Confronting anxiety

Superstar Jennie Blackpink usually experiences panic attacks when surrounded by fans at airports. Similarly, artist Jeongyeon of the girl group Twice experiences anxiety and panic disorder so much so that she reportedly had to halt all activities three years ago to allow herself to recover.

Panic attacks among Thai celebrities are also prevalent, in recent years a rising number of Thai entertainment figures have come out and shared their experiences battling mental health conditions including Keerati "Gypsy" Mahaplearkpong, Suphaphorn "Boom" Wongthuaithong and Thanapob "Tor" Leeratanakachorn to name a few.

Psychiatrist Dr Ornpailin Ratanapinsiri from Phyathai Phaholyothin Hospital said the fact that people have more knowledge regarding mental health has led to better access to services and treatments. This explains why panic attacks have been increasingly diagnosed in recent years, especially following the Covid-19 pandemic.

"Panic attacks are associated with anxiety. The spread of Covid-19 brought about changes and people started to feel uncertainty and challenges. People lived in isolation to prevent getting infected and many lost their jobs. These experiences worsened people's anxiety which later turned into panic attacks," explained Dr Ornpailin.

The psychiatrist pointed out that excessive social media use can turn the situation from bad to worse as information overload apparently affects mental health, especially when it comes to negative data and dialogue.

Dr Ornpailin cited statistics from epidemiological articles and research both in Thailand and abroad which found that 7%-9% of the global population suffers from panic attacks annually while 1% fall prey to panic disorder. In Thailand, approximately 0.7% to 12.4% of new mental health patients are diagnosed as having panic disorder.

On a positive note, the number of patients suffering panic attacks and disorder capable of socialising has risen from 0.2% to 0.7%, added the specialist.

A panic attack is usually characterised by physical symptoms first such as a rapid, pounding heart rate, and therefore patients are first referred to a cardiologist. In fact, according to Dr Ornpailin, a panic attack can be described as a sudden episode of intense fear that triggers certain physical reactions. Although patients might feel like they are in real danger or even feel like dying, symptoms of panic attacks are not life-threatening.

Both physical and mental factors are responsible for panic attacks. Heredity plays a significant role while defects in the body's autonomic nervous system are also likely to cause the development of panic attacks and disorder.

"Mental or emotional factors, including stress, anxiety or changes in life such as career, relocation, break up or loss of loved ones are contributing factors to panic attacks," Dr Ornpailin said.

Panic attacks usually begin suddenly and can strike at anytime, anywhere without warning. Symptoms vary, such as pounding heart rate, shortness of breath, tightness in the chest, sweating, trembling or shaking, numbness, abdominal discomfort, faintness, chills or hot flashes, and fear of losing control of oneself or of becoming insane.

"When panic attacks happen so frequently that they lead to behavioural changes for at least a month, then it could potentially become panic disorder," Dr Ornpailin added.

How bad is too bad?

If the symptoms are beyond control or happen too frequently, then a consultation with a psychiatrist or psychological expert is highly recommended.

"The bottom line is panic attacks should not affect people's daily life," Dr Ornpailin stressed. "If the symptoms are left unattended for so long that patients cannot continue working or cannot live by themselves, then it could take longer to keep the condition at bay."

Treatments do not necessarily involve medication. However, it is paramount to understand that signs and symptoms are not fatal and that patients are not in real danger when conditions develop.

"I would recommend breathing exercises," advised the specialist. "Gently breathe in and out until your anxiety is relieved. Then the symptoms will go away."

If that doesn't work, medication to restore the balance of neurotransmitters can be prescribed for at least six months as it takes at least one month for the medicine to take effect.

It is also important to note that if left unattended, panic attacks can lead to depression. But medically speaking, panic attacks and depression are in fact two different psychological conditions.

"Panic attacks are characterised mainly as feelings of anxiety that strike for a short moment -- minutes to half-an-hour," she said. "Depression, on the other hand, involves hopelessness which lingers for at least two weeks."

In the context of Thai culture, people are usually told that emotions must be curbed. But Dr Ornpailin said that emotions are common -- be they anxiety, stress or sadness.

But emotions should be monitored. "Emotions should not be too intense," she noted. "If you are, for example, worried about one thing for two or three days that you start to feel so down, it could lead to a bad mood and even depression.

"Stress is not a crime. But you must be mindful of it. You might allow yourself to have a negative mood, but if it gets too much, go find something else to do. Make sure you have control over your own emotions."

In case of uncontrollable, unmanageable stress and anxiety, talking to a trustworthy person can be a way out, said the mental health expert. Being a good listener without judging is therefore important when dealing with a person with mental health conditions. However, if things get beyond control, it is a good idea to visit a psychiatrist or psychological expert for consultation, discussion or therapy.

"A friend or a family member can be a good listener. But in many cases, we found that there is a certain level of sensitivity among them. Medical experts can maintain neutrality when dealing with mental health patients, so do not hesitate to reach out for help."