Why do we have panic attacks?

The sense of impending doom sets in as your heart begins to pound. It becomes hard to breathe. You feel lightheaded and your chest feels like it’s caving in. You may even feel detached from reality as your body goes numb. 

Some people experiencing their first panic attack think they’re having a heart attack, or even dying. These episodes can be debilitating. Sometimes they’re caused by stressful situations, other times they are caused by changes so slight it feels like they come out of the blue. They leave people feeling drained and exhausted, and can severely impact quality of life. 

They’ve been around for a long time. Earlier generations of humans seemingly had much more stressful lives: they dealt with intense threats while hunting, defended their families, and navigated unfamiliar terrain or life-threatening situations. They even come up in early literature — the first written descriptions of panic attack-like symptoms appeared in ancient Greek and Roman texts.

Today, survival looks a lot different than it did for our ancient ancestors. The average person experiences one to two panic attacks that last a few minutes in their lifetime. But about four percent of the general population has panic disorder, meaning their panic attacks are reoccurring. Repeat panic attacks can lead people to avoid certain situations or stressors, which can get in the way of daily functioning. 

Our fight-or-flight instincts aren’t required in the same way, yet panic attacks remain. So why did we develop them in the first place? 

“It was critical for early humans to be sensitive threat detectors, ready to activate the sympathetic nervous system” at a moment’s notice, said Rafaella Reytan, an assistant professor of clinical psychiatry at the University of Pennsylvania, via email. That’s the system responsible for “gearing the body up to fight, flee or freeze in response to a potential danger.”

While giving a high-stakes presentation at work or finding yourself stuck in an overstimulating situation is different than being chased by a pack of wolves, it may trigger the same physical symptoms — like sweating, heart racing or lightheadedness — that we associate with being in physical danger. Our brains are wired to identify these as risks, misinterpret the situation as dangerous and activate the sympathetic nervous system.

Reytan said the function of these symptoms was to keep us safe. For example, lightheadedness many people experience during a panic attack is the body redirecting oxygen away from the brain to other muscles. This allows the body bursts of energy and a quicker reaction time in the face of a threat. 

And even though these symptoms are uncomfortable or even painful, Reytan said they were key in keeping our ancestors alive. 

However, it is possible to reinterpret and deescalate these physical symptoms. Reytan said a big part of that happens in therapy: “Therapists help patients to disentangle this connection by learning that these sensations (though uncomfortable and frightening), are in fact not dangerous, or can be tolerated.”