Some people experience episodes of extreme panic that cause physical reactions. These panic attacks occur even without an external cause or real threat. Most people experience only a couple of panic attacks in their lifetime, but some individuals have panic disorders that lead to more frequent attacks. Though there are many triggers for panic attacks, the exact reason for these disorders is unknown. Many diseases and disorders also have panic attacks as a symptom.
Genetics and Inheritance
Because of the genetic complexity of panic disorders, it is difficult to identify the specific genes that cause them. However, some researchers believe panic attacks have a genetic component and may run in families. Additionally, studies of twins show that if one identical twin has an anxiety disorder, the other twin has between a 31 and 88% chance of having one as well. Women are twice as likely to have panic disorders as men; the reason for this is also unknown.
Obsessive-Compulsive Disorder
Panic attacks frequently appear as a symptom of obsessive-compulsive disorder (OCD). People with OCD feel a compulsive desire to inspect items or perform specific actions repeatedly; they have difficulty controlling these urges, and sometimes a panic attack is a result of attempting to resist. However, not all panic attacks have so direct a cause. A person with obsessive-compulsive disorder may experience a panic attack despite following their normal rituals.
Post-Traumatic Stress Disorder (PTSD)
After someone experiences a traumatic event, he or she may develop a disorder that leads to disturbing thoughts, dreams, or feelings about the event. PTSD can also affect how a person thinks and reacts, even causing significant personality changes. Intrusive thoughts or flashbacks can be brought on by something the person sees or feels that reminds them of the event. These triggers can cause severe panic attacks.
Hypoglycemia
Low blood sugar or hypoglycemia has a wide range of symptoms. The shortage of glucose in the brain can cause a person to experience shakiness, abnormal thinking, and fatigue, among other issues. In rare cases, people with hypoglycemia even experience episodes of extreme anxiety that result in panic attacks. Some studies refute the link, suggesting panic disorders and hypoglycemia are separate and unrelated. Some doctors believe that misdiagnoses are responsible for this apparent link and that the symptoms of hypoglycemia simply mimic panic attacks.
Labyrinthitis
Bony labyrinths are the rigid walls surrounding the inner ears. Labyrinthitis is inflammation of the inner ear. Because this area is responsible for sensing changes in head position and balance, labyrinthitis can cause spinning vision, nausea, and vomiting. It can also cause chronic anxiety, which, in turn, can result in panic attacks. The primary trigger of these panic attacks is the ears misinterpreting internal stimuli and tricking the body into believing there is a real danger.
Neurotransmitter System Failure
Chemicals in the brain transmit signals to trigger various bodily functions. For example, norepinephrine is a neurotransmitter involved in the regulation of emotion, anxiety, sleep, stress hormones such as cortisol, and other functions. Norepinephrine pathways are disturbed in panic disorders. In situations of high stress, levels of norepinephrine significantly increase, and the sudden rise of this neurotransmitter can trigger a panic attack.
Phobias
A phobia is an excessive fear in the presence of specific items or stimuli; many people experience this type of anxiety disorder. There are three divisions of phobias. Specific phobias include arachnophobia — fear of spiders — and nyctophobia — fear of the dark. Social phobias describe intense fear and dread during public or social situations. Finally, agoraphobia is the perception that the environment is unsafe and inescapable. Though all phobias can cause panic, agoraphobia is the most likely to prompt an attack.
Major Stress
Certain short-term stressors can also cause panic attacks. For example, when a person experiences a personal loss such as the death of a close family member, increased stress from the event may result in a panic attack. Other major stressors include going to college, retiring, or giving birth. Some people have panic attacks following events that seem minor to others, such as an emotional moment with a romantic partner.
Temperament and Mental State
There is some evidence that temperament and mental state affect the likelihood of having a panic attack. Studies link anxious and negative thinking, including constant worrying about what-if situations, to panic attacks as well. Even repressed anger or sadness could trigger an event.
Withdrawals
People undergoing withdrawal from a drug or other substance may have an increased risk of panic attacks. Many people use antidepressants or marijuana to treat anxiety disorders and experience conditions such as antidepressant discontinuation syndrome when reducing their dosage. Typically, the symptoms are flu-like, though they may also result in anxiety issues. The Harvard Mental Health Letter states that 20 to 30% of recreational marijuana smokers experience anxiety issues and panic attacks after reducing their marijuana use.