What are silent panic attacks?
Silent panic attacks are a subgroup of panic attacks. They are also known as non-fearful panic attacks. Silent panic attacks can occur randomly, without a fearful trigger.
Unlike regular panic attacks, silent panic attacks are not necessarily triggered by the fear of dying or going crazy [1]. They can be triggered for example by stressful situations like public speaking or presenting or intrusive thoughts.
When compared to regular panic attacks, silent panic attacks lead less often to anticipatory anxiety, known as silent anxiety attacks, and are usually not treated with medication [1]. Although it is less common, silent panic attacks can also lead to panic disorder and mental health conditions. However, they are less often associated with conditions like agoraphobia (a type of anxiety disorder), major depressive disorder and substance-related disorder [1]
Symptoms of a silent panic attack are for example shortness of breath, trembling, smothering and depersonalization [1].
However, it is important to note that these symptoms may differ from patient to patient and can also change overtime. Therefore, if you have concerns, it is important to get in touch with a mental health professional and often cognitive behavioural therapy is recommended [1].
What causes silent panic attacks?
There are a variety of causes which can trigger a silent panic attack. Although the exact cause is unknown, patients with mental health conditions like major depressive disorder, post-traumatic stress disorder, anxiety disorders or obsessive-compulsive disorder [2].
Further, genetic and epigenetic factors may also contribute to the development of panic attacks. To be precise, some studies have suggested panic disorder-related genes exist and epigenetic modifications (for instance hypomethylation) is associated with panic disorders as well [3].
However, there are other factors which can contribute to the occurrence of a silent panic attack:
For instance, psychological changes within the body have been detected as early as 47 minutes before the onset of panic attacks. In the study, they detected changes in the heart rate, skin conductance levels and respiration [4].
Further, self-administered pharmacological agents like caffeine, alcohol or nicotine, habits including sleep deprivation, diet and exercise or even environmental influence of lighting or life stressors can trigger the frequency and intensity of these attacks [5].
Excessive sweating might also contribute to the generation of panic attacks, as in a study investigating panic attacks they found a group of patients who had breathing difficulties and heavy sweating problems [6].
In addition, psychological causes like the fear of experiencing severe physical symptoms will need to be followed by a medical emergency can contribute to producing a panic attack [7].
Interestingly, hyperventilation has also been associated with panic attacks. In a study by Nardi et al., 69.2 % had a panic attack after hyperventilating [8, 7].
In conclusion, silent panic attacks can be caused by a combination of physiological, psychological, genetic, and environmental factors.