Picture this: you’re in a dark room that reeks of sewage. Twine ties you to a chair, rubbing your wrists and ankles raw. You haven’t eaten in 48 hours.
A man approaches, holding a gun to your forehead. He clicks off the safety. Fires.
Though no bullet comes out, and your heart tries to flutter in relief, there are more shots, more potential bullets. He shoots you again. Again. Again—
Little do you know, the man has no access to bullets. His aim is only to scare you, but he’ll release you soon when he realizes he captured the wrong person.
But that is the terror of a panic attack. They’re as scary as a real life-or-death situation, despite causing you no physical harm.
As such, they’re potentially traumatic experiences that should be handled carefully.
If you’re looking to write a panic attack, you may be able to find lists of possible panic attack symptoms, and some videos where people give brief descriptions of theirs. But what if you have a major panic attack scene in your story? What if you write from the point of view of the person having a panic attack? Is that enough information for you?
Here is, in detail, what panic attacks are like for me. Because of this, I’m giving a trigger warning for the rest of the article for discussion/descriptions of anxiety, panic attacks, and vomiting.
My first panic attack happened my junior year of high school. I had (and still have) emetophobia, the fear of vomiting, and one of the phobia’s unique characteristics is that unlike other phobias, exposure to the trigger (vomiting) actually often makes the anxiety worse instead of it being a helpful exposure. Many people have panic attacks that don’t stem from obvious triggers, but some do, such as mine.
At the time of this story, it was Christmas season, and we were having extended family over to celebrate. But before they arrived, I began to feel nauseous, likely due to people I didn’t see often coming over and disrupting my space, though I didn’t make this connection then. This nausea did not let up as the afternoon and then night continued. Because I felt nauseous, I didn’t eat, which likely contributed to the feeling of sickness but I didn’t realize it at the time.
I tried to distract myself with other thoughts and by interacting with family, but the nausea carried on for hours and hours, pumping my body full of anxiety—was I going to get sick? It wouldn’t go away no matter what I did. I couldn’t shake it off. With the high anxiety combined with the uncomfortable nausea, I just wanted to fall unconscious, but of course, no one would knock me out for that. I did manage to fall asleep that night, however.
But I woke up in the middle of the night, my torso burning with a feverish heat. I had never felt this sensation before, and found it so uncomfortable I got up and went to the bathroom in the hopes that doing something would shake it from my head. I pulled off my shirt to try to ease the heat.
But I ended up vomiting there.
When I did so, the nausea went away, so I thought I was safe. But then I started worrying about what if it did come back, and the fear returned with an even greater force than the first. I was trying to sleep on the floor of my parents’ room now, but the feverish heat came back. And the terror that caused it felt as if I was in a life-or-death situation. It was a flaying, consuming terror. I was trapped in my body. I was trembling, sweating, and my ears rang before I vomited again.
I ended up falling asleep on the bathroom floor because it was the only place I felt remotely safe. Having to move to a different room before I could vomit would make it all the more stressful. Eventually, I woke up feeling better, and crawled back into the sleeping bag.
That night was my first panic attacks, and the experience was so awful and traumatic that it was the sole reason I decided to go on anxiety medication.
For me, the fear that can lead to a panic attack is almost… muted. It feels different from a raw, urgent terror of more normal worries that everyone experiences. But it is still nightmare-like, mimicking a life-or-death situation. It feels like the world turns into an apocalypse.
Many people who experience panic attacks say it feels like a heart attack, like they’re dying. They have chest pain and tightness, and often go to the hospital at least the first time because they’re convinced they need emergency medical attention. I, on the other hand, have more “atypical” symptoms, according to public knowledge of panic attacks.
Nowadays, with medication and as my emetophobia has calmed on its own, panic attacks for me are very rare. Even if I’m nauseous and I end up vomiting from anxiety, I still might not reach panic attack level as far as terror and physical symptoms go. But my panic attacks have changed since the first incident as they’ve settled into my body as a normal thing. Here’s how they go:
At the very beginning of an episode that will lead to a panic attack comes the anxiety. I have to be feeling anxious about something. Since I’ve only gotten panic attacks related to my emetophobia, I’ll be anxious about vomiting. This means I’ll also be nauseous at the same time, as nausea comes with emetophobia worries.
Next comes a need to defecate. When I reach a certain anxiety level, I get this feeling. The shaking and/or sweating also begins here.
Third comes the symptom that I know means I’m crossing over into actual panic attack territory: the feverish heat. It starts in the center of my chest and grows outward the more and more anxious I get, until it will eventually cover my whole torso if I get anxious enough.
Finally, if I still haven’t managed to calm myself down, I will enter a full-on panic attack. In this stage, the terror is so intense that I only have the mental capacity to stare at a single app on my phone—look at it on the homescreen, not play it—and focus on my breathing. This is because any sensory stimuli I experience in this stage bounce around inside my skull, making the chaos in my head worse. I can’t stand any sounds or watching things move, and if someone touches me, even just tapping my hand, I will feel trapped. Also in this stage, the part of my brain that keeps track of time warps. I am incapable of giving an accurate guess on how much time has passed. Once early last year, when I was going in and out of this state, I thought the episode lasted for 20 minutes, but when I checked my phone, I found out it actually lasted closer to an hour. Vomiting is not guaranteed from the panic attack level, but if the anxiety goes too far, I will vomit.
Since I’m terrified of vomiting, and panic attacks are torturous, my utmost goal during an anxiety spiral is to not reach that last level.
I try to prevent this, first, by reassurance. I tell myself all the reasons I could actually not be getting sick. For example, I don’t have a stomach virus because if I were, I’d be feeling the nausea in my head as well as in my stomach. The nausea also goes away some when I distract myself, so it must be anxiety. And I’ve felt nauseous for four hours, so if it were not anxiety, I likely would’ve been sick by now.
Anxiety medication has made me more able to reason with myself this way. But as I mentioned in the previous paragraph, I can also try to distract myself with activities that draw my mind away from anxious thoughts. For example, I can listen to music while daydreaming or play videogames. I also find going to a place with dimmer lighting or smelling nice scents helps calm me.
If despite all this I do enter a panic attack state, however, every coping mechanism except for going to a dim room stops working. I’m too scared of where my thoughts might lead at this stage to think much and I can’t stand any sensory stimuli. I just have to concentrate on my breathing to try to force my mind away from focusing on the nausea.
This means that people can’t really help me get out of a panic attack. The only thing they can do is help me leave a social situation so I can be alone in a dim room. Hugs or talking, things that help others, would make it worse for me.
Going along with that, I’ve also only had two people in my entire life be able to tell if I’m having a panic attack from the outside—my mom and my ex-boyfriend while we were still together. People who knew me very well. Because I also fear social repercussions due to my high social anxiety, I’m very good at acting normal from the outside even if I’m having the worst panic attack of my life. Though it’s very difficult and worsens the chaos in my head, I can hold a conversation, I can participate in a class, I can sing a song, etc.
Fortunately, however, with the help of my medication and just my general improvements with my phobia, I haven’t had a full panic attack in about a year.
Panic attacks are terrifying. They shouldn’t be used as a point of humor in a story (I’m looking at you, Avengers: Endgame), but instead treated with as the awful experiences they are. However, people and characters can deal with them. Your characters will survive, and will get better one day. They can go to therapy, get medication, and just grow through life, and they’ll get there.
I’m a sensitivity reader for anxiety, panic attacks, OCD, and other related topics. Click here to learn more about my services!
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