a complete guide to panic attacks for writers
Iâve seen many posts about this and many of them are either not very complete or somewhat misleading, so here goes, a certified anxious wreckâs guide to panic attacks.Â
First thing: there isnât a clinical distinction between a panic attack and an anxiety attack so Iâm not sure why everyone is splitting hairs over it. In the DSM âpanic attackâ refers to the quick, sudden onset of intense fear and stress, the sympathetic nervous system response, and all the associated physical symptoms (that iâm about to get into). âAnxiety attackâ isnât a clinical term, and yet I see all kinds of posts âexplainingâ the difference and none of them actually agree on what the difference is (duration? severity? trigger or lack thereof? Iâve seen so many different things), so to me it seems like a dumb thing to split hairs over. Generalized anxiety is definitely different, but even then the lines can blur and when weâre talking about a discrete *event* where the symptoms come upon a person, thatâs an âattackâ and saying panic attack suffices. Or anxiety attack. Just. Whatever.Â
TL;DR: there is no clinically recognized difference between a âpanic attackâ and an âanxiety attack,â everything I see explaining the difference has a different idea of what the difference is, and itâs not like, offensive or something to use the âwrongâ term so just. Yeah itâs not a big deal.Â
A panic attack is basically when someone all of a sudden feels extremely terrified and panicked, without being in actual danger. Theyâre associated with anxiety disorders and post-traumatic stress disorder, though they can happen to someone who doesnât have a mental illness.Â
Panic attacks are not just the emotion of fear, though; there are a lot of physical and mental reactions that go along with them. Feeling terror isnât the only thing thatâs happening. When the brain perceives a threat, the sympathetic nervous system causes a bunch of things to happen in the body to prepare the person to either fight or run away from the threat. Thatâs called a fight-or-flight response. Breathing and heart rate speed up, while digestion is suppressed, and so on. These responses affect almost every system in the body. The personâs mental state also changes. They become very hyper-vigilant to threats and âtunnel-visionedâ on whatever it is that seems to be the threat.Â
A panic attack is basically all this stuff happening, but thereâs nothing to fight or run away from. Itâs bad.Â
Symptoms, physical and mental
Some things to keep in mind, that I havenât seen addressed in any post before: Iâve known a lot of people, including myself, with various anxiety disorders who experience panic attacks and all of them experienced a different grab-bag of symptoms. In some cases, the symptoms could be very weird. It would take forever to exhaust all the possible symptoms of a panic attack, but Iâll do a list and explain (Iâll go into more detail about how to write all this in a bit). Thereâs a whole range of severity, and the loss of control/thinking youâre going to die happens with the more severe ones. One person can have both small attacks and huge ones that are much worse, and the symptoms they have can change over time.Â
Intense fear - panic attacks are terrifying. They vary in how terrifying. I know saying âterrifyingâ is exactly what it says on the tin, but itâs hard to convey to someone who hasnât experienced this exactly HOW terrifying they can be when theyâre really bad. When I was younger, I had attacks that lasted hours wherein it seemed almost as if I had suddenly realized that nothing in the universe is kind or good or safe and nothing I could hold onto for security felt even real. I know that sounds damn dramatic, but itâs what happened. On that note:Â
Feeling a sense of immediate impending doom. Again, no real way to describe this well but its BadÂ
Being convinced you are going to die. I mean convinced. Â
Feeling like you are losing control or going crazy. This goes along with the things I just discussed, and is usually with a severe attack.Â
Racing or pounding heart - this is one everyone will know. Basically, your body is convinced you need to run from something or fight something.Â
Feeling that the room is swirling or spinning around you.Â
Choking/suffocating feeling or feeling like you have trouble breathing - This is scary. Honestly, a lot of why panic attacks are so scary is that the *symptoms* are scary. I used to always feel like I couldnât pull air far enough into my lungs, or that no breath I took in was deep enough. You might feel like your throat is closing up. Expect a character to possibly gulp or gasp for air that they donât feel like theyâre getting.Â
Dizziness or feeling lightheaded or faint. Can result from hyperventilating as a result of feeling like you canât breathe. Your character might need to sit down all of a sudden, or lean against a wall.Â
Crying, or screaming: Not everyone will respond this way, but a personâs stoic-ness or âtoughnessâ doesnât have a lot to do with whether they do. Even a strong, tough person can react this way. An emotional person wonât necessarily cry. It depends.Â
Talking to oneself, babbling, muttering, moaning, really any kind of vocalization. âOhmygodohmygodohmygod.â That kind of thing.Â
Pacing rapidly, fidgeting uncontrollably, unable to sit still. Messing with items around you and throwing them aside. Your character might walk around in tight circles or gesticulate frantically, clutch at their hair, etc.Â
Really any tic or nervous habit that a character has might get worse and possibly harmful.
Shaking/shivering/trembling uncontrollably: A lot of people will think hand tremors or being âshakyâ with nervousness, which I guess happens, but this can be and very often is very intense, teeth-chattering, whole-body stuff. Often seems to happen in waves or spasms, and you canât stop it. If youâre having a very bad attack, think violent, uncontrollable waves of shivering. Itâs very unpleasant.Â
Tunnel vision or black around the edges of your vision: This is not something I can find on google but I know itâs happened to me at least once.Â
Goosebumps or chill-bumps.Â
Chest pains. Not something I have experienced much, so I canât elaborate too much.Â
Numb, tingly fingers or hands. I donât have any personal experience with this, but apparently this happens to people.Â
Racing or spiraling thoughts. Even if it didnât have a trigger at all, your thoughts can still be really panicked and disjointed. Expect your characterâs internal monologue to be very repetitive and unstructured. If there was a trigger, expect extreme obsessing over the thing that caused the panic. But in some cases, panic attacks can be almost purely physical responses. Multiple times Iâve been overcome by the symptoms and mentally just been like âOh, this isâŚhappening to me.âÂ
Anger or aggression: The intense feelings of a panic attack can come out in some weird ways, and this is one of them. Snapping, lashing out, irritability, or other ways of responding with anger wonât be out of place. You might be extremely defensive or ready to fight back.Â
Nausea: Panic attacks always came with very severe nausea for me, though I never actually threw up (thatâs rare, but it happens to some people.) This doesnât happen to a lot of people, though.Â
Other digestive distress: You can definitely have diarrhea or stomach pains.Â
Face turning pale/blanching.Â
A feeling of weakness in your body.Â
Feeling like whatâs going on around you isnât real; your surroundings seeming surreal. (Derealization. I havenât experienced this much, so you can do more research on your own if you want to explore this one.)
Feeling detached from your body or like youâre observing yourself from far away. Feeling like you arenât real. (This is called depersonalization. Not much personal experience with this, either.)Â
And these symptoms arenât even close to all of them. Honestly, a lot of weird crap can happen, because panic attacks affect the entire body and everyoneâs body is different. Of the list above, Iâve experienced everything at one point or another except depersonalization, stomach upset, and the tingling hands/arms and many of the above symptoms happened to me as flukes (I think chest pains happened like once). Some of the things on the list developed later in life. (I started getting hot flashes due to anxiety when I was 16.) Some symptoms disappeared as I got older. (I havenât actually experienced shortness of breath much since I was a kid.) Everyone I know has a different set of these traits. I have no idea why. This is all just to show the wide variety of symptoms that can occur, and show that everyone is going to experience it differently. As for your character, you can just pick whatever feels right to you. Racing heart and shortness of breath are pretty much staples of the panic experience, and the shaking/trembling and dizziness are very common as well, but everyone is going to be different.Â
Now, how does one actually write a panic attack?Â
If youâre writing about panic attacks, you most likely have a character who has some form of trauma or anxiety disorder. Now, panic attacks can happen totally at random, but there is usually some sort of cause.Â
When I say âcause,â that can be âthe room is too hotâ or âI saw something in an article about one of my phobias.â (These examples are drawn from my friend and me, respectively.) Really little things can set the snowball rolling. Stress or anything unexpected will do it, and so will exposure to your characterâs triggers.Â
When I was younger, my triggers were all related to my phobias, which were mostly health-related. That meant reading something about some rare form of cancer, or something like that, could cause me to have an attack. Triggers could be related to a characterâs trauma, or they can just be something that scares or stresses out a character. it depends on the character. Trauma related triggers can be very little and random. Anything they associate with their abuse or abuserâa scent, a certain song, a phrase said in a certain wayâcan set them off.Â
When I say âsnowball,â thatâs really how it works. The thing about panic attacks is that the attack itself is absolutely terrifying, to the point that a lot of people who experience them develop extra anxiety just over the prospect of having another one. The hallmark characteristic really is intense terror. When youâre not good and jaded and used to having them, the symptoms themselves will make you freak out more. Panic results in feeling like youâre struggling to breathe, and struggling to breathe results in more panic. I was especially screwed because my main triggers wereâguess whatâall related to illness. Yay.Â
Your character is going to be in a very altered state of mind, most likely. They will be obsessing and spiraling and latching onto worst-case scenarios so that they canât really objectively analyze what is going on with their body. Everything is Bad. Everything seems like itâs as bad as it could possibly be. On this same note, your character is not going to be able to think or reason their way out of this. Their irrational, fearful thoughts are going to be a lot stronger than the reasonable ones and will be flashing like strobe lights on top of it. If that didnât do it, the extremely powerful bodily response they are dealing with sure would. The âsense of impending doomâ or of feeling like you might die is overwhelming and hard to counter with thoughts because it just feels so vast.Â
Write a severe panic attack as you would excruciating pain, because thatâs the best way to put the kind of mental state. It has to stop, it HAS to stop, but it doesnât stop, thereâs nothing you can do because thereâs no actual threat.Â
And yet, if your character has experienced this many times, they may be able to hold onto sanity and control their physical responses. Iâll get into coping skills in a bit, but Iâm putting this out there to say that the first time and the fiftieth time might be really different.Â
The first time people experience a panic attack, they often call 911. Iâm serious. The thing is, you have to learn that what youâre physically experiencing is a result of panic; you donât just instinctively know that. The first time I had one, I was 10 and the shaking and spasming didnât feel like an emotional response, it felt like what in the actual hell is going on? Am I dying? It takes several more times experiencing this to figure out how your body reacts during a panic attack and several MORE to be able to piece yourself together enough during it to say to yourself, âI am having a panic attack,â and identify the symptoms.Â
That said, even when you know whatâs going on with you, itâs still very scary because what do you do when you feel like you have to run, but thereâs nothing to run from? Or you feel like you canât breathe, but you know youâre taking in air?Â
All that to say: the emotional response of fear isnât the central thing your character will be conscious of. Their thoughts, and their physical reactions, are as important and they might even seem detached from the feelings of fear. So donât just have your character being like âIâm terrified, Iâm terrified, Iâm freaking outâŚâ It feels like some kind of medical disaster. I wasnât always able to identify my attacks as fear at all. Obviously your character is scared. But show that through their thoughts (spiraling, disjointed, obsessive, babbling) and whatâs going on in their body (cant breathe, sweaty, shaking uncontrollably). Â
Panic attacks can last anywhere from a few minutes to hours. When you get to ones that are hours long, usually itâs happening in multiple âwaves.â Your character can start to calm down, and then they can start to think about stressful things again and hyperventilate and go back into it. A lot of definitions list them as âbriefâ but the briefest one Iâve ever had probably was no less than 20 or 30 minutes. Again, it will vary with the character.Â
After your character starts calming down (this can just happen due to utter exhaustion, getting the symptoms under control, or just realizing that itâs been two hours and theyâre not dying), they will feel exhausted. Especially if itâs a long attack. If theyâve been in panic mode for hours expect them to be feeling like a beaten rug hanging on a porch. Panic attacks are draining. They probably wonât feel up to much after. Their energy will be gone. They might feel a sense of calm and security after theyâre done, or they might feel very sick and bad. It just depends.Â
The best coping skills usually target the body itself and focus on slowing down the fight-or-flight response. This is why breathing exercises are recommended. But they donât always work. Being super aware of my breathing would always make me freak out more. The mental and physical aspects bounce off one another and if something thatâs helping in one area is making it worse in another, it wonât help overall.Â
In my experience, knowing what was happening to me, all the causes of the physical things I was feeling, and that they were all just results of the panic attack helped me fend off the worse thingsâfeeling like I was going to die, et cetera. It may not be that way for everyone. But just knowing what is happening to you, or not knowing, makes a lot of a difference.Â
What not to do: I know itâs hugely tempting to have your character be held and reassured by their love interest and calm down, butâŚreally, with a panic attack, youâre not going to pull someone out of it. It has to pass. Especially once the snowball is already rolling, it needs time to pass. Even the best damn coping skills in the world arenât going to erase this and neither is a hug from someone cute.
Different people will need different things. Some people will be helped by being hugged or held tightly, but thatâs not everyone. Some will want to be left the hell alone. Some people will want you to be near them and talk to them, but not touch them. For some people, holding their hand is enough.Â
Thereâs a post going around somewhere saying that grabbing someone and holding them tightly to you will stop a panic attack. This goes for both real life and fictionâDO NOT DO THAT. Ask!! Ask!! if itâs okay! to touch them!!!!!! Never ever ever ever ever touch someone who is in this sort of distress without permission and especially donât keep doing it even if they struggle. They could feel trapped and start to feel even worse, or if their panic is trauma related, they might have a flashback to an assault. In either case they might fight back and hurt you or themselves. Donât put this in a book and show it actually working and being a good thing because NO.Â
If you want to indulge some hurt/comfort or fluff, just show the love interest character staying with them, asking what they need, doing what they can to help. Your frightened characterâs love interest can coach their breathing, bring them a blanket or a glass of water, or just talk to them. They can remind the character that they arenât suffocating. I mean, sure, they can hug if you like. Some people are comforted by being hugged. Just donât portray it as some kind of cure or instant fix. Someone who is having a panic attack isnât going to just immediately calm down upon falling into the arms of the right character. They may not calm down at all. The love interest might feel very inadequate. The most comforting things in the world are not going to be that comforting right then. Anyway, showing the love interest sticking through and being compassionate and attentive through ugly, scary hours of terror, even if thereâs not a lot they can do, is sexy.Â
If you wanna do cuddles, put those in post-attack, when your character is mostly calmed down and now is just spent and tired. They probably need the comfort and a long hug or back rub might do them good.Â
On the topic of hugs, give someone with an anxiety disorder a hug for me today, will ya? (Ask first.) This was emotionally exhausting. Whew.Â
