Once the groundwork of stress is laid there is usually a specific trigger that is the cause of panic attacks.
Triggers usually relate to an issue that is already anxiety producing or has been a source of fear previously. They are usually the symptoms that sufferers find particularly scary or a thought or event that is particularly anxiety producing. These triggers are different for different people but there are several common themes.
Some typical examples:
When he was younger David had an extremely unpleasant experience with an especially strong dose of an hallucinogenic drug. He found the shift in his experience of reality very frightening but because he knew it was caused by the drug he was able to cope, just about, until the effects wore off.
Later in life, after many stressful years in a difficult marriage, he experienced a building up of anxiety symptoms. He’d had experience of these in the past and was able to deal with them largely by ignoring them. This time though they didn’t go away. They continued to build until one day he experienced what he describes as something like a shutter falling over his visual perceptions, making everything seem strange, unreal and distant.
He immediately remembered the drug experience of many years ago but this time there was no drug. In fact he had no idea what was happening to him. This triggered his first panic attack. The symptoms didn’t go away but continued to be extremely frightening, triggering many more attacks over the following weeks. He felt like he was going mad.
Sarah had been under pressure for several months at work and was taking a holiday at her father’s house by the sea. But they were having a particularly difficult time in their relationship and the visit turned out to be almost as stressful as being at work.
It was very hot and Sarah decided to go swimming with her young son to get away from her father for a while. Her son panicked when he realised he was out of his depth and climbed on top of Sarah, pushing her under the water. The combination of not being able to breathe under water and the fear for her son made the experience very frightening, but she managed to get them both out of the water with no harm done.
Later that night, Sarah was trying to sleep in a hot, stuffy room. It seemed airless and she was suddenly overtaken by the feeling that she couldn’t breathe. It was her first panic attack. In the months ahead, situations where she became out of breath, after exercise for instance, acted as triggers for more panic attacks.
John was having a hard time. He was in his late sixties and his wife had just died after a prolonged fight with cancer. Now he was alone, already having been estranged from his children. He was facing a major change in lifestyle since it was his wife that had most of the money and she had left a large part of it to her children.
His wife’s illness had made him start to worry about his own health for the first time in his life. His parents had both died of heart disease and he started to worry about every ache and pain. He was completely unaware of how much stress he was experiencing and how it was affecting his body.
When he felt a pain down his left arm, he immediately jumped to the conclusion that he was having a heart attack. His heart started to race, making him even more convinced and his symptoms escalated as his fear increased. It turned out that the pain was from a restricted nerve in his upper back due to the amount of muscular tension he was carrying.
Sometimes sufferers aren't aware of the trigger - in this case it is usually a very subtle thought or feeling that is not quite put into words. In every case though it is the reaction to the trigger that ultimately is the cause of panic attacks.