Panic Attacks Are Paradoxical

Panic attacks are paradoxical because they continue to happen even if what's causing the panic doesn't happen. In other words, the person panicking about dying doesn't die. In this article, we're going to talk about equipotentiality. Also, the role of the hippocampus and avoidance or safety behaviors.
Panic Attacks Are Paradoxical

Last update: 23 June, 2021

Panic attacks are so common that you probably know someone who suffers from them or who will at some point in their life. Therefore, it’s important to understand why panic attacks are paradoxical.

Panic attacks are intimately related to anxiety, even though not all anxiety disorders manifest with panic attacks. Panic attacks are counterintuitive.

When someone has a panic attack, they feel like they’re going to die. This sensation comes on suddenly and is extremely intense. In fact, the sufferer often feels terrified. However, in reality, very few, if any, people have actually died from the symptoms caused by a panic attack per se.

Therefore, it’s interesting to study the paradox of recurrent panic attacks. Why does a person experience another panic attack if they’ve already had one and didn’t die? Furthermore, why is their next panic attack just as bad or even worse?

The feedback loop of panic attacks

Before talking about the paradox of a panic attack, it’s important to understand how they happen. Various explanatory models suggest that the idea of a feedback loop between several elements. These could be:

  • Physiological or cognitive changes. For example, fear, anger, and frustration. In other words, any circumstances that cause a person to be tense.
  • Perception of body changes. The sufferer becomes aware of their breathing or their heart beating faster and begins to worry. However, some panic attacks occur without these warning signs.
  • Association with a threat. If a sufferer feels threatened, this causes body changes that trigger fear, and anxiety.

These three factors are all fed back, thus becoming a positive feedback loop. For example, a person who’s already had a heart attack might be extremely afraid that they’ll have another one and they start to sweat excessively. This symptom only disappears when a negative feedback element comes into play, such as sitting down, trying to relax, or employing coping strategies.

There are primary and secondary symptoms of panic attacks. The primary symptoms are those that the sufferer notices first. They include choking, dizziness, and palpitations. The secondary symptoms occur when the first ones have been negatively judged by the sufferer. These include sweating and trembling. They occur because the sufferer believes that something is, indeed, happening to them.

The cognitive theory of a panic attack

Catastrophic thoughts are automatic and instantaneous in panic disorder and agoraphobia. Sufferers also tend to interpret their bodily sensations in a negative way.

Due to their negative bias, sufferers tend to find catastrophic meanings in the smallest of things. For example, people with greater sensitivity to panic attacks will tend to answer every question with a catastrophizing answer. For instance, possible answers to the question “Why is my heart beating so fast?” could be “Because I’ve just seen my girlfriend”, “Because I’m happy”, or “Because I’ve smoked too much”, “Because I’m having a heart attack”. People with a negative bias will choose this last option.

The key factor of catastrophic interpretation is the sufferer’s degree of belief, not the number of symptoms they experience. Consequently, even if they only experience one symptom, these people really think they’re going to die and have a panic attack.

Panic attacks are paradoxical because they don’t disappear

If a person has a fear of mice and is exposed to a roomful of rodents they can play and touch, they’ll realize that the animals pose no threat. Thus, they’ll stop fearing them. This is known as habituation. It happens in virtually every area of our lives.

For example, a child stops being afraid of school when they get used to it and see it poses no threat to them. Or a man stops fearing taking his car out when he realizes he’s able to drive without having an accident.

This happens due to exposure. Exposure is a technique that allows a sufferer to become habituated to a certain stimulus. Consequently, they realize that the catastrophic consequences they expected to happen before they underwent the exposure, don’t occur.

With panic attacks, the initial symptoms of choking, dizziness, and palpitations the sufferer experienced should no longer frighten them. Because they now know that these symptoms don’t lead to a heart attack. However, this isn’t always the case.

In fact, some people may only suffer a panic attack and never have another in their entire life. Others may have more than one and some may develop a panic disorder with weekly or even daily panic attacks. There are some answers as to why panic attacks might reoccur.


Depending on the nature of the stimulus, the sufferer may experience more or less fear. Preparedness theory suggests that there are certain fears and phobias with pre-existing associations that are slower to extinguish. These tend to be biological and acquired through evolution. For example, we’re more threatened with those fears that could be life-threatening, like height, due to the risk of falling.

Therefore, eliminating these kinds of fears is much more problematic. One such example might concern snakes. Indeed, just because you don’t get bitten on one occasion, doesn’t mean another snake won’t bite you in the future. Likewise, with a heart attack. It may not occur on every occasion, but there may be a time when the symptoms are a real warning sign.

Memories in the hippocampus

According to biochemist P. Quijada, the hippocampus is responsible for consolidating in the memory these dangerous events as memories. This means that, when people experience panic attacks, they’re “stored” in the hippocampus.

As a result, panic attack sufferers tend to have emotional memories of how badly they felt after their attacks. Those memories with high emotional content will be difficult to erase from their minds.

Diagram showing the hippocampus.
The hippocampus

Safety behaviors that worsen the problem

People who suffer from panic attacks tend to try to avoid the situations or stimuli that cause them. However, avoiding those situations or carrying out safety behaviors, actually makes the problem worse. Therefore, anxiety leads to avoidance which leads to anxiety.

Fear of panic attacks

The fact that the perceived threat doesn’t materialize after an attack doesn’t mean there’s nothing to fear. On the contrary, a new panic attack doesn’t confirm that the sufferer’s fear doesn’t exist; it actually validates it.

In fact, they find that having a panic attack is almost as dangerous as really having a heart attack. Because, even if they don’t die, they feel like they’re about to.

Nevertheless, panic attacks and disorders, while unpleasant, can be quickly and effectively treated. Thanks to psychoeducational, cognitive restructuring, behavioral techniques like relaxation and breathing, attentional focalization techniques, and exposure with response prevention, sufferers may never experience another panic attack.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Aronson, T. A. y Logue, C. M. (1987). On the longitudinal course of panic disorder: development history and predictors of phobic complications. Comprehensive Psychiatry, 28, 344-355.
  • Chambless, D. L. y Renneberg, B. (1988). Personality disorders of agoraphobics. Paper presented at World Congress of Behavior Therapy, Edinburgh, Scotland.
  • Green, M. A. y Curtis, G. C. (1988). Personality disorders in panic patients: Response to termination of antipanic medication. Journal of Personality Disorders, 2, 303-314.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.