How do you know if you're having a panic attack or just a normal reaction to stress?
By Daniel DeNoon
Reviewed By Michael Smith
Army Sgt. Georg-Andreas Pogany didn't know what was happening to him. His head throbbed, Pogany told The New York Times and The Gazette of Colorado Springs, Colo. His chest ached and his stomach rebelled. He shook for hours with an overwhelming sense that he could die at any moment.
Was it cowardice? That's what the U.S. Army said in its first formal charge of "cowardly conduct as a result of fear" since the Vietnam War. Just one day before his court martial, the Army dropped the cowardice claim. Pogany still faces reduced charges of dereliction of duty.
The Army has its own definition of cowardly conduct. But what Pogany experienced isn't the result of cowardice, experts tell WebMD. It's the result of being human.
Trauma, Stress, and Panic
About a month ago, on his second night in Iraq, Pogany saw an Iraqi cut in half by heavy machine-gun fire. It was his first exposure to this kind of situation, and he had what he describes as a panic attack. An interrogator assigned to a Green Beret team, Pogany told his superiors he was unfit for duty and needed help.
Instead, he was confined to his room and put on suicide watch, even though he says he wasn't suicidal. Eventually he was moved to a larger military base. A psychologist there diagnosed normal combat stress reaction and recommended he rejoin his unit after a few days' rest. Instead, he was called a coward and sent back to the U.S. for court martial.
Was it really a panic attack? That's what it sounds like to David H. Barlow, PhD, director of the Center for Anxiety and Related Disorders at Boston University.
"It certainly sounds like a panic attack," Barlow tells WebMD. "A panic attack is the fundamental emotion of fear. It's the flight/fight response that we all have in us. It involves massive changes in the brain. It is meant to prepare you to deal with this life-threatening event by running away or by fighting, attacking the source of danger."
Barlow says panic attacks occur in two different conditions. One is a "true reaction" to a traumatic event. The other is a "false reaction" where there is no obvious triggering event.
Barbara Rothbaum, PhD, director of the trauma and anxiety recovery program at Emory University in Atlanta, prefers a different term for what Pogany seems to have experienced.
"This soldier's case sounds more like a posttrauma reaction, which many people describe as a panic attack," Rothbaum tells WebMD. "Seeing something like that and having that kind of reaction is basically responding to a trauma."
Barlow and Rothbaum both say that this is a normal reaction to an abnormal event.
"Your emotions take over before your brain can react with rational thought," Barlow says. "In cases with a trigger, like this soldier, any time that something occurred that reminded him of it he will relive it and have flashbacks. That is a part of acute stress disorder. It is not uncommon immediately after major trauma if you were not prepared for it: 50% to 60% of the population would have this reaction."
Why do some people get panic attacks and not others? Barlow says we inherit the ways we respond to stress.
"If a person is under stress at work or home, or even under the stress of a positive thing like getting married, panic attacks can happen," he says. "If you have it within you that this is the way you react to stress, you may have one of these false alarms. Others might get irritable bowel syndrome instead. But all of these ways of reacting to stress run in families."
Panic vs. Anxiety
Rothbaum makes a distinction between panic attacks and anxiety attacks.
"A panic attack is very brief. Most people describe it as a wave coming over them," she says. "Most of the time it is over in a minute or two. There are a lot of physical symptoms: You get shortness of breath, lightheaded, dizzy. You feel your heart pounding, you may feel like choking, and there are a number of other unpleasant sensations. Then, afterwards, some people develop the fear of this fear, which can trigger new panic attacks. This is panic disorder."
Unlike panic attacks, anxiety attacks keep on going.
"People can maintain an anxiety attack for a long time," Rothbaum says. "It can have a lot of physical symptoms.
What it all comes down to is the very common -- and sometimes very useful -- human experience of fear.
"We are hard wired for fear. As long as we have been humans, we have experienced fear," Rothbaum says. "It kept our ancestors alive. We don't need it as much in our modern lives, if that system gets fired it feels just like a lion is chasing us. One fear may seem rational and another may be less rational, but both feel the same."
But some people become immobilized when they experience fear. Is that cowardice?
"It has nothing to do with cowardice," Rothbaum says. "I talk about people being brave or courageous when they can do something in the face of fear. But if we can't do something we fear, it is called avoidance. Sometimes a person can't overcome the avoidance. It is very strong in us."
Published Nov. 11, 2003.
SOURCES: David H. Barlow, PhD, director, Center for Anxiety and Related Disorders, Boston University. Barbara Rothbaum, PhD, director, Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta. Jeffrey Gettleman, "Soldier Accused as Coward Says He Is Guilty Only of Panic Attack," The New York Times, Nov. 6, 2003. John Diedrich, "Carson Soldier Faces Charge of Cowardice," The Gazette, Colorado Springs, Colo., Oct. 30, 2003. Jeffrey Gettleman, "Reduced Charges for Soldier Accused of Cowardice in Iraq," The New York Times, Nov. 7, 2003.
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