Anxiety attacks are extremely stressful for those affected. But what exactly happens when the body panics? In any case, not every attack indicates an illness.
The heart is racing, the hands are shaking, breathing is becoming increasingly difficult: if a feeling of fear takes over, the human body can react with a panic attack. Such an attack comes with force – and sometimes makes those affected think that they are dying. In Germany alone, an average of around 30 percent of people have experienced a panic attack in their lifetime, explains the head of the anxiety clinic at the Berlin Charité, Andreas Ströhle.
On the occasion of World Mental Health Day on Thursday (October 10th), a look at the figures from German health insurance companies reveals: diagnosed anxiety states and corresponding illnesses are increasing. According to DAK-Gesundheit, days of absence due to mental illnesses such as depression or anxiety disorders rose sharply in the first half of 2024. At the IKK health insurance company, the proportion of insured people affected by an anxiety disorder has increased by more than 37 percent within ten years, as the insurance company announced last year.
Charité physician Ströhle describes panic attacks as the body’s own alarm system. “You can imagine it a bit like an alarm that is triggered by an alarm system. It goes from 0 to 100 very quickly and then slowly decreases again,” explains the psychiatrist. But not every anxiety attack is the same – and there is not always a mental illness behind it.
What happens in the body and brain
During a panic attack, certain regions of the brain are activated, explains Ströhle. “The brain stem and the physiological centers in the brain that regulate circulation and breathing are responsible for these physical reactions.” These phylogenetically ancient centers are partly responsible for reactions such as accelerated pulse, shortness of breath or sweating.
If these processes are set in motion, a massive alarm reaction occurs in the body. According to Ströhle, this leads to “the body adjusting to a major threat, reactions such as fight or flight being easier and the muscles being better supplied with blood.” This allows the body to react as well as possible to a potential threat.
If the attack takes its course, the symptoms are varied, explains the expert. “Shortness of breath, hyperventilation or rapid breathing are classic symptoms of a panic attack, but do not necessarily have to occur.” Those affected sometimes also suffer from sweating, restlessness or an increased urge to urinate. Those affected also report the fear of losing control, going crazy or even dying.
Panic attack is not the same as panic disorder
But why do panic attacks like this happen? Ströhle cites, among other things, mental and physical illnesses, life events and drugs such as alcohol or tranquilizers as reasons. Certain risk factors also make it more likely to occur. Increased coffee consumption, lack of sleep, stress or certain medications can have a beneficial effect.
There are also situationally triggered seizures. If you have a phobia of snakes and are confronted with the animal, you can have a panic attack. “In terms of symptoms, they can be similar to panic disorder, but they are triggered by certain situations or sometimes the idea of them.”
It is important to differentiate between a panic attack and a panic disorder. The attack can also occur in healthy people, for example in a life-threatening situation or a strong threat. “When I, as a healthy person, am confronted with a snake, I know: Okay, it was completely normal that I reacted like that,” says Ströhle.
Overly sensitive alarm system
However, panic disorder is a serious illness in which, according to Ströhle, unexpected panic attacks occur repeatedly. “This means that those affected begin to avoid certain situations and activities, withdraw or develop more fear.” According to Ströhle, what then emerges can be described as an “overly sensitive alarm system.”
However, it is unclear how often such a panic disorder occurs. The German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) explains that the most recent representative data collected on the frequency of this diagnosis in Germany dates back several years. A study from 2014 showed that around two percent of the population were affected by the disease at the time.
Ströhle reports from his experience in the Charité anxiety clinic that this disease can be easily treated. Psychotherapy, especially behavioral therapy, and either additionally or instead of antidepressants would be used. The chances of success of such a therapy are very high.
IKK on anxiety disorders Anxiety clinic at the Berlin Charité Study on the frequency of panic disorders DGPPN Basic data Mental illnesses