During the Covid-19 pandemic, there was a 12% increase in the use of anxiolytics compared to the previous year (2019). The AIFA (Italian Medicines Agency) reports that peak consumption occurred during the so-called phase 2 of the epidemic. Indeed, as revealed by research conducted by the Catholic University of Rome, the climate of uncertainty and concern, fear of contagion, and prolonged social isolation negatively affected psychophysical well-being. In recent months, there has been an exacerbation of pre-existing Anxiety Disorders and an increase in new cases among the general population.
The most frequent and well-known anxiety symptom is the panic attack.
What Is a Panic Attack
A panic attack is characterized by a specific experience of fear and intense distress that reaches its peak within a few minutes. It can occur suddenly from a state of calm or emerge unexpectedly from an already anxious state. Furthermore, panic attacks are distinguished as:
- Expected: dependent on the clear presence of a triggering element (trigger);
- Unexpected: in which no evidence of a trigger is found in the situation where they occur.
Although panic attack is the most common anxiety disorder, it can also be present in Depressive Disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and Substance Use Disorder.
To define the experience as a panic attack according to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), at least 4 of the symptoms listed below must be present simultaneously:
Physical Symptoms of Panic Attack
Physical sensations and manifestations of panic attack are as follows:
- Palpitations
- Sweating
- Trembling
- Dyspnea or “air hunger”
- Sensation of choking
- Chest pain or discomfort
- Nausea
- Sensations of dizziness or fainting
- Chills or hot flashes
- Sensations of numbness or tingling (paresthesias)
- Sensation of unreality (Derealization) or Sensation of being detached from oneself (Depersonalization)
Cognitive Symptoms of Panic Attack
The typical thoughts that arise during a panic attack are:
- Fear of losing control or “going crazy”
- Fear of dying
When an unexpected Panic Attack (PA) is recurrent, followed for at least one month by avoidance and/or fear of having another one, then we speak of Panic Disorder, ensuring that the PA is not attributable to either another mental disorder or a specific medical condition.
Panic Disorder: From Solitude to Fear
The fear experienced during a panic attack and the fear that it may occur again (the so-called “fear of fear”), which leads to avoiding environments and situations believed to trigger panic, have been the gravitational center of etiological interpretation and psychotherapeutic treatment for many years.
Gianni Francesetti, together with Antonio Alcaro and Michele Settanni, however, in a recent article (Panic disorder: attack of fear or acute attack of solitude?), question the approach that views fear as the primary cause of panic disorder. Indeed, meta-analysis of numerous studies would emphasize that therapies embracing this view (based on systematic desensitization) do not achieve significantly effective long-term results.
The three authors propose an alternative understanding of Panic Disorder: it would not be an exaggerated and uncontrolled fear response, but rather “an acute attack of solitude“.
What Is the Cause of Panic Disorder?
Francesetti, using the phenomenological-Gestalt method (to learn more), meticulously reconstructs the experience of those suffering from Panic Disorder. The onset and evolution of panic attack are thus described in 3 steps.
- Experience of dying or going crazy perceived as physical distress (physical symptoms);
- Fear of dying or going insane (cognitive symptoms);
- Fear that once the episode ends, it may happen again (the fear of fear that gives rise to avoidance).
But what experience provokes such a response? When one perceives the absence of those significant affective bonds and support in facing a new environment, devoid of relationships and sense of belonging: in short, when one feels alone, estranged, exposed.
The onset of panic attack occurs, therefore, when the body somatizes the experience of solitude (solitude that is not recognized, indeed mostly denied by the person) and only subsequently evolves into the emotion of fear which, being recognizable and pervasive, covers the real need: not to be alone.
On the other hand, the “attack of solitude” thesis also finds support in recent research in Affective Neuroscience, a field of study inaugurated by neuroscientist Panksepp. In experiments on mammals, it was observed that when the subject perceives danger, a specific neurophysiological pathway is activated, the Fear emotional system; whereas when the subject is separated and isolated from its relational and affective context, another brain pathway is activated: the Panic/Grief emotional system due to separation distress. Indeed, the latter, and not the Fear system, would explain many of the symptoms of Panic Disorder.
Furthermore, following this trajectory, one would also understand why the peak of anxiety during the pandemic did not occur at the beginning, but only in the second phase. The experience of estrangement (disrupted personal and social habits) and sense of exposure (to contagion, job loss, etc.) due to social isolation (as well as the loss of loved ones) did not find that secure relational and affective ground essential for the person to process them, but instead generated, as AIFA reports, the progressive increase in anxiolytic consumption.
Psychotherapeutic Treatment
Usually, a person with Panic Disorder seeks a psychotherapist almost always long after the first Panic Attack and is generally a very autonomous person, accustomed to managing on their own. Only when anxiety makes the space of their daily life so narrow that they can barely move do they decide to ask for help.
Working on recognizing emotions, achieving personal awareness, and reconstructing one’s affective biography are paths to undertake during that adventurous journey that is therapy. Such is life: the other is significant because they accompany us through those life passages that involve the inevitable access to unknown landscapes.
