchestra, I would get yelled at, punished, and put down.

“You don’t work hard enough”.

”I don’t think you are better than [someone else]. Look at how good they are.”

“You never learn.”

“Why do you keep making the same mistakes?”

All the put-downs, comparisons to other people, and punishment repeated and formed the following script in my mind: “You have to achieve to prove that you are good enough, because you’re not good enough as you are. Someone else is always better than you.” Since I was stuck with my parents more or less 365 days of the year until I was 18, there was a lot of time for that script to get wired into my mind. 

Home is supposed to be a safe place, but I didn’t feel safe at all. I was constantly on edge because I was constantly trying to prove myself or was scared I would get punished. Fear, not love, was the theme of my childhood.

College didn’t offer much relief either. As a teenager, my mom barely let me go out and hang out with my friends because the main focus was academics and extracurriculars. Most of the friends I made occurred naturally because they were in my classes. I ended up going into college very socially awkward and socially anxious. My social anxiety was so high I hated walking / biking through campus because I thought everyone was staring and laughing at me. I wasn’t even able to proactively go up to someone and introduce myself.

My freshman year roommate quickly caught up on that fact. He was cool initially, but the “jokes” he started making became more and more biting. I felt like I was being attacked, but he always made it seem like he was “joking”.  Other times he would be nice to me. The reality was he enjoyed putting me down constantly. I didn’t have the self-respect to call him out on his bullshit. Since I didn’t feel like I had a lot of friends in college, I ended up being this person’s roommate for 4 years. I lived life out of fear and scarcity. I remember constantly having my entire body tensed up in my bed with anxiety as I was trying to go to sleep because I could hear him in the other room. I wondered if he was talking shit about me (since he tended to gossip a lot about people). This was not a good feeling to have to deal with for a few years. Unsurprisingly, research shows victims of bullying have higher rates of depression, anxiety disorders, and suicidality7https://www.ncbi.nlm.nih.gov/pubmed/24743774.

Fast forward a fear years…

“Well, you made your choice so stick with it.”

That’s the last thing she said when I decided to end it. She didn’t care at all about us. I had thrown my whole heart into the relationship and she had tossed it callously aside. In the following days after the breakup, all the deleted texts and other micro-actions she had taken during the relationship started to make sense. She had cheated on me (at the very least emotionally).

When I started to date again, I started to experience jealousy issues that were steeped in anxiety. I would wonder if the women I saw were seeing & sleeping with anyone else. I would obsess and interpret certain signs as her being with another man or cheating on me (i.e. taking a while to respond to my text messages).

Relationships with women turned into an incredibly nerve-wracking experience where there days at a time I’d lay awake in bed at night with my entire body tensed up. I felt like a prisoner in my own body: I didn’t want to worry about the other person, but the anxious thoughts kept rushing through my mind and would not stop. They were like waves washing up on the shore.

I don’t think I need to link a research study on how being cheated can lead to anxiety and trust issues…

Let’s dive a little into the neurobiology of how panic attacks occur.

The amygdala and hippocampus portion of the brain play significant roles in most anxiety disorders. The amygdala is believed to be the communications hub between the sections of your brain that process sensory inputs and interpret those inputs. It alerts the rest of the brain that a threat is present and triggers a fear / anxiety response. The hippocampus encodes threatening events into memories, and research shows that trauma survivors tends to have a smaller hippocampuses on average. Research is still being done on how a smaller hippocampus affects memory function. People who suffer from panic disorder have an overactive hippocampus and altered activation in their amygdala, which results in exaggerated formation of fear memories8https://www.sciencedaily.com/releases/2013/11/131128133921.htm.

Anxiety, biologically speaking, is designed to make you more alert so you’re prepared for potential threats. However, when you experience and process too many “threats”, you become wired to be on the lookout (since you’re used to threatening situations happening to you). Your mind & body become hyperactivated and your fight-or-flight response is perpetually activated even when there are no actual threats around you. Anything can easily make your anxiety flare up (especially inputs that remind you of past trauma) because you’re already on edge all the time. This becomes a vicious cycle because every time your panic / anxiety is triggered, it reinforces the idea that life is full of threats and fear. It’s only a matter of time when the pressure builds too much and escalates into a full-blown panic attack.

Summary 

The following led to my panic attacks:

  • Genetics
  • Recreational Substances
  • Past Experiences

Although my experiences are unique to me, I’m willing to bet the above factors have played a role in your panic attacks as well.

For help and relief, go to Part 3 to learn how to manage panic attacks.

References   [ + ]

1. http://www.medicaldaily.com/gene-behind-panic-disorder-discovered-targeting-fear-memories-could-lead-treatment-264015
2. https://www.ncbi.nlm.nih.gov/pubmed/12880648
3. https://www.ncbi.nlm.nih.gov/pubmed/23660456
4. https://www.ncbi.nlm.nih.gov/pubmed/15598551
5. https://www.ncbi.nlm.nih.gov/pubmed/23660456
6. https://www.researchgate.net/publication/227580688_The_role_of_serotonin_in_panic_Evidence_from_tryptophan_depletion_studies
7. https://www.ncbi.nlm.nih.gov/pubmed/24743774
8. https://www.sciencedaily.com/releases/2013/11/131128133921.htm