Sweat beaded on his neck. A few seconds later, his fingertips went numb. Mark, a 28-year-old Web developer who was in his Manhattan office preparing for a crucial product launch, knew what would happen next: In about 15 seconds, he'd feel as if he'd lost control of his thoughts, then he'd start hyperventilating. Mark was having a panic attack, his body flooded with adrenaline, his fight-or-flight instinct ratcheting to DEFCON 1 without prompting. It feels like a heart attack, marked by chest pain, dizziness, sweating–even a fear of death—except that, after about 10 minutes, the symptoms usually subside and the sufferer is fine. At least in the short term. Over time, the afflicted often experience depression, substance abuse, and phobias, not to mention countless uncomfortable moments. "I had to say, 'I need to leave right now, I apologize,'" Mark says. He bolted the office and paced the streets, focusing only on his steps: left, right, left, right. Twenty minutes later, he came back and e-mailed his colleagues an explanation. "Once you've apologized to your boss," Mark says, "it's less embarrassing to have to excuse yourself."
Panic attacks are becoming mainstream in our hyperscheduled, hyperstressed world—6 million Americans are affected by panic disorder (episodes that occur from once every few months to multiple times a day). And although statistics show that female patients outnumber males by two to one, anecdotal evidence suggests that men are sometimes silent sufferers, and studies show that men are less likely to seek treatment for mental-health problems.
There are signs that the stigma may be fading, though—a string of high-profile athletes and A-list actors have recently acknowledged suffering from panic attacks, including Houston Rockets rookie Royce White, Robert Pattinson, Ryan Reynolds, and San Francisco Giants first baseman Aubrey Huff. "Most of us see plenty of male patients," says Sally Winston, Psy.D., the director of the Anxiety and Stress Disorders Institute of Maryland. In fact, according to experts, successful young men are probably just as likely to be at risk as the women who supposedly make up the majority of sufferers. C. Matthew Nichols, a New York City–based psychologist whose patients include Wall Street hard-chargers, says, "For very high-achieving, goal-oriented people, what's helpful in getting promoted can be really unhelpful to your mental health."
RESISTANCE IS FUTILE
The root cause of the disorder is not known, but genetics may be partly to blame; a study in Biological Psychiatry found that 40 percent of the risk for panic attacks is heritable. High-stress situations like business meetings and flights, life changes such as breakups and bereavement, and stimulants—caffeine and workouts, which elevate the heart rate—can cause the body to sense danger and trip an episode.
So how best to combat an attack? It may sound counterintuitive, but just let it happen. If you fight the symptoms, it's like physiological quicksand—resistance only gets you in deeper. Instead, surrender and wait for the feelings to pass. "Anyone who comes in to see a doctor thinking, 'I don't want to feel this, I don't want anyone to notice it,'" says Reid Wilson, Ph.D., of the Anxiety Disorders Treatment Center in Chapel Hill, North Carolina, "all of that is resistance, and it keeps the disorder alive." Although most sufferers develop coping rituals (Mark, the Web developer, relies on rhythmic pacing), these provide only a temporary fix. There's no silver bullet that will eliminate panic disorder. Doctors commonly prescribe SSRIs like Prozac and Paxil, or faster-acting benzodiazepines like Xanax, to help patients manage during particularly stressful times. Experts agree, however, that the only effective long-term treatment is cognitive behavioral therapy. The goal isn't to eliminate the episodes but to allow men to lead normal lives despite them. "So if you're really willing for it to happen, and you even invite it—okay, c'mon, come get me—it's less likely to actually happen," Winston says. In cognitive behavioral therapy, doctors attempt to trigger an attack—say, by having the patient breathe through a cocktail straw, which mimics shortness of breath—then coach the patient through passive recovery. "You get the symptoms, then you do nothing for 60 seconds, and in the next minute, the attack starts to dissipate," Wilson says. "These men realize that their sacred cows—the things they are doing to protect themselves—aren't necessary."
That's why Mark has decided to be open about his attacks with new coworkers and people he's dating. "I tell them, 'Hey, these things happen. It's not about you, I know how to handle it. Give it 10 minutes.' So that's an awkward conversation." But the next time it happens, Mark says, his friends and colleagues are prepared. And that helps him break the anxiety cycle. The fear of the next attack gradually recedes—and fearing an attack is an obstacle to kicking the condition. Or as Wilson says, "In general, follow this rule: Be scared and do it anyway."
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Six Surprising Triggers
Alcohol: Booze destabilizes blood-sugar levels, and energy highs and lows may cause you to feel physically unsteady.
Camping: Being far away from a hospital or medical care can make you feel vulnerable and out of control.
Dressing rooms: Being in a compromising position (in this case, undressed) in a place you can't quickly exit might induce fear.
Fluorescent lighting: Extremely bright or flickering lights can increase your heart rate.
Grocery stores/video games: Your eyes move quickly while you're in a grocery-store aisle or watching a screen with lots of action, which can incite dizziness.
MSG: Those sensitive to the food additive may experience cramping, flushing, elevated heart rate, and nausea, all of which mimic an attack and can trigger a real one.
Sources: David Sack, M.D., CEO of Promises Treatment Centers in Malibu and Los Angeles; Sally Winston, Psy.D., director of the Anxiety and Stress Disorders Institute of Maryland.
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