Is your child really having a panic attack?

Some things I frequently hear from my child patients and parents alike are “I [my kid] is having panic attacks all the time.” After I ask what symptoms they are experiencing, usually only around 2/10 are experiencing actual clinical panic attacks. In order to really start reducing this confusion, let’s begin by defining a panic attack (not an “anxiety attack,” which is a layman’s term). According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), also known as the DSM-5, a panic attack is “an abrupt surge of fear or intense discomfort that reaches a peak within a few minutes, and during which four or more of the following symptoms occur”:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Chills or heat sensations
  10. Paresthesias (numbness or tingling sensations)
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. Fear of losing control or going crazy
  13. Fear of dying

The presence of panic attacks are not a diagnosis in and of itself. However, depending on how frequently they occur, and in what context they appear (e.g., do they appear “out of the blue” or do they occur only in social situations), this clinical information can determine a more serious diagnosis (e.g., Panic Disorder vs. Social Anxiety Disorder).

I frequently hear “my child is stressing out, crying all the time, and is nonsensical when they speak.” While these symptoms can accompany panic attack symptoms, they alone do not count for panic symptoms. If you do think your child is experiencing panic symptoms, they should be getting a proper clinical evaluation by a mental health professional to determine the duration, type, and clinical presentation of the symptoms. This way, they can be properly diagnosed and then treated.


Speaking with your children about Terrorism

With recent events in Brussels, Paris and the Ivory Coast, and current threats in my home area of Washington, D.C., I find this topic is coming up quite a bit in sessions with my patients. So, I thought I would address it to my readers.

Colloquially, I hear a lot of parents saying “talking about terrorism is not appropriate for a child to learn about” and they take the stance of “hear no evil, see no evil.” The problem is, as much as I would love (and I mean LOVE) for that to be reality, whether we discuss it or not with our children, they may hear about it in some form or another from friends, extended family, teachers, news broadcasts, or a random stranger on the street.

So, the question is, if we know that our children may get some exposure to this harsh reality, do we avoid talking about or do we not? If we do talk about, how do we do so? Some questions I hear frequently from my parents with anxious children is: “I don’t want to make them more scared of the world, I don’t want them to be frightened to leave the house, I want them to know the world out there is safe.” These are very legitimate concerns I hope to address.

Terrorism causes fear of an unpredictable nature, or more technically, our ability to “tolerate uncertainty.” When I meet with patients, especially those with pre-existing anxiety, I ask them to look at 7 days of their life, a week, and assess how much control they have over their life throughout the week (i.e., how much time to do you spend making deliberate decisions that are thought out, and decide how you will react emotionally to an event, situation, or another person). In the office, I initially get a response of 70-90%. However, when looking at the actual recorded data over a real-time period of 7 days, the percentage dramatically and consistently drops to 5-15%. This example demonstrates that we believe we have much more control over our life than we actually do. We can also overestimate our belief that we can control bad things from happening AND that if we hear more about an event happening, it is likely to increase the possibility of that event actually happening.

Did you know that your chances of getting hit by lightning is 1 in 700,000 (and in your lifetime is 1 in 3,000), whereas your chances of dying from a terrorist attack is 1 in 20 million? Because we hear more about these awful terrorist situations on the news or from friends, we can have what is a called a “thought-action” fusion. It feels as though the mere thought of dying in a terrorist attack somehow increases our actual chances. Logically, we all know this just is not true, but our emotions tell us something different altogether. It is hard for parents to tolerate the discomfort of knowing the majority of our own lives and our children’s lives are not within our conscious control. However, if we can teach our child to begin to tolerate circumstances such as these, it can have generalizing effects for being able to tolerate uncertainty and distressing situations in the future.

If you decide as a parent to speak with your child about current events, it can be done in several ways. A younger child, ages 3-7, may or may not have been introduced to the concept of terrorism. A way to gage whether they have been already exposed is to ask them, “do you ever hear about bad guys?” Keep it general and more elusive, and let them take the helm of the conversation. They may say, “yes, kids at school are talking about scary things in Paris” OR they may say, “you mean like Ursula from Little Mermaid?” There really is no reason to bring up unnecessary horrors of terrorism to young children if you can be relatively sure they are not thinking about it. However, it DOES NOT mean that you can’t give them skills in place in case they do hear about it in the future. A younger child, ages 3-7, has likely already been introduced to “bad guys” in movies or books. It’s a relatively effective way to frame people who want to hurt others. However, letting them know that you are there to protect them and the world still remains a safe place is important for them to know.

With older children, ages 8-14, you can be more specific (and increasingly complex with older teenagers) when discussing world events. This is an age group that will likely have gotten some exposure to current events. Frame the events in a way that they can understand there are some unpredictable events in the world, but the chances of something happening to you is still extremely small (you can even use the example above). You want to model for them that you do not avoid harsh topics, because when we as parents avoid, it reinforces to the child that there is something legitimate to be concerned over. Sometimes it also helps to develop a specific plan of action in case there is anything that the family ever encounters. Worrying is non-productive if there is no end date in mind, but it can be productive if it leads to problem-solving techniques.

In these strategies, we can help our children tolerate the harsh realities of the world, build their resiliency to stressful events, and their abilities to tolerate distress and uncertainty. Let me know your thoughts on this very difficult, personal, and challenging family topic.