Anatomy of a panic attack

There is a subtle but important difference between the triggers and underlying causes of anxiety, and sometimes it can be hard to recognize this difference without help. Triggers are usually small, specific instances that put you on alert. Underlying causes are more about why you’re feeling the anxiety – what you’re actually thinking about. Clues to these can often be found in the ruminating or racing thoughts that you have when feeling heightened anxiety or panic.

For most of us with anxiety or panic disorders, our underlying cause(s) have something to do with control. For instance, I tend to experience anxiety when I feel my behavior can influence the outcome of a situation. I had a panic attack when meeting the dude’s parents because I believed that if I wasn’t (or didn’t appear to be) good for him they would tell him they didn’t approve and that it would lead to the end of our relationship. This was a particularly big deal to me because I’d started to realize that I was in it for the long haul, and I’d never really felt that before. I can’t even explain how important it was to me that the dude and his family felt like I belonged with them. And, to be clear, never, EVER did the dude or his family put any kind of expectations on me. They were nothing but kind, empathetic, and a joy to be around.

I realize now that there are multiple levels on which these thoughts were not accurate. But that’s what happens with anxiety: something triggers it, and then your brain ruminates or races and you end up spiraling into this place where your thoughts feel real and inevitable and like the worst case scenario is automatically the most likely scenario. It takes a lot of work to get to the point where you can recognize that your anxiety is running away with your thoughts, and even more work to learn how to reframe those thoughts. But it is possible, and it is worth it. When you’ve put in the work, you get to the point where you feel a little anxious, a thought like that pops up, and instead of seizing it and spiraling it your attitude is just kind of oh, you and then you move on. To get to this point, I highly recommend three things:

These three things helped me immensely, and even using just one of them is a great start.

For a long time, looking back on the experience of each of my panic attacks just brought up those feelings, which is natural. It took a lot of work to distance myself from the experience of anxiety, and to really learn that it is not part of my personality, it’s part of my body. It’s biological. This depersonalizing is essential. The difference between my anxiety and the anxiety I feel is so incredibly important. If you do nothing else, please start to talk about the anxiety you feel in this way.

Now that I have this perspective, I want to take the time to really break down that first panic attack and talk about triggers versus underlying causes. This process – thinking through the timeline and anatomy of a panic attack – is one that has been really helpful in identifying triggers and underlying causes. It’s also helpful to do in the middle of an attack, because you’re not distracting yourself (and making the problem worse next time), you’re giving yourself a focus and stepping outside of the experience of anxiety while still addressing it and dealing with the feelings and symptoms.

A panic attack functions like this:


I’m sure you’ll be able to see in my description below how my thoughts followed the panic loop to a T, but I’ll try to also be really clear about which step I was experiencing at each time.


I woke up early, feeling what I considered a “normal” level of anxiety with regards to traveling. I’d been feeling this for a couple of years, so nothing seemed unusual or more heightened. I felt nauseous but also like I needed to go to the bathroom, so I spent the morning alternately sitting on the couch shaking my leg and leaning over the sink or toilet. Again, this felt “normal”. I didn’t recognize this initial feeling of anxiety as a trigger(step 1) because it had never escalated to a panic attack before. I was assuming that once we got to the airport, I would be fine for the rest of the trip. Now, though, I see the waking up early as a trigger and I know that this would be my cue to start belly breathing or meditating.

Once we got to the airport, things felt better. Going through security was familiar, as was the flight. They both occupied my mind and I could sort of forget about the anxiety I was feeling. I was sure that it was done and that this was going to be an awesome trip. The next thing I knew, the flight attendant had announced that we’d started our final descent, and I was crying quietly in my seat with my headphones in. Again, I didn’t recognize this as a trigger(step 1), because I didn’t know then that anticipation is a huge factor for me, and I didn’t know about control of my own behavior being one of my underlying causes. I hadn’t really thought through why meeting the parents was such a bigger deal this time, and I didn’t understand how high my expectations of myself were. I let myself cry, thinking that was it, and hoping the dude’s parents didn’t notice. Everything was fine for the rest of the day, because I had enough to keep me distracted.

The next morning, I was up at 4 something hurrying as quickly and as quietly as I could to the bathroom. The trigger here was actually something that we all have – the left side of my brain was alert because I was sleeping in a new place – but I didn’t know that(step 1). I wasn’t expecting it. My racing thoughts were as follows: what’s going on? Why do I still feel like throwing up? What if his parents can hear me crying? What if this doesn’t stop and I can’t go out and do anything today? Are they going to think I’m doing this on purpose? Are they going to think I’m like this all the time? Oh my god, what if they think I’m like this all the time – they won’t want him to be with me! What will I do if he thinks they’re right? What if I can’t get it together and he doesn’t want to deal with that and this is the end of our relationship?(step 2)

All of those thoughts happened in about 30 seconds. Unbelievable, right? But this is what your underlying causes do. They hijack you. They make you panic and worry and think that EVERYTHING is controllable and your responsibility when it is not. They force you to assume that the worst thing you can think of is the thing that is absolutely without a doubt going to happen. Mine – the need to be in control of my own behavior and fear of losing someone important to me – were out in full force. Anxiety tricked me into believing that my actions, and more specifically my ability to hide how I was feeling, were all that were keeping me from doom. Add to that the intense physical symptoms like nausea, crying, or shortness of breath, and you are literally in the second circle of hell, in the middle of a storm with no hope of rest. This is a panic attack. It sucks.

Eventually this subsided, as panic attacks always do. I was able to stop crying, shower, and the dude and I went out shopping at the outlet malls. By the end of the day, I felt more calm if not entirely myself, but I was left wondering if this would happen again and definitely scared of the possibility(steps 3 and 4).

The cycle of events happened every morning I was there. It was hard to break because I was surrounded by triggers: unfamiliar places, unfamiliar people, not knowing what was expected of me. Add to this the expectations I placed on myself because of my underlying causes of anxiety, and I consider it a miracle that I even made it out of the bedroom, let alone made some jokes at dinner. I was trapped in this cycle for the entire trip, and then for a few days after I got home.

Once you’re in it, the panic loop is incredibly hard to break, because it’s self-perpetuating. Most of a panic attack is not about whatever the initial thing that triggered your anxiety is. It’s about your fear of losing control in a public place or your fear that you’re going crazy. And then you start to fear having another panic attack, and you end up keeping yourself anxious all the time and actually giving yourself panic attacks.

The important thing to understand here, though, is that people don’t do this on purpose. People don’t say “you know what, let me have a panic attack right now.” (And if there are people who fake a panic attack as an excuse to get out of something, FUCK THOSE PEOPLE. THOSE PEOPLE SUCK.) It’s important to understand that panic is a physical, biological response, so when I say “give yourself panic attacks” what I mean is that you haven’t yet learned the tools to break the panic loop and so it continues. I don’t mean that you’re intentionally doing this to yourself or that you are consciously escalating your anxiety; I just mean that your body feels something weird, your instincts respond a certain way, and usually that leads to more panic. (I’ll talk more about tools you can use in the middle of an attack soon.)

I had about 4-5 months of what the fuck is happening to me?! before I was ready to dive in and really start looking at my triggers and my underlying causes. Then it took about a year of work to learn when I could expect to feel anxiety and how to work with it when I did. It was really hard, but I have never done anything so worth it in my life.

If you’re still in your WTF phase, it gets better. I promise. It’s horrible AF now, but you can do this. You are not alone.

14 thoughts on “Anatomy of a panic attack

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  2. So Interesting reading this right now, because my son who is 24 is going through this right now…just started a week ago. But however, I think he may not have been aware that he using the restroom many times a night might have been a sign of what was going to happen. Aaron has been having severe panic attacks for a week 1/2 now, what triggered it was a walk to the store listening to his metal music and feeling like he wasn’t himself. A couple of night later he fell asleep and had a bad dream that someone broke into his room with a gun, he went to our (his parents) and the man with the gun was in there too. He woke me up scared to death, panicking with fear, heart racing and then eventually vomiting, Which then lead to him thinking of that scary movie Emily Rose, where she became possessed by a demon, which now he thought was happening to him, because he couldn’t stop feeling nausea. He told me that thoughts were rushing through his head like flashing lights traveling so fast that he didn’t know what to think, but theses thoughts were sending him negative thoughts that told him in his own voice to hurt someone. But he knows that in his heart he would never do this. So we spent time at a behavioral center, then the hospital twice this weekend, which lead him to make the decision to put himself in a Recovery Institute over night, until the next day. They examined him and found out that he was support form his family, wasn’t in danger of hurting himself or others. However, we are seeking help through a counselor and to ease his mind our church priest to rest assure that he’s not possessed by a demon. Our son is now on medication and it seems to be working for him, but like our daughter who also suffers with anxiety (yes we been through this before) about 10 years ago. I like that the medication works for him, he’s on three different kind right now, but one of them is temporary for severe anxiety attacks and to help him sleep. I hope to teach him how to recognize the syptoms of the panic attacks and to redirect his train of thought to something positive,praying and giving his worries to God..and that he has a heart and would never hurt anyone. You see Aaron has carried a lot of heart ache loosing a friend at the age of 15 due to huffing gasoline and just dealing with kids who made in fun of him, or walking to the store and having bottles thrown at him, (just out of cruelty) plus just choosing the wrong kind of friends who may have been a bad influence on him. I guess we call this LIfe. I think this experience of life have lead to a heavy heart of not be able to trust people and loose someone to death.


    • Thank you so much for sharing, Mary. I’m so glad that your son is getting help. It’s important to get comfortable with the feelings of panic and make room for them, so I encourage you both to do so. Please feel free to reach out if you have any questions. I’d love an update, as well.


  3. Medication is kicking in more and more each day for my son. But of course its baby steps here. He has been having less of the panic attacks thus far, going into the second week since the attacks started. My concern is becoming addicted to the medication.


  4. Thank you for sharing. This is a very lucid explanation of what goes through the mind and body of anxiety sufferer as I am. I know now that it helps to go back to my first panic attack amd the subsequent events where my anxiety took hold of my life. Back then, I did not have a name for it. But when I saw a doctor after three nights of not being able to lie down and being terrified of slightest noises, that was when I was told I might be having a ptsd or anxiety disorder. I have given up medication and tried to rein in the symptoms. But it does come back every once in a while. As for triggers, I realize that noisy places and too much visual stimulation are the culprits. But you are right, sometimes it is the smallest things that instigate it. Thank you for saying that it does get better. But for now, it is like living and dying several times in a bad day. On good days, it is imperatuve to smile and enjoy. I only wish a day would come when I just could face that little death head on and not have a damn care.


    • I know what you mean; even though a panic attack itself is short, it feels like forever because you spend literally every second of it feeling like you’re about to die. I have the same triggers, and knowing that has made it easier to make sure I have more good days and less bad days. To be honest, one of the things that’s been the most helpful for me has been just kind of expecting it every day. It’s helps me to accept anxiety’s place in my life, and to not feel so caught off guard when it happens. It has taken two years of steady effort to get there, though. You are doing some incredibly hard work, and I’m so proud of you for that.


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  8. “But that’s what happens with anxiety: something triggers it, and then your brain ruminates or races and you end up spiraling into this place where your thoughts feel real and inevitable and like the worst case scenario is automatically the most likely scenario.”

    This is the best description I have ever read of what goes on in my head. Thank you.

    Liked by 1 person

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