OVERCOMING PANIC ATTACKS

Renu Sud Sinha

• Ashima (30) has been having panic attacks for nearly 20 years now.
• Harsimran (20) cleared NEET in her third attempt due to severe exam anxiety.
• Mayank (26) couldn’t clear JEE and had to settle for BSc because of anxiety; he hasn’t been able to take any entrance test for government exams, and remains without a job.
• Gautam (26) started experiencing panic attacks during his second year of BTech “due to the stress of the competitive atmosphere in a prestigious engineering college”. He had to take an extra semester to complete his degree.
• Poornina (37) has been facing relationship as well as job-related problems for a long time because of the “fear of the unknown”.

ENTREPRENEUR Anupam Mittal, founder and CEO of Shaadi.com, recently spoke about his anxiety issues and about having panic attacks since he was in his 20s.

The National Mental Health Survey, the last comprehensive mental health assessment conducted in 2015-16, estimated that about 3.5 per cent of India’s population suffered from some form of stress or anxiety-related disorder. Another study by Lancet in 2017 found that of the nearly 19.7 crore Indians affected by mental health disorders, 4.59 crore were suffering from depression followed by anxiety, impacting 4.49 crore. It also said that women were affected more by anxiety.

Calming exercises

• Belly/deep breathing
• Simple neck, shoulder and back stretches can release tension
• Practice mindfulmess using all senses. Imagine yourself in a calm setting like a beach, forest, hills, etc
• Meditation
• Grounding techniques: Called the 5, 4, 3, 2, 1 method, it involves naming 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, 1 thing you can taste

While the pandemic saw a steep rise in mental health issues, awareness about panic attacks or disorders remains low.

“Many people land up in hospital emergencies after a panic attack as the symptoms can often be mistaken for heart attack. Signs can include rapid heartbeat, shortness of breath or tightness in throat, chest pain, dizziness or feeling of faintness, numbness or tingling sensation, etc, and the attack can happen suddenly. Many times, these cases are referred to us after cardiology examination and tests,” says Dr Sandeep Grover, Professor, Psychiatry, PGIMER, Chandigarh. Panic attacks can occur independently or co-occur with other mental health problems like depression, OCD, personality disorder, etc, he adds.

Most people can experience one or two panic attacks in a lifetime, but when these reoccur, it is called a panic disorder. These can start at any age but diagnosis is usually delayed as symptoms are sudden and short-lived. Factors can be genetic or environmental, or both. External factors can include trauma and abuse (sometimes sexual) often during childhood, says Chandigarh-based psychiatrist Dr Simmi Waraich. People with poor coping skills are more predisposed to panic disorder, a type of anxiety disorder.

The difference between a panic and anxiety attack is that certain stressful situations often trigger anxiety attacks, which build up gradually, with physical symptoms such as a rapid pulse or tightness in stomach. But these symptoms are usually less intense and last longer than a panic attack, which is unexpected and sudden with intense but brief symptoms.

While Dr Grover pegs the age range of patients between 18 and 45, Ludhiana-based psychiatrist Dr Priyanka Kalra sees three to four patients daily, some as young as 10, especially after Covid. “Academic difficulties became pronounced after schools reopened, kids have problems while writing and face exam anxiety. An 11-year-old girl refused to go to school for months. After many sessions, she revealed that a teacher had scolded her in class.”

During early teenage years, many can have panic attacks due to over-criticism, peer rejection, bullying, etc. “In older children, particularly those studying for competitive exams like NEET, JEE and other entrance tests, exam anxiety has emerged as a major trigger. Some of the older children face body-image and self-esteem issues,” says Dr Waraich.

A good orator, Chandigarh-based Harsimran was good in academics as well, scoring above 90 per cent in classes X and XI. The combined stress of the lockdown and preparing for NEET made Class XII a hellish experience. “There was no escape, no school. I would keep crying without reason, wouldn’t talk to anyone, had rapid heartbeat, couldn’t sleep all night. It has taken me more than three years of counselling, medication, yoga and developing coping skills to be stronger mentally. I have finally cleared my NEET with a good rank,” says the young girl, who now feels equipped to face the rigours of a medical college.

The incidence of panic attacks is more among the young because their stressors are more. “Tougher competition, unemployment, work stress, social media pressure and dysfunctional coping mechanisms,” lists Delhi-based clinical psychologist Ashita Mahendru.

Consequences of untreated panic attacks are life-long. The fear of recurring attacks limits their life choices or results in poor choices. Agoraphobia (fear of public or crowded places) is common. This limits their job options and relationships and even leads to a faulty choice of partners. In the absence of any treatment, substance abuse, stress eating and self-harm are common among patients, adds Mahendru.

“I would often have nausea and diarrhoea during childhood as my mother used to get angry often and the fear of her beatings would trigger these reactions,” says Delhi-based Ashima. “I had no support system. My father was mostly absent. I wasn’t allowed to go anywhere but school. The only friend I could share my feelings with was in a similar situation. So, I thought this was normal. When it would become too much, I would shut down completely, keep crying, sleep for 12-13 hours, not speak to anyone. By Class XI, these symptoms turned into extreme back pain and swelling. I started drinking alcohol, freely available at home. I wanted to study psychology but was forced to opt for engineering. I agreed because it meant moving to Chennai, the only way to escape home. There, too, my mother found a way to control by limiting my finances. Even now, financial insecurity remains a trigger,” says Ashima, who started therapy only in 2020, as “it was costly and my mother refused to give me money initially”.

While a dysfunctional family (her parents are separated now) triggered mental health issues for Ashima, for Bengaluru-based Poornima, repeated sexual assaults since she was five and a closed family atmosphere were the reasons behind her panic attacks which started when she was 13. “I blamed myself, had no confidence, couldn’t share with anyone, as I had no friends. All these piled-up feelings would cause choking sensations, unknown fears as if someone is always in the room with me,” recalls Poornima, who is now quite vocal about her mental health issues. Despite undergoing therapy, a toxic boss or a failed relationship can still trigger attacks.

Good in studies and sports, for Delhi-based Mayank, it was the fear of losing at games that stared his downslide. “The situation slowly worsened to 10 to 12 panic attacks a day, affecting everything. My father was a teacher in a small town of Uttarakhand. My parents thought it was ‘devta’s curse’. After Class XII, I came to Delhi to prepare for IIT. Pressure during coaching led to substance abuse and self-harm. My family still doesn’t know about my mental health or that I’ve been in therapy for two years now,” adds Mayank.

Gautam was also diagnosed with mixed anxiety-depressive disorder and has been in therapy since 2019. “I prioritise my mental health now. I follow a good diet and sleep hygiene,” says the entrepreneur, who is setting up his own business now.

Experts say that 15-20 continuous sessions of cognitive behaviour therapy (weekly or biweekly), beta-blockers, anti-anxiety and anti-depression medicines in more serious patients, and consistent follow-up have given good results. A healthy lifestyle is a must. Panic attacks may still happen in extreme stressful situations but, as Poornima says, “Therapy equips us to better handle these.”