Anatomy of an Anxiety Attack

In the past, I have used the phrase anxiety episode rather than anxiety or panic attack, but I’ve come to the conclusion that although I like to be picky about some words for the sake of clarity, others, like this one, just suit the thing. It is an attack, whether it’s small and manageable or huge and debilitating. Whether you continue to buy your milk in the crowded corner store during, or sit rocking in the corner of your home with a blanket over your head, sobbing, trying to catch your breath but failing, clutching your chest like Fred Sanford, it’s a freaking attack.

So that’s what I’m going to call it.

Some very specific things happen during one of these, regardless of the severity. Like a fear of flying, though, if you have some deeper understanding of what’s going on at any individual point, you can gain some semblance of greater control. I’m going to try to pick one of these apart as best I can, in my own inimitable way, with an example from my own life, and with only enough sciency words to satisfy my appreciation of them, yet not confound those who don’t.

That’s the thought, anyway.

The Trigger Event

My cable modem has been randomly dropping connection for a couple of weeks. It will sometimes pick right back up again, or make the attempt for up to forty-five minutes before being able to, and as often drop again shortly afterwards. The other day, because telephones scare me, I contacted my cable company’s customer service through its Twitter account. Lynne, the person handling the desk that day, was very helpful and understanding. After contacting her tech guy, she told me that yes, there seemed to be an issue with my line, but there was no way to tell if it was the modem itself or the actual cable without one of those Gandalf types coming out to the house. Could she schedule one for tomorrow?

Though much better than I was as little as a year ago, I am still agoraphobic, and nobody but me has been further inside my apartment than the little foyer for almost five years. At even the suggestion, presented harmlessly in a Twitter DM chat, things began happening inside the ol’ noggin closet.

First, though, some sciency stuff.

The Amygdala

amygdalaI used to call mine Amy until an Amy on my friends list teasingly took issue with that, so now she’s Amber. She handles emotional responses in general, but fear and aggression more specifically. The predominant hypothesis about panic attacks, and the one I subscribe to, is that they begin here. Several studies that stimulated this lovely little almond-shaped pair of nodules in the brains of animals produced similar effects.

On a side note, is it still anthropomorphising to anthropomorphise a part of the human body? Moving on…

The Hypothalamus

hypothalamus_pituitaryHarold is the master and commander of the stress response, and also holds the keys to the dispensary, stimulating the release of hormones like adrenaline, cortisol, and testosterone among others, that help activate and regulate other emergency responses deeper in the body. He’s probably the only part of the entire team that’s aware of the crisis at hand, but even then we’re not entirely sure. He just does his job, and generally does it pretty well.

The Periaqueductal Gray

periaquductalLove that name. Sounds like something Frank Herbert might’ve come up with, doesn’t it? This is a section of the midbrain believed to be responsible for basic defence mechanisms in the body, things like running or freezing (think deer in headlights), as well as pain reduction. In an article for Scientific American, Dr Paul Li of UC Berkley mentioned another study showing, through functional MRI, that this bit sparkled like a unicorn fart when someone was presented with an imminent threat. Let’s call him Petie.

Petie also mitigates the pain response by regulating the release of natural analgesics and activating neurons that work to block those that react to pain. He’s quite a busy little clump of matter and handles other things, but for our purposes we’ll stick to those.

Sympathetic/Parasympathetic Nervous System

auonomicThese two parts together are referred to as the autonomic nervous system, and are comprised primarily of little clumps of cells that I call cute wee brains but those with more book learning would call ganglion. It also includes all the other nerves in your body as well as the spinal cord itself, and handles all the little niggly stuff of daily life that the Big Boss upstairs can’t be bothered with. Stuff like normal breathing and end-game peristalsis (pooping).

The former’s primary purpose, on its own or with orders from above, is to manage the bits and pieces of our fight or flight response. There’s a distinction here, because on its own it can pull your hand away from a hot stove before the brain even knows you’re in the kitchen, but in most panic attacks its activated by Petie and Harold.

The latter, the parasympathetic nervous system, is our own little internal zen master. When he has trouble calming his crazy brother regardless of how many incense sticks he burns, then Houston we have a problem.

The Threat

So Lynne asked me if she could schedule a tech guy to traipse through my safe space, move my furniture, look askance and judging at the dust and general state of my digs, at me, at my life as a whole, and not just in a side room but in the very heart of the bubble I have protected so fiercely for so many years and oh my gawd oh my gawd oh my gawd. It was certainly not a real threat, that’s just silly, but one my injured insides perceived as imminent anyway, and that was enough to begin the process that I, and so many like me, have trouble controlling.

The Response

Amber opens up the door to the closet she’s normally relegated to and begins making evil little cackles in the shadows. Harold looks up from his desk where he’s been writing Twilight fan fiction, sees her bile yellow eyes glowing in the dark, and smashes the big red button because, you know, she frightens the crap out of him.

Petie has no idea what’s going on, why she’s woken up or the why the alarms are sounding, but like an ambulance dispatcher who sends out a crew (normally during lunch) with only an address and priority level, he just knows he needs to start the wheels turning.

Hormones are released, signals are sent to the substations down the line. A few of the cute wee brains wake up. Being wee, they, too, have no idea what’s going on so they simply start flipping through their protocols.

With the activation of the emergency response system, the entire body begins to mobilise:

  • Heart rate increases, peripheral blood vessels dilate (more blood to the muscles and vital organs)
  • Lungs dilate and respiratory rate increases (more oxygen to the blood)
  • Liver releases a store of glucose and fats (extra energy to supplement the extra oxygen)
  • GI tract stops whatever it’s doing and shuts down (have you ever craved a taquito while fighting for your life?)
  • The big muscles shift from a general state of relaxation to ready tension (flipping the safety)
  • Testicles are pulled up closer to the body, menstruation stops (no sidebar required)

Physical Manifestations & The Dumbasses up at HQ

At the thought of this stranger bursting my safe little bubble, my eyes widened (the better to see you with, my dear) and began darting around. I pulled my arms in closer to my body (protecting the core), and my fingers began a dance I’ve seen in others; they alternately wiggle and clench into a fist before the hand itself would shake is if cramped. I also have some internal scarring in my right medial trapezius from once having my head wrenched too fast and too far with a laryngoscope, and that bit always stiffens up painfully, too.

Most first responders, I think, or military vets and really anyone who’s ever worked as a small cog in a bigger wheel, will know that headquarters is pretty slow on the uptake (define that as you will). Eventually, the bigger part of my thinking brain catches on, though. Normally at this stage, that would be enough to recognise there’s really no imminent threat and the parasympathetic nervous system would light the aromatherapy candles. Everybody would calm the fuck down, go back to their stations (and their cold lunch), and we’d all have a good giggle at how silly we were. In the injured brain, however, Amber has locked our zen master in the closet.

The response continues unmitigated, and I am having an anxiety attack.

After Action Report

I paced a little bit to help focus. I took back active control of my breathing and the larger muscle groups because those are things we can consciously do. I worked the initial problem with some focused thought, and arranged to swap out the modem at a retail cable outlet nearby, settling on the need to have a technician come out if that didn’t resolve my issue. I got some great advice on that from friends who understand, because friends can be a wonderful asset to help ground you. Eventually, I was able to take a small nap, and when I woke up a couple of hours later I was feeling fine.

For many, the response itself will become a threat that only allows the amygdala to scream with more rage and more fury. Anxiety can feed on itself, and if you don’t understand, you might think you’re dying; Unable to breathe properly, chest pains, fear layering on fear, nausea, head pounding. The body is in control, while the thinking brain is along for the ride and it’s a scary freaking ride, Bubba. While it’s not within the scope of this essay to describe any in detail, I have, over much time and with much effort, gathered tools and tricks I use that essentially allow me to be all sneaky ninja and pick that closet lock while Amber’s not looking. The first step, though, and perhaps the most important one, is to recognise and acknowledge what’s going on and that she may take a bit of time to pacify.

It’s my hope that this helps someone in just that way. Right now, though, I need to go get a new modem, and going into a busy mall is a whole other adventure all unto itself.

You are never alone.

What happens in the brain when we experience a panic attack? Scientific American

How The Brain’s Fear And Threat Centers Backfire Medical Daily

Interactions Between the Lateral Hypothalamus and the Periaqueductal Gray  (pdf) Journal of Neuroscience

2 thoughts on “Anatomy of an Anxiety Attack

  1. Pingback: Common Misconceptions About PTSD Part II | Patrick Riley

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