Most people with panic disorder aren't ever quite sure why they had their first panic attack.
There is a reason for this.
(A panic or anxiety attack is severe anxiety.
Panic disorder is the fear of having attacks, fear of the effect of the attack and a significant life change as a result of an attack or attacks.
I am using very specific terms, an attack and a disorder are not the same thing.
) Because a panic attack is such a terrifying and intense experience people naturally think there ought to be an equally powerful cause or reason; something that would be severe enough to evoke such a reaction.
But attacks often seem to drop right out of the blue, completely unexpected.
That's why it's hard to put your finger on a specific cause.
If there was a clear cause then the attack probably wouldn't become panic disorder.
An attack might be an occasional thing when it is connected to things you are worrying about.
It can become a panic disorder because it doesn't seem to make sense and feels unpredictable.
To develop panic disorder you have to start fearing having a panic attack.
When people write online about panic attacks they are usually talking about panic disorder.
Sometimes the hidden cause of an anxiety attack is purely physiological.
For example, a heart arrhythmia can cause a general fight-or-flight response.
Different things can signal your body to go into the prepare-for-danger mode.
Sometimes it might be reaction to a medication.
It can be an allergic reaction to something, it could be a virus.
Sometimes there is a trauma in the past and there is some similarity with your present circumstances not obvious in the moment.
The brain remembers trauma in a general or impressionistic way.
It doesn't have to be exact, just close.
If you're terrified of snakes then a stick in the weeds might be close enough.
But most of the time, it is the result of a "perfect storm" of stress.
No single element is fully responsible or strong enough; rather it is the accumulation of many things.
It is set off by the proverbial "straw that breaks the camel's back".
What causes the first attack is very important but it is what you do next that actually determines whether this is a single episode or a disorder.
Any and all kinds of anxiety involve the fight-or-flight response.
Every single symptom of a panic attack is the result of the fight-or-flight response.
In other words, these strange symptoms are actually normal physiological reactions from your nervous system to prepare you for danger.
It is how they are interpreted that makes them seem so different.
If you're zooming down the interstate and have to slam on your brakes the fight-or-flight response makes perfect sense.
But, if you're sitting in your car at a stoplight and you are not aware of anything dangerous then the fight-or-flight response seems threatening, overwhelming and bizarre.
In the first situation, the fear is directed toward avoiding hitting cars in front of you.
Your body's reaction makes total sense.
In the second situation, your fear is directed toward how you are feeling (terrible!) and that it makes no sense.
Since there is no apparent external danger you may think you are either sick or mentally unstable (you are not).
Something subtle happens right then.
You become afraid of your body.
The fear from this point forward, only requires your fear about yourself.
You, up there in your head, is not in control of the you below in your body (actually not the case but seems this way).
This emotional ambush is the heart of what goes wrong.
The fight-or-flight response, technically, is not something that you choose; it's your body's automatic response to danger.
Although it happens in a split second, the neurological sequence is 1) react and then 2) think.
Nevertheless, the danger response normally fits the situation so that it feels under your control and expected.
In other words, it seems congruent with the circumstances and even if you didn't have time to choose it you would have (unless it is a result of an obnoxious friend who jumps out from behind a door to scare you, in which case you think about going into the "fight" part of the response:-)).
The beginning point for a panic disorder, on the other hand, seems extremely incongruent with the circumstances, unexpected and therefore, out of your control.
It is this feeling of being out of control that provides the fuel for an ongoing problem.
Once you begin to believe that your panic has control of you rather than you having control of it, then you are under its grip.
The necessary treatment for panic disorder, whether medical or psychological, is to restore your sense of control over your own body.
I will describe those treatments in a companion article.