We talked about it with Professor Emi Bondi, president of the Italian Society of Psychiatry, DSMD Director, ASST Papa Giovanni of Bergamo
Fabio Fognini he confessed to suffering from panic attacks. In this regard, you said when a few years ago, while you were in Paris, “one night I got up almost crying, next to Flavia Pennetta. I thought I was dying. I was sweating, tachycardia, I didn’t feel my left arm. I thought I was having a heart attack. But no, it was a panic attack. The next day I entered the field and I didn’t know which fish to catch, I couldn’t breathe well. These panic attacks must be managed, they must be worked on, accustoming the mind with exercises”. We are talking about a disorder that is estimated to affect 1.5 to 5% of the Italian population. It usually occurs between the ages of 15 and 35, with a second peak of onset between the ages of 44 and 55. It is more common in the female population, but cases are increasing among men, especially professionals and managers.
What is it about? When we talk about “panic attacks” what exactly do we mean and how are they distinguished from anxiety crises?
“Anxiety in nature is an alarm system that is activated in situations of ‘potential danger’; panic attacks are an acute anxiety crisiswhich arises suddenly in the apparent absence of a triggering reason, characterized by a strong somatic component”, explains the professor Amy Bondi, president of the Italian Society of Psychiatry, DSMD Director, ASST Pope John of Bergamo. “The danger here,” continues Bondi, “is the ‘fear of dying’ from something that’s physically happening to us that we can’t understand. The affected person has a physical sensation of being sick, initially as difficulty breathing well and then with a physical sensation that he is unable to decipher but which scares him because it is as if something very serious were happening to him (heart attack, illness, stroke..). From the physical sensation it then develops mental anxiety, i.e. the fear of being able to die in that instant. It is an acute crisis that rises rapidly in a few minutes, reaches a climax and then gradually passes, due to a dysfunctional activation of the amygdala (the emotional center of our brain that processes the stimuli linked to the emotions that reach it). In ‘normal’ anxiety crises, i.e. belonging to what is defined as generalized anxiety or phobias, the anxiety starts from our mind, however generated by an apparent external danger. In other words, there is a thought, a concern for something we have to do, for a family member, for any stressful situation we have to deal with we respond with a hyperactivation, the anxious state precisely, which in this case can last even hours and which is of lesser intensity”.
What are the main causes and the most typical situations that can lead to a panic attack?
“Rather than causes, appearing precisely without cause, there are genetic risk factors (there is also a familiarity for panic attacks) and environmental ones: childhood trauma, situations of strong work or emotional stress, important life changes, dysfunctional lifestyles characterized by sleep deprivation, smoking, substance use”.
Depending on the factors that can trigger a panic attack, what can they reveal about us?
“The need to stop because our ability to cope with stressful events has decreased. Practically, we must regain resilience, that ability to know how to adapt to a traumatic event or a particularly difficult period”.
People who suffer from it also tend to implement avoidance strategies for fear of suffering an attack. For example, let’s think of those who are afraid of traveling by car in a tunnel and for this reason choose longer and more tortuous routes to get around them. Can you give us other examples?
“For those who have experienced it, a panic attack is equivalent to a real psychic trauma, so it is easily associated with avoidance behaviors, often related to the place or situation in which they experienced it, but also to situations in which it could occur . In people suffering from panic attacks you often have agoraphobiawhich is not the simple fear of open spaces, but a complex situation characterized by fear of being in a situation from which it is not possible to escape or find help in case of danger or in which it can be embarrassing to feel bad (e.g. crowds, supermarkets crowded) and that affects people’s lives a lot. Another situation is claustrophobia, the fear of closed places, where there may be ‘lack of air’, elevators, tunnels, in fact, travel by plane. Even in these cases, as can be easily guessed, avoidance behaviors lead to a significant reduction in social life and autonomy”.
How can we get out of this situation? With what therapies and also actions to implement?
“We have to go to a specialist to help us understand what is happening to us, to recognize the psychic genesis of the disorder (people are convinced they have a physical illness and continue to carry out tests and checks) and to undertake the most suitable path, both pharmacological and psychotherapeutic”.