Let's call him "Eric," a seasoned officer, of formidable size and a strong command presence. Eric works the second watch in a medium-sized department and is considered one of the most squared away guys on the team. If it is hitting the fan, you want Eric covering you. He has been with the department for nine years, and at 34 years old is in overall excellent health. Eric is dispatched to a routine disturbance call in the middle of a generally quiet residential neighborhood. He waives cover. In route, Eric pulls to a curb, without any other reason than basic cop instinct; he senses imminent danger and is suddenly overwhelmed with anxiety. Things quickly go from bad to worse for Eric. He feels nauseated, dizzy, hot and sweaty. His vision becomes blurry and his ears burn. His fingers and toes feel numb. Eric has severe pain and tightness in his chest and can feel his heart beating way too fast; breathing is almost too difficult to accomplish. Eric is certain that he is dying and things begin to happen in slow motion as an intolerable sense of dread immobilizes him. When Eric didn't answer up to the dispatcher's request for a status update, his beat partner headed to the call, finding Eric's patrol car haphazardly parked two blocks away. Paramedics were called and Eric was rushed to the hospital. After an extensive examination, x-rays, EKGs, and lab work, the emergency room doctor advises Eric that he had not had a heart attack, but had most probably suffered a panic attack. She instructs Eric to follow up with his primary care physician and a mental health professional, and gives him a prescription for Xanax. Eric takes a few days off, telling the department the incident was related to food poisoning, and jokes with his peers. He tells himself it was a fluke occurrence and makes no follow-up appointments.
Panic Attacks
Panic attacks are very common and can happen to anyone, given the circumstances. Conservatively, more than one in ten people experience at least one panic attack during their lifetime. The lifetime prevalence of panic attacks is 23%. Attacks often happen at times of stress/strain, after an unpleasant or traumatic experience, or may occur unexpectedly. An attack can last from minutes to hours; most typically symptoms peak in approximately ten minutes and subside in under an hour.
Panic attacks are also very real. Paramedics respond frequently to suspected, and later unfounded, heart attack calls. True attacks are nearly impossible to fake. Those who suffer from panic are not hypochondriacs. The housewife with two kids in the backseat who freaks out when you pull her over for a minor traffic violation, may indeed be in the throngs of a panic attack. Your probable cause stop has just become a living nightmare.
What happens during a panic attack? The body is equipped with an automatic nervous system response to fear, commonly known as the "fight or flight" response. An individual either copes with a real or perceived danger, or runs from it. Law enforcement officers are trained to safely confront all types of danger. A panic attack results when the nervous system reacts as if it is facing a life-threatening situation, even if no actual danger exists. The response triggers a silent alarm that screams danger. People experiencing panic attacks often fear they are dying, suffocating, having a stroke or heart attack, or are simply going crazy. Anyone with these symptoms needs to first be assessed as a medical emergency. The diagnosis of a panic attack is based on the exclusion of medical diagnosis that may manifest with same symptoms.
Eric returns to work, and things seem to be going fine. Within a week, he is back at the top of his game. However, on an extra patrol call a mile from his previous incident, he begins to feel funny. Going by that fateful intersection, he realizes that he is hyperventilating and white-knuckling the steering wheel. He can't seem to focus, and he senses severe indigestion, but much lower in his gut. There is a feeling of dread, of impending doom, but it passes. Eric learns to avoid the neighborhood as much as possible, and finds alternate routes when he has to respond to a call. Luckily for Eric, two weeks later there is a beat rotation, and he feels free.
Seventeen days later, Eric awakens in his bed three hours after a long shift. His eyes pop open, it is still dark. He is chilled, sweating profusely, with a familiar crushing pain in his chest. Nothing feels real, he senses he is detached from himself and is looking down at himself from the ceiling. He has no control over his body or thoughts, he is virtually paralyzed. He wonders if he should call 911; he wonders if he can. He waits, eventually the symptoms subside, and Eric secretly believes he has gone over the edge, and that he is in fact going crazy. Embarrassment prevents him from talking to his family, supervisors or friends. He takes some comp time to regroup. The mere thought of leaving the house stresses him out.
Treatment
Sometimes, panic attacks just go away. Some people have one and never have another, while others are plagued for years or a lifetime. Some sufferers learn coping strategies; others rearrange their lives and may eventually become totally isolated and alienated.
Treatments for panic attacks and panic disorder are very effective and include both medications and counseling. The most commonly prescribed medication for a panic disorder is an SSRI antidepressant, such as Zoloft, Prozac, Paxil, Celexa or Luvox. Trials have shown that these medications reduce the frequency of panic attacks by up to 75-85%. Unfortunately, it takes from three to six weeks for a SSRI to be effective in treating a panic disorder. Benzodiazepines or diazepam (Xanax, Klonopin, Ativan, and Valium) can decrease panic attacks by up to 70-75% almost immediately, but these tranquilizers have some major drawbacks, including sedation, memory loss, decreased reaction times, increased tolerance, the possibility of addiction, and withdrawal symptoms.
Therapy for panic attacks includes education about the disorder, as well as learning how to differentiate a panic attack from life-threatening disorders such as a heart attack or stroke. Therapy can help an individual realize the first signs of a panic attack, to initiate muscle relaxation and breathing techniques. Sufferers are taught to calm their thoughts and reactions by reminding themselves that the attack will be time-limited. Behavioral therapy may be another component of the treatment plan, related to gradual exposure to feared situations. A panic attack sufferer will tend to avoid perceived trigger situations at all costs. Cognitive therapy includes slowly introducing the individual to a trigger situation while he/she is in a safer environment. The goal is to make small strides towards confronting and overcoming a trigger.
What Can You Do If You Experience a Panic Attack?
- Don't be frightened; a panic attack cannot harm you.
- Flow with, rather than fight, the experience. The attack will pass sooner.
- Tell yourself, "I will not die," "I will not lose control," "I will not faint," "I am not going crazy," "I can breathe," "This will pass." Repeat.
- Breathe deeply in through your nose, hold it, and forcefully exhale through your mouth (like you are blowing out candles).
- Be cognizant of muscle tension. Relax your shoulders first, next progressively tense and hold, then relax each of your major muscle groups one by one, working downwards. Re-evaluate and notice where you are still tense; rework those areas.
- Write down everything you can remember about the attack after it passes. It will help you and your therapist understand the circumstances in which your attacks occur.
- Watch out for those frightening trigger thoughts. You have a better chance of winning the lottery than having a plane fall from the sky onto your patrol car.
- Call a hotline: 800-64-PANIC.
How to Help Someone Having a Panic Attack
- Remember, a panic attack may be caused by very real conditions, such as hypoglycemia, inner-ear infections, and even congenital heart defects. If uncertain about a person’s medical stability call for paramedic back-up. Ask the person to describe what they believe is causing them to have a panic attack. Individuals who experience panic attacks often feel as if they are having a heart attack or dying. It is important to determine as quickly as possible whether there is a real physical danger or medical emergency.
- Ascertain the individual if he/she is currently being treated by a medical professional for an anxiety disorder. He/she may be using prescription medications, combined with behavioral modification techniques to deal with panic attacks that may be helpful in the current situation.
- Avoid discrediting the reasons why someone is having a panic attack. Do not use phrases like "there's nothing to worry about" or "it's all in your head", this will make the person feel more isolated, exacerbating the situation. Try to remain empathetic.
- Stay with someone who is having a panic attack by staying with him for the duration of the episode (usually about ten minutes). Have the individual sit down and talk to him/her in a relaxed and calm manner.
- If the individual is transported to a corrections facility notify the staff of their condition. A trip to an emergency room is normally not necessary and may in fact make the situation worse.
By the way, Eric received effective treatment, and will be testing soon for a promotion. He has learned to make physical and mental health a priority in his life.
For anyone experiencing panic or anxiety I suggest using the song/video “Weightless” by Macaroni Union. It has been scientifically proven to reduce anxiety by 65% and the resting heart rate by 35%. It takes about 8 minutes, but it is time well spent.
https://www.youtube.com/watch?v=UfcAVejslrU
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
