Steph, now 23, started having panic attacks when she was 11 years old. “It was around the time I started secondary school, and no one knew what they were”, she says. Although she went to her GP at the time, they had no inkling that the attacks were to do with an underlying mental health problem. “If I’d been diagnosed at 10 or 11 properly, my life would have been so different. My teenage years were absolute hell. It was all-consuming.”
Panic attacks are characterised by a sudden feeling of anxiety – one so strong that you become overwhelmed. They fill you with fear and dread. They can make you sick, they can make you tremble, and they can make you sweat. Lasting from around five to 20 minutes – sometimes longer – they can be utterly terrifying.
While having a panic attack is horrible, it doesn’t necessarily mean you have an underlying mental health problem. Panic disorder, however, which is when the sufferer has recurring and regular panic attacks, is the condition that is formally classified by doctors as an anxiety disorder. And this is a disorder which you’re 2.5 times more likely to be diagnosed with if you’re a woman than a man.
Laura Whitehurst from Anxiety UK, the nationwide charity that helps people with anxiety, explains. “Women in general are more predisposed to anxiety, which is why they’re more likely to develop panic disorder. A recent study, for instance, showed that 22% of women feel anxious all or a lot of the time, compared to only 15% of men. Other explanations are to do with the differences in brain chemistry between men and women."
Studies have shown that women tend to have lower levels of serotonin, the brain neurotransmitter that is critical to treating anxiety, than men. Others argue that female hormones linked to the menstrual cycle may be to blame. A further explanation for why women report having panic attacks more than men may be social: men are less likely to come forward and seek treatment for recurring panic attacks, instead dealing with their anxiety on their own.
Dr Rose Aghdami, a psychologist specialising in panic disorder, agrees. “In my clinical experience, men tend to use alcohol to deal with their feelings of panic. It's not that they don’t have panic attacks as often, but they deal with them differently, by blotting it out and escaping." It's important to remember though, that women also use alcohol to deal with anxiety, along with other substances.
I was having six major panic attacks a day, the ones where you’re crying, shaking, curled up in a ball.
For 36-year-old Louise Smith, like Steph, panic attacks started early in life, shortly after her parents divorced in her teens. “I never sought any help for it, I just thought it was normal to feel upset all the time.” After a breakdown at university, Louise finally went to a doctor and was placed on medication. But the panic attacks continued.
“I was fired from my job as a procurement manager because my employers just didn’t understand. They were terrible about it. I was having six major panic attacks a day, the ones where you’re crying, shaking, curled up in a ball. Sometimes I’d try to go to work and I’d spend half an hour in the toilet crying, or have to leave suddenly. My bosses hadn’t ever come across anyone who’d had panic attacks before, and they didn’t have any awareness of how to deal with it”.
The difficult thing about panic attacks is that, often, the sufferer can get caught in a vicious cycle, whereby being conscious of your anxiety can increase your likelihood of further panic attacks. Dr Aghdami explains. “Part of what will make further panic attacks more likely is the person’s prediction they will happen. So if men have found other ways of dealing with panic and anxiety, like alcohol, they’ll be less fearful of them happening. Women who experience panic attacks often will become locked into a cycle where they change their behaviours to prevent them happening again. This is called avoidance, and it’s a common feature of panic disorder."
For Steph, avoiding situations that could trigger her panic attacks made her reclusive throughout her teens and early twenties. “At school, if I had to go to a sleepover I wouldn’t get a wink of sleep. By 5am I’d be retching and throwing up from anxiety. My whole social life was completely gone.” Later on, when living with her boyfriend in Liverpool, she says, “It would be weeks at a time without me leaving the flat. I’d go whole days only eating a Lucozade tablet for lunch because I was so anxious that I’d have a panic attack and be sick."
Certain triggers are, however, best avoided. Whitehurst tells me Anxiety UK’s helpline receives a spike of calls on Mondays linked to weekend drug and alcohol abuse. “We call it ‘hangxiety’, and it’s clear that drug and alcohol use exacerbates anxiety. People call after a big night saying they have heart palpitations, which is a common side effect of taking illicit substances. If you’re already prone to anxiety, this can send you into a panic spiral and you can end up having an attack."
CBT worked for me, alongside citalopram [an anti-anxiety medication]. I learnt to rewire my brain differently.
When you’re living with a panic disorder, sometimes things can seem hopeless. “If I’d carried on the way I was going”, Steph explains, “I’d have maybe killed myself. I felt like a drain on everyone around me”. After trying various treatments – “hypnotherapy did not help, they told me to imagine my anxiety as a yellow egg I flushed down the toilet, which seemed like bullshit” – Steph had a breakthrough with CBT.
“CBT worked for me, alongside citalopram [an anti-anxiety medication]. I learnt to rewire my brain differently. So, with panic attacks, I’d imagine them as a bell curve. It’s going to get worse, but when you hit that peak you know the only way for the panic to go is back down. Visualising the attacks was the beginning of me understanding them and dealing with them.”
Louise also had success with CBT – although it came at a price. She went private to see a therapist every week. "It cost me thousands of pounds," she tells me. "My Mum helped out at first but after a while she stopped. I think she thought that I would just ‘get better’. I had to explain to her that I might never be 'better'." The CBT did help eventually though: "Before, if someone said something at work, or didn’t say hello to me, I’d take it the wrong way and freak out and have an attack. So that’s something CBT’s helped me with, learning to train my brain out of that”.
While panic attacks can seem like something that’s not worth bothering your doctor about, if left untreated there’s the possibility they can develop into a full-blown anxiety disorder. Whitehurst would like to see more men reaching out for support. “There still seems to be a stigma around men asking for help. Women are more likely to do so, but there’s still the problem of NHS waiting lists of ten months just for therapy."
I feel like women are constantly slammed. You’re working too hard, or you’re not working hard enough. I’ve had panic attacks because I feel fat, because I don’t look the same way as other women or I don’t feel like I’m working hard enough in my job.
Steph agrees that her gender might have influenced how she handled her panic attacks. “If I was a man, I’d have felt a bit more like I have to man up. I think I wouldn’t have had as much understanding and love.” Meanwhile, Louise wonders whether social pressure was part of the problem. “I feel like women are constantly slammed. You’re working too hard, or you’re not working hard enough. I’ve had panic attacks because I feel fat, because I don’t look the same way as other women or I don’t feel like I’m working hard enough in my job. I know if I don’t control those feelings my anxiety will kick off again."
Gender aside, recognising that feelings of anxiety and panic are relatively common, and totally treatable, is the most important first step. Steph explains. “It’s about your attitude towards it. Know it’s a completely normal problem, and that so many people have it. People won’t think you’re a weirdo. They will try to help you and look after you.”
If you're struggling with feelings of anxiety, Anxiety UK has a dedicated helpline which can provide support. You should also always speak to your doctor.
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