Many troops and veterans face various emotional challenges after combat. Hardly a week goes by without a front-page story about post-traumatic stress, depression or traumatic brain injury.

But one psychological ailment that rarely gets its due attention is panic attacks.

Panic attacks are among the most common anxiety complaints across all groups and cultures. An estimated one out of every three people will experience one at some point in their life. Characterized by periods of intense fear or apprehension, panic attacks appear suddenly and often with no warning. The person experiences a feeling of dread, impending doom, suffocation and even a sense of dying. Thoughts of "I'm going crazy" or "I'm losing it" are common.

The person also experiences distressing physical sensations: a racing heart, sweating, trembling, shortness of breath, dizziness, nausea and tingling in hands and feet. Reports of chest pain are also common, leading some to think they're having a heart attack.

Ironically, normal and harmless physical sensations often jump-start a panic episode. The person may interpret a slight twinge, ache or flutter as a sign of an impending attack, which then leads to one.

While panic attacks are common and, by themselves, are not considered a psychiatric disorder, repeated attacks and chronic worry about having future attacks generally lead to a diagnosis of panic disorder in about 3 percent of people.

The cause of panic attacks is complicated. But put simply, the fight-or-flight system — the part of the mind and body that prepares us to fight or run when threatened — is partly responsible. Since the dawn of mankind, this has served as an internal warning system that keeps humans safe from dangers in the environment. In panic attacks — and panic disorder in particular — there is a "misfire" in the nervous system that leads to feelings of threat when there is none.

At the onset of fear, several physiological processes kick in.

First, the adrenal glands dump the hormone epinephrine, or adrenaline, into the bloodstream. This leads to the racing heart, sweating and shortness of breath.

The increased rate of breathing then depresses carbon dioxide levels in the body, producing the lightheadedness, numbness, twitching and flushed skin.

Lastly, epinephrine causes the blood vessels in the body to constrict, bringing on the chills, dizziness and fainting.

The good news is that panic attacks and panic disorder can be treated. A variety of self-help techniques, talk therapies and medications can help. With prompt and effective treatment, panic can be controlled if not outright eliminated in most people.

For more information on panic, visit


Bret A. Moore is a clinical psychologist who served in Iraq. Email Names and identifying details will be kept confidential. This column is for informational purposes only. Readers should see a mental health professional or physician for mental health problems.

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