On the Dynamics of Panic Attacks

According to Franco DeMasi, "A panic attack is characterised by the sudden emergence of entirely unpredictable and unstoppable episodes of intense anxiety. Its intensity is such that it leaves behind a sense of utter exhaustion. Usually the panic attack is accompanied by strong neurovegetative manifestations, such as palpitations, tachycardia, vertigo, body tremors, diarrhoea or excessive sweating and, most importantly, a sense of suffocation. The panic attack always manifests itself psychosomatically, being a pathology that greatly affects the body.

A specific characteristic of panic attacks is the failure in the mental function that should contain anxiety. The subjective drama experienced during a crisis is a form of "nameless dread" because the mind cannot contain contain the fear and then pours it then into the body. When the mind fails to perform a sufficient regulatory function the anxiety, via various hormones, is manifested in the body and becomes deadly panic. One will then think, ‘I am not anxious, I am dying!’. What we can observe here is the same constellation that belongs to the experience of terror during real death.

In a panic attack the defense mechanisms, including the management of anxiety, that would normally protect our existence, seem not to exist. People experiencing such attacks are without a ‘psychic skin’. The skin tears open, the boundary between inside and outside is lost and anxiety spreads into the body. (A sense of confusion in one's bodily integrity, which is at the root of the panic attack, also manifests itself in the body's problematic relationship to space. Claustrophobia, as the anxiety of being invaded, or agoraphobia, as the fear of vanishing into open spaces and loneliness, continually threaten those individuals who have a poorly structured self and who suffer from occasional panic attacks.)

In order to emerge from a panic attack, the patient needs an interlocutor who can function as a container of anxiety: if by any chance he is on his own, it is important that a telephone is within easy reach. Fear requires a prompt reception by a calm and thoughtful listener. When the patient dreads that a panic attack may get close, he becomes just like a young child looking into his mother's face in the hope of getting information about the dangerousness or otherwise of a disturbing element that has caught his attention or threatened his body. If the listener is detached or irritated, or trivializes the catastrophe, fear will grow to the point of becoming nameless dread. Even the slightest emotional resonance, anxiety, or doubt in the listener may sound suspicious to the patient and confirm the potentially somatic nature of the problem, making the patient's anxiety an even more concrete experience.

-- from The Psychodynamic of Panic Attacks: A Useful Integration of Psychoanalysis and Neuroscience. By Franco De Masi.