Teen Panic Disorder: How Adolescents Experience Panic Attacks

Teens With Panic Disorder Describe What They Feel Like

We’ve all heard of panic attacks.

Many of us have had them.

But for those of us who haven’t, it’s not obvious how intense and overwhelming they feel. The phrase itself should tell us how serious they are, but it’s been used so much it’s lost real meaning for most people.

Think about it.

Panic means uncontrollable fear and anxiety.

Attack means aggressive or violent action against a person or place.

Therefore, for those of us who’ve never had a panic attack, and especially those parents among us who’ve never had a panic at whose children or teens have panic attacks, we should think about those words and the phrase they create.

What it means in its most basic form is this:

“I am being aggressively and violently attacked by uncontrollable fear and anxiety.”

It’s like walking down a street and getting mugged by your own thoughts. No one wants to be mugged and no one asks to be mugged. But muggings happen.

Panic attacks are like that: no one asks for them, no one wants them, but nevertheless, panic attacks happen every day.

Most people who report panic attacks have what’s called panic disorder. Data from the National Institute of Mental Health (NIMH) shows that in the U.S.:

• 2.7% of adults have panic disorder
  • 3.8% of females
  • 1.6% of males
• 2.3% of adolescents have panic disorder
  • 2.6% of females
  • 2.0% of males

Here’s the breakdown by age:

• 13–14-year-olds: 1.8%
• 15–16-year-olds: 2.3%
• 17–18-year-olds: 3.3%

Among all teens, 2.3% report panic disorder with severe impairment, which means they disorder prevents them from participating in typical daily activities on more days that not. Based on an estimated twenty-five millions teens in the U.S., those numbers tell us that over half a million teens experience debilitating panic on a regular basis.

So, for those teens, how does a panic attack feel?

New Study Describes Panic Attacks in Teens

We can answer that question thanks to a study published recently called “The Experience of Panic Attacks in Adolescents.” In the study, researchers interviewed adolescents with panic disorder who experience panic attacks in order to get a window into exactly what happens in their thoughts and feelings when they experience a panic attack.

We’ll get to those details in a moment. First, let’s offer a clinical definition of panic attack so we’re on the same page.

According to the American Psychological Association (APA) and the Mayo Clinic, a panic attack is:

“A sudden episode of intense fear or anxiety and physical symptoms, based on a perceived threat rather than imminent danger. Surges of fear arrive quickly and reach a peak within minutes.”

Panic attacks have both cognitive and physiological symptoms, including:

• Accelerated heart rate (palpitations)
• Sweating
• Shaking
• Shortness of breath
• Feeling smothered
• Hot flashes
• Chills
• Chest pain
• Nausea
• Abdominal cramps
• Dizziness
• Depersonalization (similar to dissociation but without the associations with psychosis)
• Fear of losing control
• Fear of dying

There’s another cognitive symptom listed in almost all definitions we find with a word we don’t love: fear of going crazy. We include that here because in many first-person accounts of panic disorder, people say I was afraid I was going crazy or I felt like I as going crazy. For obvious reasons – respect for people with mental health disorders primarily – crazy is not a word we use, but nevertheless, for the sake of full disclosure, that’s how people who don’t work in mental health or have a stake in reducing stigma describe the panic attack experience.

Now let’s take a look at what teens who have panic attacks say they feel like.

Panic Attacks in Teens: The Subjective Experience

There are scores of studies and articles about how adults experience panic attacks. We found a good, easy to read, informal article here with several firsthand accounts. If you’re curious about the difference in panic attacks between adults and adolescents, please read that article, or read this informative piece  published by the NIMH.

The study we refer to above found six distinct patterns in panic attacks experience by adolescents. We’ll describe those six patterns below, along with quotes from the teens in the study about exactly how each pattern of panic attack feels as its happening.

1. Being Unable to Think and Fearing Losing Control of One’s Mind

The teens in this study frequently used metaphors to describe how panic attacks feel, and these metaphors often likened the attacks to natural disasters or extreme weather events. We’d like to note that both natural disasters and extreme weather events are objectively huge things in which humans are tiny, in comparison, and that humans have absolutely zero control of them. With that in mind, here’s how teens describe this type of panic attack:

• “Like a tornado, a storm…a malevolent tsunami that has engulfed my soul.”
• “It kind of feels like this wave…and I can like feel it building up and up and up, until like, it hits and then it’s like a full blown one.”
• “Like an uncontrollable force”
• “Infinite.”

2. Feeling Disconnected: The Experience Supersedes What They Know is True

Many teens describe feeling disconnected from the panic attack experience as its happening, while simultaneously feeling overwhelmed by the attack itself. They have a real experience of fear, both of getting hurt and fearing it will never end, while also knowing that it will end and it’s very unlikely they’ll come to any physical harm. Here’s how they describe the experience:

• “Part of my brain’s like, it’s never going to stop, and then the other part is, you know it’s going to stop, it’s stopped before, it’s fine…”
• “It’s almost like my brain has a brain of its own…like sort of putting really bad situations that I know won’t happen.”
• “I feel like these images are things that I’m scared of…like they’re made of exactly what, my brain sort of knows exactly what I’m scared of, and then the image is what I’m scared of.”
• “Afterwards it feels completely different to compared to when it actually does happen.”
• “It was kind of like battling against myself.”

3. Feeling Completely Out of Control

According to the study authors, “Every participant described feeling out of control during a panic attack.” Some reported a sense of being overtaken by an external force and losing their sense of self. Here’s how they describe those experiences:

• “Once you’re in the grip of it, it’s like you can’t just switch off, it just gets worse and worse.”
• “It feels like a dementor [Ed. evil character from Harry Potter books] is sucking the life out of me.”
• “My head’s just spinning out of control.”
• “I’m not going to be able to go back to normal now”.
• “I guess they’re a bit like hallucinations really I don’t know but they really, they scare me quite a bit.”
• “[images are] kind of like disturbing…I don’t trust myself.”

4. Feeling Embarrassment and Shame

Most of the study participants reported feeling embarrassed or ashamed of their panic attacks. They all felt like they were events that they needed to hide, not discuss in detail with friends, and never mention to people like acquaintances or people who didn’t know them very well. They feared stigma from other while also self-stigmatizing their panic attacks. Here’s what they said about this aspect of their experience:

• “I don’t want people to see me like that.”
• “My friends will be embarrassed to be around me.”
• “I don’t people want people to think that I look like I walk around looking like a nervous like wreck.”
• “[I feel] worthless because no one else is [having them], it’s not happening to anyone else.”
• “[I feel] like a bit of a weirdo.”
• “I don’t really want [my friends] to know, I don’t want to seem weird.”

5. Feeling Cut-Off and Isolated From Others

The teens who participated in the study reported they thought most people they know did not understand their panic attacks. Not how serious they were, not how scary they were, and not how debilitating they can be. All this made them feel isolated and separate from their community of peers. This isolation made them feel there was no way to truly let people in and understand the experience. Here’s how the describe what the experience of isolation:

• “You can’t really fully understand the feeling unless you’ve really…had those thoughts in your mind and gone through that yourself.”
• “People try and normalize it, and I think that’s where it goes wrong…they need to notice and understand that although you want to try and normalize it, it’s not normal and it’s scary.”
• “I don’t want you to tell me it’s OK. Because like my brain’s telling me it’s not OK at all.”
• “My friend was so scared for me that she had a panic attack herself.”
• “I see myself in my head in this tube and when erm, when I’m having one and I can’t move I feel like the tube’s getting smaller and smaller, and then it, I can feel physically, well I know I can’t but it’s my head but I can feel, myself kind of being squashed in and I feel like I’m being crushed…and then like, there are all the people on the outside like, erm, that, like are trying to like get me out. And I know they’re all free and I want to be free as well but I can’t because of like my brain.”

6. Finding Ways to Cope

Several teens in the study reported that distraction and avoidance were the primary ways they tried to cope with the panic attacks as they happened. Others say they did their best to learn to understand their thoughts, where they came from, and why they had them, and others felt the best way to handle them was to physically change their location. Here’s how they describe their experiences:

• “I would get my friends to distract me, because that’s like the best thing.”
• “I tried and create distractions to try and ease myself.”
• “I tried to concentrate on school, and tried to concentrate on my friends, try to find a distraction,”
• “I don’t know what would happen if I didn’t distract myself…I don’t know what would be on the other side of that, what would happen, it’s not something I’m willing to take a risk to find out.”
• “I think one of the best things is to take me out of the situation I’m in.”
• “I knew that it was gonna get worse if I just stayed [where I was].”

Why Getting Help for Panic Attacks is Important

Learning to manage panic attacks is essential for a teen with panic disorder. They need robust coping skills at the ready. Without effective ways to cope, panic attacks can interfere with life at home, at school, with friends, and in extracurricular activities.

In addition, researchers list three negative consequences of panic attacks in teens:

1. Panic attacks can degrade self-esteem and create a negative sense of self.
2. The feeling of a lack of control, being out of control, and not being able to control personal thoughts can interfere with the personal autonomy necessary to create a whole, viable, individual identity to carry into adulthood.
3. The isolation caused by panic attacks can interrupt the process of peer bonding and group identification required to create a sense of self-in-context. This can lead to low-self esteem, symptoms of depression, and increase suicide risk.

These three consequences – as well as the fact that no parent wants their child or teen to experience what teens describe above – are compelling reasons for teens who have panic attacks to seek evidence-based treatment as soon as possible. The most effective known approach to treatment for panic disorder (PD) and panic attacks is a combination of therapy and medication. Once a teen receives a full biopsychosocial evaluation administered by a mental health professional, they may receive a referral to participate in cognitive behavioral therapy (CBT) and, in some cases, a prescription of an anti-anxiety medication called an anxiolytic.

Some teens learn to manage panic attacks with therapy alone, others can manage attacks with medication alone, but for most, a combination of therapy and medication is most effective. Whatever course of treatment a professional recommends, we recommend that parents initiate that treatment for their teen sooner, rather than later.