Can You Get Traumatized From Panic Attacks And Intense Anxiety?
When people think of trauma they usually picture some scary, intense outside event, like a bad car accident or being mugged. Anxiety is seen as an effect of being traumatized, not traumatic itself. However, some people have had horrible panic attacks or episodes of severe prolonged anxiety, and the thought of it happening again haunts them. They might rearrange their lives to avoid situations where they may panic, or spend a lot of time fretting about whether they'll become extremely anxious again. They may ask themselves, "Could I have trauma just from all my panic attacks?" or "Have my periods of acute anxiety given me PTSD all by themselves?"
I wrote this article to validate the people asking these questions. Yes, I think panic and severe anxiety can be traumatizing. Certainly they can in the looser sense of the term traumatic. That is, an experience that's really upsetting and overwhelming, gets seared into your brain, and you become afraid of it happening again. You may steer clear of settings that feel risky. Anything that reminds you of it may bring those awful feelings up again. You're generally alert and on edge. You can have an exaggerated sense of how dangerous your fear is, and how unable you are to cope with it.
Whether intense anxiety and its impact would qualify someone for a textbook diagnosis of Post-traumatic Stress Disorder is another story. I think in some cases it could. However, for this article I'm more interested in a general sense of feeling traumatized, even if it doesn't tick off every item on an official symptom checklist.
Panic attacks have many potentially traumatizing features. That's especially true the first time you have one and don't realize your body is only going through an over-the-top anxiety response. You may later learn what you went through was uncomfortable but harmless, but you didn't know it at the time.
- Feeling like you're going to die of a heart attack
- Fearing you may die because you're panicking in a situation that seems dangerous, like being behind the wheel
- Even if you don't think you're going to die, just feeling really, really physically miserable
- Intense feelings of fear and dread
- Feeling like you're going to go crazy and never come out of it
- Possibly having something happen during the panic attack that feels extremely humiliating and damaging to your reputation, like suddenly running to a trashcan to throw up during a presentation at work
Then there are long episodes of high anxiety. I mean something like you're going through a really stressful patch at work, and one day it hits you all at once, and you spend the next week feeling really scared and on edge. You can barely eat or sleep. You're constantly worried and can't concentrate on anything else. You have so much nervous energy you keep pacing around. You may or may not have full-on panic attacks during that time, but even if you don't one never feels far off. It's also easy to make a case for how that could be traumatic:
- You may think you're having a total nervous breakdown and will never be the same again.
- You may worry about the horrible effect not eating or sleeping will have on your health or lifestyle ("What if this insomnia never goes away, and I'm so sleep deprived I can't drive anymore?")
- You may worry about your anxiety never going away, and your life falling apart - "I'll lose my job. My friends will all get sick of me and ditch me. My wife will divorce me. I'll wind up on the streets sooner or later."
Of course, some people have a panic attack or super-anxious week and don't think much of it once it's over. They tell themselves, "I was under a lot of pressure at school, but that's passed, so I'm fine now." However, some people could find the ordeal so frightening that it scars them and damages their mental health longer-term.
How this affects recovery
Thinking of panic attacks and prolonged severe anxiety spells as possibly being traumatic can help how you approach your recovery from them. There are many common suggestions for dealing with panic:
- Learning relaxation techniques
- Learning and accepting panic attacks are very unpleasant, but harmless
- Getting used to sitting with and tolerating your anxious symptoms
- Getting into a mindset where you don't fight panic when it comes on, but let it run its course
- Slowly facing your fear of panicking itself, and the situations that may bring it on
- Generally vowing to live your life, whether you panic or not on any particular occasion
These can be very effective. Many people put them into practice and stop panicking all the time. But some can't seem to make these approaches work, or they get some relief, but the "What if?" fear of another attack is always in the back of their mind. It's dulled, but it hasn't fully gone away.
Another option is to use trauma therapy techniques on the memories of your bad panic attacks or anxiety episodes. When we're traumatized the fear and other intense feelings we felt at the time get frozen in our mind. When something reminds us of it our thinking gets snapped back into that moment, and we feel like we did all over again. Your day-to-day logical self may know on paper panic is harmless, but when you flashback to that evening you literally thought you were going to die or have your life unravel, you're temporarily cut off from that knowledge.
The way to resolve traumatic memories is to process them. Roughly, that's letting yourself fully experience all the emotions you had at the time, but weren't able to work through in the immediate aftermath of the event. That means deliberately bringing up memories of your bad panic attacks, and all the distressing emotions and thoughts that go with them, and then sitting with those feelings until they naturally run their course and dissipate. Once those memories have been drained of their emotional intensity they won't impact you as much. You can go into a situation that normally makes you panic, and it's no longer being fed by those old, frozen feelings of, "This is deadly. You're going to die!" You're able to access your calmer, rational adult perspective.
Deliberately recalling your worst, most scarring panic attacks could be quite intense. If you don't feel up to doing it on your own you could work with a trauma therapist, who knows techniques to help you safely, slowly process painful material without getting overwhelmed. However, if remembering your bad anxiety spells only makes you mildly or moderately uncomfortable, you could process the memories on your own (not that you have to).
Processing your panic attack memories may not single-handedly cure you. You might still need to do real-life exposure exercises to realize firsthand you can deal with them. However, it's definitely a part of the puzzle to consider.
If you have trauma for another reason, of course you need to process the memories of the core incident, when you're feeling ready for it. But if you also had a lot of panic and anxiety in the months after the trauma, those experiences may have been traumatic in their own way, and got mixed in with your main trauma symptoms. It could be worth thinking about whether you have some anxiety-related trauma you should also try to process at some point.