How Does Panic Disorder Start?

Updated on September 6, 2017
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Meloncauli is a former nurse and anxiety management therapist. She hopes everyone can take something away from her articles.

Scenario 1

A man at work one day suddenly began to feel ill. He didn't sleep well the night before, so he wasn't feeling great all morning. At first, he felt very weak and shaky, but soon, this was accompanied by a feeling that his heart was racing too. He felt alarmed by this. He sat down and noticed he had started to feel very hot, and his mouth was very dry. He found it a bit hard to swallow, and that was frightening him even more. He started to gasp for air, and then the dizziness began along with some chest pains. He shouted over to a work colleague for help, who, seeing this man is in some distress, calmly calls for a first-aider to attend to the scene, and then leaves the room.

The first-aider lays the man in the recovery position on the floor and decides it is best to call a paramedic. The paramedics arrive, take his blood pressure and pulse, and say, "Best to get checked out at the hospital." In the ambulance, they say, "Just as a precaution for anyone who has chest pain, we will put you on a monitor."


An hour later, this same man, after seeing a doctor at the hospital, is given the all clear and told he had just had a panic attack. The relief was enormous. He really did think he was having a heart attack and that he may have died. When he left the hospital and went home for the rest of the day, he had a spring in his step and felt glad to be alive.

It was only a panic attack. He’d panicked. He’d probably felt a bit weak and shaky because he’d had little sleep, but it had shocked him and taken him by surprise. He recognized he had become very fearful, and after an explanation by the doctor about the effects adrenaline can have on the body, he readily accepts the logic of what had happened. The following day, he pushed the experience to the back of his mind, and thereafter, he didn’t have another panic attack. It soon became history.

What Causes a Panic Disorder?

This man avoided panic disorder. How? What makes a panic attack become a panic disorder? There are many people who have had or will have an isolated panic attack in their lives. For others panic attacks can occur every day, sometimes several times a day. Repeated and regular panic attacks over the course of time will take on the diagnosis of panic disorder which comes under the umbrella of anxiety disorders. Sounds a whole lot worse, doesn’t it? It is! It can be extremely debilitating and lead to conditions such as agoraphobia and depression.

What happens when that initial panic attack takes place is all important. How you react to it and, if medical professionals are involved, how they handle your panic attack will all play a part in what happens next.

A first panic attack may be checked out as a heart problem
A first panic attack may be checked out as a heart problem | Source

Scenario 2

So! Let’s take a look at a different scenario but using the same man as an example. The man has called over the colleague, but this time, the colleague panics. He ran off saying he would get help, and the man instantly got the message reinforced that something was indeed very wrong when he saw the panic on the colleague’s face. The symptoms got worse as he added more fear.

The first-aider arrived, along with the supervisor and the colleague. This made the man more nervous as he saw himself as a spectacle. When he checked the man out he asked if he had any heart problems. The man thought that his suspicions might be right — this could be his heart and was serious. He replied with a "Negative," but the fear is now greater. The paramedics arrived, and the first thing they did was place him on a heart monitor with no explanation. As soon as he was placed on that heart monitor he was sure now that he was having a heart attack. They also gave him an aspirin. He had lots of tests in the hospital and was told the same thing. It’s a panic attack. The doctor didn't give an explanation about what a panic attack is and assumed the man must know.

Questions add confusion to a panic attack
Questions add confusion to a panic attack | Source

In the second scenario the man the man goes home rather confused. How can a first aider and a paramedic think it’s his heart when it’s a panic attack? What if they made a mistake with those tests because those pains sure felt real? He knows what panic is but wonders why he should have had a panic attack; everything felt very physical not mental. He doesn’t trust what happens and keeps reliving it all in his mind for the rest of that day. He sleeps badly again but this time he is pacing the floor. What if it happens again? What if they got it wrong? What if it happens at work again and he can’t stop it. The embarrassment would be too much. Will he keep having them and lose his job?

By the time the man set off for work the next day, he was extremely anxious. By the afternoon, he was so anxious that he began to feel a little strange. He recognized some of yesterday’s sensations starting up and thought, "Oh no, it’s going to happen again! I can’t deal with this. Why is this happening to me?"

A full blown panic attack happens again. He suffers this in the restroom to avoid embarrassment and when he feels a little better he asks if he can go home as he’s not feeling too well. In the following weeks, although he may have some days when he doesn’t have a panic attack he has experienced quite a few more. Not only are they happening at work but also on the way to work and some happen in his home. He is now afraid he can have a panic attack at any time in any place. He has fearful anticipation of the next one, has lost an amount of confidence, still isn’t sure there isn’t something physically wrong with him and has panic disorder.

You may argue that there are other factors involved in why some people get panic disorder and some don’t but the bottom line will always be how much residual fear and confusion from that first panic attack lays the path down for more to follow.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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