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Panic attack and vegetative dystonia – Article series “How to treat the soul?” Part 5!

Panic attack or autonomic dystonia? When we get to know different mental health problems in more detail, it becomes clear that various mental symptoms have affected almost every one of us during our life. They are usually part of a normal response to stress, bereavement or some unusual event. It is the same with the topic discussed this time. Everyone can remember a situation when the heart began to beat faster due to the experience, increased sweating began, a heat wave or cold tingling appeared, “turned in the stomach”. A little different for everyone and yet…it has happened! When it comes to panic attacks, the feelings are much stronger – disabling – that they even stop the usual daily activities and activities.
Individual panic attacks do not mean that a person suffers from panic disorder. In their case, without panic attacks, the patient has constant anxiety, waiting and fearing a repeated attack. He avoids certain situations, places and environments associated with the possible recurrence of attacks, thinks about the unpleasant feelings.
There is little data on how many people in the world experience individual panic attacks during their lifetime, but panic disorder (repeated, frequent panic attacks within at least half a year) is found in approximately 3-5% of the country’s population. In Latvia, it would be around 78,120 people. Panic attacks often go hand in hand with other mental illnesses, such as depression, bipolar affective disorders, or somatic illnesses, such as heart disease, hyperfunction of the thyroid gland (thyrotoxicosis), hypoglycemia, cerebral circulation disorders, etc. Therefore, in the case of these disorders, the first step is to exclude somatic illnesses as the cause panic attacks. The next step is to differentiate panic disorder from other mental illnesses, such as acute psychotic disorders, in which anxiety, panic is triggered by exposure, perceptual disturbances (hallucinations) or nightmare ideas.
Speaking of panic attacks, it is worth mentioning a frequently heard diagnosis – vegetative dystonia. It should be noted that this name has survived only in the “vernacular”, the diagnosis of somatoform autonomic dysfunction can be found in the classification of diseases. It is often confused with panic disorder. However, each of the mentioned belongs to a different subgroup. Panic – for another type of anxiety. “Vegetative dystonia” – for somatoform disorders. Both of these subgroups are considered neurotic disorders.
To better understand this division, let’s start by briefly reviewing the functional division of the human nervous system.

Distinguish between:

  • the somatic nervous system, which innervates the striated musculature and skin and is subject to human will;
  • the autonomic nervous system, which innervates all internal organs, i.e. see, heart, blood vessels, glands; it works independently and is not subject to human will; sympathetic and parasympathetic parts are distinguished for this nervous system.
The sympathetic part prepares the organism for intensive action, “fight, flight”, consumes energy resources. Under its influence :
  • the heart beats faster,
  • breathing speeds up ,
  • dilated pupils
  • the blood glucose level increases.
The parasympathetic part works opposite to the sympathetic part. Turning to the renewal of energy resources. They affect:
  • heartbeat slows down, weakens,
  • the pupils of the eyes narrow;
  • the bronchi narrow;
  • the production of digestive juices increases.
For the organism to function fully, the functioning of these systems and their parts must be in balance. Looking at the symptoms of a panic attack, we see that the activity of the sympathetic nervous system dominates in this condition.

So how exactly are panic attacks different from autonomic dystonia?

In panic attacks, anxiety is the leading symptom. It is not related to any special surrounding situation, and often patients also note that this feeling is sudden, without an understandable reason, “just a feeling that something bad is coming”. In the case of a panic attack, the reaction, as the name suggests, is paroxysmal – it develops in a relatively short period of time and is transient.
In the case of autonomic dystonia, or somatoform autonomic dysfunction, complaints are related to an organ or organ system. In addition, there are two types of symptoms, but neither of them indicates physical damage to an organ or organ system. As with a panic attack, there is an excitation of the autonomic nervous system – palpitations, sweating, tremors, fear, blushing, concerns about possible physical health disorders. It is accompanied by complaints about various, often changing, sensations – sharp and sudden pain, pulling, swelling or a feeling of pressure, which a person associates with a possible damage to some organ or organ system. It is characteristic that these patients have already been thoroughly investigated and refuse to accept the idea that these disorders have rather psychological causes, which are essentially the same as panic disorders (and all neurotic disorders in general). The stigma of psychiatry plays a certain role here – in a part of the society, it is better to “be physically ill than mentally ill”. As a result, internal anxiety can also lead to panic attacks in these disorders.
A lot can be written about the causes of panic attacks, but one definite reason is not clear. It is known that people whose parents have a mental illness have a higher risk of experiencing panic attacks in their lifetime and also a higher risk of having other mental illnesses.
There are several theories about the reasons for the disorders mentioned in this article, which are related to various biologically active substances and their malfunctions in the body (norepinephrine, dopamine, GABA, etc.), as well as excessive activity of receptors in the nervous system, genetic characteristics, external factors affecting the nervous system activity (strong emotional upheavals, regular stress, lack of sleep, problems in relationships with loved ones, their death).
From a psychological point of view, anxious personalities and those who tend to view anxiety as harmful are more at risk of experiencing panic attacks.

How to recognize a panic attack?!

The following symptoms are characteristic of a panic attack:
  • is unexpected and develops rapidly;
  • can last from a few minutes to several hours;
  • persuasion, comforting does not help during it;
  • shortness of breath or, on the contrary, deep, increased and/or accelerated breathing;
  • increased heart rate and/or palpitations;
  • chest discomfort or pain;
  • tremors, chills;
  • feeling of suffocation;
  • feeling as if watching yourself and what is happening from the outside; feeling of unreality;
  • stomach pain, indigestion, nausea;
  • sweating;
  • dizziness, unsteadiness, feeling faint;
  • numbness, tingling in a part of the body;
  • hot or cold flashes;
  • fear of losing control over oneself, “going crazy”, dying.

How to help yourself?

If it is clear that there is no other reason for the attack (physical/somatic illness), then you should seek help from a psychiatrist or psychotherapist. However, to begin with, we will give you some advice on how to try to help yourself:
  • understand your symptoms; read what a panic attack is, what the feelings are during them, which of them you have, and that it does not necessarily mean “going crazy”; understanding what happens during a panic attack makes it easier to control it; the good news – you’ve already started reading!
  • avoid alcohol, caffeinated drinks, smoking; there is a known connection between these substances and the occurrence of panic attacks in people who are already prone to them; it would also be desirable to avoid other stimulants, such as slimming agents, teas, certain medications intended for the treatment of colds that do not have a sleeping effect;
  • breathing exercises; learn to control your breathing, breathe more slowly, more deeply; often directly intensified, rapid breathing causes unpleasant sensations such as dizziness, pressure in the chest;
  • you regularly contact close people face to face, whether it is a loved one or a good friend, if there is someone with whom you have a trusting relationship, it is easier to survive panic attacks;
  • regular physical activity is a natural anxiety reliever; especially recommended are rhythmic aerobic activities involving both hands and feet, such as walking, swimming, running;
  • sufficient, healthy sleep; it is precisely several nights of poor sleep that often lead to the onset of panic attacks; it is important to provide yourself with a restful sleep of 7 to 9 hours at night.

Panacea for panic attacks.

Regarding panic attacks and somatoform disorders, it could really be said that awareness, understanding and acceptance are half way to recovery.
Treatment should be evaluated individually for each patient. There are cases when symptoms can be controlled without medication. In this case, cognitive behavioral therapy (hereinafter CBT) is effective.
This type of therapy focuses on making the patient understand how their thinking, beliefs and behavior patterns can lead to heightened, unbearable feelings and how this leads to further consequences in the form of panic attacks. By changing mindsets and exposing individuals to anxiety-provoking factors, CBT can help bring control over panic symptoms.

CBT can help:

  • • understand a person’s changed perception of other people’s behavior, feelings or life events;
  • • try to reduce the patient’s feeling of helplessness during an attack by recognizing and correcting panic-causing thoughts and feelings;
  • • learn stress management and relaxation techniques to help yourself;
  • • to understand what is the basis of the disorder;
  • • overcome fear.
Antidepressants with an anxiety-reducing effect are used in the treatment of panic and somatoform disorders. These are selective serotonin reuptake inhibitors (SSRIs). In more complex cases, antidepressants or sleep aids from other groups can be added to these medications to improve sleep quality if it has worsened due to anxiety.
Tranquilizers from the benzodiazepine group are relatively common for reducing anxiety. However, it should be remembered here that these medications should not be used as the only means of treating these disorders. They are not intended for long-term therapy, because they reduce the symptoms and do not cure, there is a risk of addiction, and thus the completely opposite effect is achieved – increased anxiety when stopping the use of the medication.
If the patient is willing to try to cope without medication and has no other accompanying psychiatric disorders, only CBT is worth using. Today’s fast rhythm of life means that patients want the fastest possible result. In this case, CBT can be combined with pharmacotherapy. Such an approach is useful if the patient already has other mental disorders and fails to achieve the goal with only psychotherapeutic methods. In some cases, the doctor may decide to add drugs of other groups, taking into account the leading complaints. The main goal is to improve the patient’s quality of life.

Let's live without panic! 😉