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The first one came out of nowhere. At least that's what you told yourself, and A&E, and your GP.
Your heart was hammering so fast you were certain it was a heart attack. You couldn't breathe properly. Your hands went numb. The room tilted. You thought, very clearly, "I'm dying."
You weren't dying. The ECG was normal. The blood tests were normal. Everything was normal, which should have been reassuring but wasn't, because something clearly just happened and nobody could tell you what.
"Panic attack," they said, as if naming it explained it. Here are some breathing exercises. Try to avoid caffeine. Come back if it happens again.
It happened again.
The most frustrating thing about panic attacks is the apparent randomness. Standing in the queue at Tesco. Sitting on the sofa watching television. Halfway through a meeting about nothing important. There's no tiger. No emergency. No obvious threat. Your body just decides, for no discernible reason, that you're in mortal danger.
Except it isn't random. It never is, even when it looks that way.
Your body keeps records you don't have access to. It can register threats your conscious mind has dismissed, suppressed, or never noticed in the first place. And when enough of those unprocessed signals accumulate, your nervous system can sound the alarm.
The panic attack may be less the whole problem than a signal. Something may be trying to get your attention, and this is the only language it has left.
If you tracked every panic attack - not just when it happened, but what was happening around it, what you were thinking about, what you were avoiding thinking about - patterns might start to emerge.
The attacks that come before difficult conversations. The ones that follow moments of closeness with someone you care about. The ones that arrive on Sunday evenings, or the morning of a family gathering, or in the quiet moments when you've run out of distractions.
Someone might have panic attacks exclusively in the car. Not while driving - while being a passenger. On the surface it looks like a fear of cars. Underneath, it might be about being trapped - about being small and unable to leave a situation that felt dangerous, and the body remembering that helplessness every time control is handed to someone else.
Someone else's attacks might cluster around intimacy. Not sex specifically - any moment of genuine vulnerability. Letting someone see them. Admitting they needed something. The panic arrives precisely at the point where closeness threatens to become real.
The body remembers what the mind has moved on from. And it speaks in the only language available to it - sensation, urgency, alarm.
What your body is saying
Panic attacks often cluster around a few themes, and the themes are not always about the surface situation.
There's the panic that says "I'm trapped." Not literally - though it often attaches to enclosed spaces, crowded rooms, situations where leaving would be noticed. This is panic about the impossibility of escape: a job you can't leave, a relationship you can't exit, a life that feels like it's closing in.
There's the panic that says "something is about to be taken from me." This shows up around transitions, around good things, around moments where you've let your guard down. If your early experience taught you that safety is temporary - that good things get snatched away - your system might panic precisely when things are going well. Not because anything is wrong, but because the absence of danger feels dangerous.
There's the panic that says "I can't hold this any longer." The feeling that's been pushed down, swallowed, rationalised away. The anger, the grief, the need, the fear. It's been managed and managed and managed, and now your body is telling you it's full. Something has to come out.
Breathing techniques help in the moment. They bring your nervous system back from the edge. They're worth having in your toolkit.
But they're sticking plasters. They manage the alarm without asking why it's going off.
The same is true of reassurance. Telling yourself "this isn't dangerous, it's just anxiety" is correct and sometimes useful. But it doesn't explore the possibility that your body is responding to something. Dismissing the signal doesn't address what may be underneath it.
And the source is often partly emotional. Something you're feeling that you don't want to feel, or can't feel, or don't know you're feeling. The panic attack may be the feeling arriving by another route - bypassing your mind entirely and speaking through your body.
In psychodynamic therapy, the aim is not simply to stop the panic attacks. We get curious about them.
What's happening in your life when they intensify? What do you notice in your body just before one arrives - not the full-blown panic, but the subtle early signals? What were you thinking about, or trying not to think about?
Sometimes the connection is obvious once you look. Sometimes it takes weeks of noticing before a pattern reveals itself. Panic attacks may not be truly random; they can be your nervous system's attempt to communicate something your conscious mind has struggled to hear.
When the underlying feeling gets heard - when the anger is expressed, the grief is felt, the need is acknowledged - the panic attacks can sometimes reduce. Not only because you've learned to manage them better, but because the signal may no longer be as necessary. The message got through.
Your body may not be broken. It may be trying to tell you something. The question is whether you're willing to listen.
