When panic attacks

The stresses of modern life, coupled with expectations that women should “have it all”, mean we’re becoming more susceptible to panic attacks. Lee Xin Hui reports.

Portrait of Tammy Strobel

The stresses of modern life, coupled with expectations that women should “have it all”, mean we’re becoming more susceptible to panic attacks. Lee Xin Hui reports

Photo Getty Images
Photo Getty Images

One moment, you’re getting comfy in your plane seat, feeling excited about jetting off for a well-deserved holiday when suddenly, your hands are clammy, your heart’s racing and your brain’s pulsing so hard it drowns out the hum of the plane engines.

That’s exactly what happened to 31-year-old Annabel Tan, socialmedia influencer and freelance communications consultant.

“I’m not claustrophobic or scared of flying, but I started to freak out about not being able to disembark. My heart rate skyrocketed and I thought I was going to faint,” she recalls. “I told my husband I wasn’t feeling well and we called the flight attendant over.”

The in-flight supervisor calmed her down, moved her to a more spacious area for take-off , and gave her oxygen to help her breathe more easily. Annabel struggled to explain the overwhelming fear and dread that engulfed her–especially since she was a seasoned traveller.

She didn’t realise she was having a panic attack – she’d never had one before, and was stunned by how it struck so suddenly, gripping all her senses and flinging her into fear. “I felt better after 20 minutes, but for the rest of the flight, I tried to come to terms with what had happened,” she shares.

It could happen to anyone

“Feeling anxious or panicky is a natural evolutionary reaction designed to protect us from danger by activating a ‘fight, flight or freeze’ response,” explains Ho Shee Wai, director and registered psychologist at The Counselling Place. “In the absence of any real danger, reactions that would otherwise help us escape from a threatening situation translate into sweating, trembling and heavy breathing.”

In most cases, such feelings are not debilitating, and they usually dissipate in minutes. But when there’s “an abrupt surge of intense fear or discomfort that reaches a peak within minutes, during which four or more of these symptoms – heart palpitations, sweating, shivering, shortness of breath, nausea, and fear that you’re losing control, going crazy or dying – occur, that’s when you’ve got a panic attack”, says Shee Wai. You might think it would take something really major – like being mentally ill or undergoing traumatic experiences such as accidents or assault – to trigger one. But truth is, it could happen to anyone, any time – even when you’re doing something completely innocuous like watching TV – or even sleeping.

Too much pressure?

While there’s no offi cial data on the incidence of panic attacks in Singapore, Dr Lim Boon Leng, a psychiatrist from Gleneagles Medical Centre, says one in three of his patients seeks help for anxiety issues. Of these, a third are diagnosed with panic disorder – making it one of the most common psychological conditions he treats. Studies show that women are twice as likely as men to be aff ected. British online charity Youthnet estimates that a third of young women in the UK suff er from panic attacks.

Citing the pressures of modernday living as a key trigger, Dr Lim notes: “Young women today are expected to be ambitious go-getters at work and responsible caregivers to their kids. This, coupled with major life events, can be very stressful.” While Annabel has no children, she’d experienced major life changes not long before her panic attack. She had recently got married and moved house. She’d been assigned a challenging new project at work. The signs of overload were there, making her susceptible to an emotional meltdown. She says: “I guess women are conditioned to just ‘go for it’ and plough on during trying periods, so much so that we don’t take time to process change, and continue trying to cope.”

Annabel is certainly not alone. Over the past two years, a handful of smart and successful women celebs such as actresses Amanda Seyfried and Emma Stone and singer Ellie Goulding have gone public about having panic attacks.

For example, despite being named one of Time magazine’s 100 most influential people in the world, producer-actress Lena Dunham says worrying about her future led to a panic attack. “I thought, in two and a half years I’ll be 30, then 10 years from that I’ll be 40, then 10 years from that I’ll be 50… it’s why I don’t sleep at night,” shared the 29-year-old in an interview with The Guardian.

Photo Mallory Morrison/Corbis
Photo Mallory Morrison/Corbis

Don’t bottle it all up

“Women have a higher tendency to experience negative emotions than men, and believe that anxiety is harmful,” notes Shee Wai. Community service offi cer Ruby Tan shares: “A family problem was taking its toll on me. My bosses knew I was stressed. They were understanding and lightened my workload to help. You’d think that this would be a good thing, but it made me feel guilty for not contributing as much as my colleagues.”

The 27-year-old recalls sitting at her desk, suddenly acutely aware of how hard her heart was beating. “The anxiety started building up and I tried to tell my colleague I was having a panic attack, but I started hyperventilating. It was a crazy feeling of thinking I was going to die – even though I knew I really wouldn’t.”

The good news is that even though panic attacks can make you feel as if your life is ending, they’re usually not dangerous or fatal.

Just breathe slowly

Personal trainer Eileen Yeo, 26, experienced her first attack while quarrelling on the phone with her ex-boyfriend. It lasted 30 minutes, and she attempted to calm herself by breathing into a paper bag. In Ruby’s case, her colleagues tried to slow her breathing by applying pressure to her nose.

For the record, the paper-bag breathing method is generally not recommended because hyperventilation may be caused by other factors (such as a heart attack or asthma) which require prompt medical assistance.

Once you’ve had your first panic attack, it’s common to experience more of them, as merely worrying about one can precipitate its onset. But it doesn’t necessarily mean you have a panic disorder “unless you’ve had at least two attacks in a month and continue to be strung out in between them”, says Dr Lim.

Regardless of the frequency or severity of the attacks, however, experts recommend seeking professional help – a medical doctor can run tests to eliminate physical conditions like heart problems, while therapy with a psychologist can help you to figure out underlying causes and coping strategies.

“Think of panic attacks as the fire alarm of your body. If it’s ringing, it’s best to investigate whether there is a fire (real danger) instead of just turning it off ,” advises Shee Wai. Thankfully, Ruby hasn’t had another attack. Eileen went on to experience two other episodes, but stopped having them after reading up on her symptoms and making the eff ort to exercise frequently.

Annabel has become more sensitive to being in confined spaces such as planes and trains for extended periods. Her family GP prescribed standby medication, but she hasn’t had to pop those pills. Instead of avoiding her fears, she prefers to face them head-on. “I schedule small trips so I can gradually overcome my travel anxiety while experiencing something new at the same time. Some might find that masochistic, but I choose to be courageous. I don’t want to end up becoming a mad cat lady stuck at home!” she says with a laugh.

Her personal message to women who are experiencing panic attacks: “Make time for your thoughts, learn to process change, and most of all, love yourself. For any recovery, it takes a small community. Talk about what you’re going through to people or a doctor you trust – it is possible for you to overcome these episodes.”

Keep calm and cope

You can’t predict a panic attack, but these tips can help you avoid a complete meltdown.

1) Know that it’s not life-threatening “Panic symptoms are not dangerous since they’re normal physiological reactions. If you correctly interpret them as being due to anxiety, fatigue or exercise, they can often pass relatively unnoticed and remain harmless,” says Shee Wai.

2) Share your experiences This helps you realise you’re not alone. “My friends and family encourage me by sharing similar experiences, off ering positive words and even laughing about it with me,” says Annabel.

3) Distract yourself during the attack What Annabel finds useful is “plugging music in and meditating on comforting verses whenever (she) recognises the uncomfortable feeling of irrational fear creeping up”.

4) Exercise frequently Manage daily stress levels so you don’t feel entirely overwhelmed. “I started swimming after my attack because the water blocks out noise, allowing me to find peace,” says Eileen.

What to do if someone you know is having a panic attack

Get the person to sit or lie down.

Help him focus on breathing slowly – ask him to take one deep breath in, hold for four counts, and release slowly for eight counts.

Offer warm water and remind him to take slow sips.

Offer a comforting touch on the shoulder and words of reassurance. What you can say: “You can do this. Tell me what you need now. Stay in the present, it’s not the place that’s bothering you, it’s your thoughts. I know what you’re feeling is painful, but not dangerous.”

Expert source: Ho Shee Wai, director and registered psychologist at The Counselling Place.

“Young women today are expected to be ambitious gogetters at work, and responsible caregivers to their kids. This, coupled with signifi cant life events, can be very stressful.” — Dr Lim Boon Leng, psychiatrist

Once you’ve had your fi rst panic attack, it’s common to experience more of them, as merely worrying about one can precipitate its onset. But it doesn’t necessarily mean you have a panic disorder.