What You Need To Know To Write Panic Attacks in Fiction
Panic attack is a topic that interests a lot of writers, over a broad range of genres, and it's easy to see why- writers are always looking for ways to pull an emotional reaction from their readers, and what better way to do that than by putting their characters through a traumatic, panic-inducing experience?
Let’s take a closer look at what is involved in a single panic attack, and at the larger diagnosis of panic disorder:
Criteria & Symptoms:
The DSM-V does not consider panic attacks an illness on their own, rather it's a symptom of something else. Panic attacks can either be expected (from an anxious state), or unexpected (from a calm state), and are defined as a surge of intense fear or discomfort that reaches its peak within minutes. To be considered a panic attack, the person must experience four or more of these symptoms during that time: (source)
Palpitations, pounding heart or rapid heart rate
Sweating
Trembling or shaking
Feeling of shortness of breath or smothering sensations
Chest pain
Feeling dizzy, light-headed or faint
Feeling of choking
Numbness or tingling
Chills or hot flashes
Nausea or abdominal pains
Feeling detached
Fear of losing control
Fear of dying
There are a couple of interesting things to note about panic attacks. The first being that panic attacks, if experienced in high frequency and accompanied with physical or psychological distress, can be diagnosed as Panic Disorder, but panic attacks can be a symptom of many other psychological disorders as well. PTSD, depression, all other anxiety disorders, OCD, and many more, all list panic attacks as a symptom. And on top of that, a panic attack can occur as a completely reasonable one-off reaction to a highly intense or traumatic event.
The second thing to consider is that a large concern for those who suffer from panic attacks is its impact on social functioning. People who experience unexpected panic attacks may compensate for their fear of having a public panic attack by reducing their exposure to social settings. This self-imposed isolation shouldn’t be confused with social anxiety because the fear of having an attack is eliciting the behaviour. The person may still want to maintain his or her social outings, but the fear is greater than the desire to be in public. (source)
A final consideration is that triggers for panic attacks are varied, depending on the person and their past experiences. In the case of unexpected panic attacks, there is no identifiable trigger necessary to produce the attack. In other cases, such as PTSD, triggers are often specific to the trauma a person has suffered. For social anxiety, the trigger can be related to being in a specific place (a crowded bus, at the front of a classroom, etc.), or to being outside the persons identified safe area (their home, etc.).
Examples:
I’ve never written about a character who suffered from a one-time panic attack, but I've written a character with PTSD and a one with social anxiety, both of whom exhibited the symptom of a panic attacks. I've talked about PTSD in a previous post, so I’m going to focus on the social anxiety character as today’s example.
Social anxiety poses many possibilities for characterization in fiction. Like anything, social anxiety is on a spectrum with some people experiencing milder symptoms and some experiencing more severe symptoms. Different people can find ways of coping with their disorder as well, such as timing their outings when places won’t be as busy, self-medicating with drugs or alcohol before having to attend a function, or avoiding going out at all. I once wrote a character who carried a pack of cigarettes in her purse, even though she wasn't a smoker, just in case her anxiety became too high during social functions. She could slip out for a “smoke break” to get away for a few minutes. Her character would be fairly low on the social anxiety spectrum- she was able to attend social outings, had a couple of tricks for dealing with the anxiety, and had never experienced the intense fear of a panic attack.
In the last novel I wrote, Something To Prove, the male character in the story has a much more severe reaction to social outings. Franco is quite recluse, enabled to do so by his friend, Lex. Rarely does he ever have to leave his apartment and when he does he's very selective on when he leaves and where he goes. He’s developed many unhealthy coping mechanisms to deal with his anxiety. Things change for him, however, when he meets Kate. He's encouraged and compelled to find better ways of coping. Especially when he makes the choice to try to hide the severity of his anxiety from her. He realizes how difficult that will be when he attempts a trip to the grocery store with Lex and finds himself in the middle of a mild panic attack at the till. This panic attack would be classified as an expected attack, because it came from an anxious state. Franco had been experiencing anxiety about the trip long before he ever reached the till. The things we do for love, right?
The following is an excerpt from the story. It's not a full blown attack, nor it is very tense, but it's just one example of how a panic attack scene can be written. This is unedited first draft stuff here, included only for the purposes of helping others. Go easy on me, okay?
The lady behind the till smiled up at me with her dentures gleaming under the fluorescent lights but I couldn’t control my face enough to smile back. She was a harmless little lady with a face like an old potato and bright red fingernails, but at the moment she was my tormentor, scanning each item with a pace a sloth would be impatient with. It didn’t help that each item she pushed through was irrelevant crap I didn’t even want. The tension in my shoulders amplified with each beep from her god damned machine.
The line was growing behind us. I didn’t dare chance a look, but I could feel all the eyes warming the skin on the side of my face. I shifted on my feet, as imperceptibly as I could, in an attempt to loosen the cotton sticking to the sweat on my back. I was losing confidence in making it out of here upright if I didn't get my bag of tic-tacs and peanut butter out the door soon.
By the time she gave me the total, my fingers were numb and pulling my wallet out was a fumbling mess. The chatter of the store faded away as the woman’s eyes watched my every movement. It felt like all the blood drained from my fingers and face and toes in a rush, concentrating in my pounding chest.
Forget this.
I reached out with a tremor I couldn’t contain and passed my wallet to Lex, gathering my bag while he fished out some bills. I sucked in breaths as I forced my feet to move as quickly as I could without breaking into a run. I was out the door before she handed him the change.
There are improvements to be made here for sure, but hopefully I have the makings of a panic attack scene and hopefully you find it helpful to have an example of how it can be handled.
I’ve included the sources for information used in this article and have updated my Resources page with links to some sites that talk more about panic attacks. This is by no means a substitute for professional advice or clinical assessment.
Leave a comment or send me an email if you have any questions about panic attacks or panic disorder as they relate to your specific character. I'd be happy to help where I can!
-Everly