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When Panic Becomes a Catastrophic Sensation: How to Cope with Panic Attacks
In today's uncertain and anxious world, panic attacks have become an increasingly prominent topic. But what exactly are they, and how are they explained from a psychodynamic perspective (a term describing how internal psychological forces, conflicts, and experiences influence a person's thoughts, feelings, and behaviour)? They are not simply "exaggerated fear" — they are a complex psychological and physical experience often associated with a sense of losing control, a racing heartbeat, shortness of breath, and even the feeling that "something terrible is about to happen" (APA, 2022; Barlow, 2002).
For people who suffer from panic attacks, even ordinary everyday situations can become a source of anxiety. With the right psychotherapeutic support, however, these episodes can be understood, managed, and even prevented.
Anxiety vs. Panic Attack: Gradual Tension vs. Catastrophic Fear
Many people confuse anxiety and panic attacks, but they are fundamentally different phenomena (APA, 2022):
Anxiety – a prolonged feeling of tension and unease associated with anticipation of future threats. Symptoms include worry, muscle tension, fatigue, and difficulty concentrating. Anxiety can be moderate and even useful in everyday life.
Panic attack – a sudden episode of intense fear or terror, often without a clear cause. The symptoms are dramatic and physically expressed: palpitations, shortness of breath, dizziness, and a sense of losing control. It typically lasts from a few minutes to half an hour.
Key difference: anxiety is gradual and anticipatory, whereas a panic attack is sudden and intense, almost "catastrophic" in sensation (Clark, 1986).
Panic as an Inner Signal: The Body Speaks When the Mind Cannot
From a psychodynamic perspective, a panic attack can be understood as a signal of internal psychological processes and conflicts that have not been fully brought to consciousness. It is viewed not merely as a reaction to fear, but as an expression of tension between different parts of the psyche.
First and foremost, a panic attack can be seen as a signal of repressed desires and impulses. Classical psychoanalysis views the panic attack not simply as fear, but as a signal from the unconscious parts of the psyche (the unconscious being thoughts, feelings, and impulses that are not accessible to consciousness but influence behaviour). Anxiety is a signal from the ego (the psychoanalytic term for the part of the psyche that balances unconscious impulses with the demands of reality) that repressed impulses are attempting to break through into consciousness (Freud, 1995).
Panic can also be understood as a signal of unconscious conflicts related to significant others from early childhood. It may be connected to internalised objects (internal representations of significant others that influence emotional experience) and early childhood experiences that are activated under stress or when a sense of losing control arises. These signals are often expressed bodily and serve to draw attention to unresolved emotional conflicts that the psyche cannot symbolise through thoughts or words (Brenner, 1975; Abraham, 1924).
Taken together, Freud, Abraham, and Brenner help us understand that the panic attack is a complex psychological and physical experience that carries information about inner conflicts and the need for awareness and acceptance of emotions.
The Collapse of Inner Security: Catastrophe in the Psyche
According to Melanie Klein and Donald Winnicott, the psyche is built during early childhood development from the child's representations of significant others — so-called "internal objects." These objects can be good — soothing and nurturing — or hostile, and they influence how the individual experiences anxiety. A panic attack often arises when the sense of security provided by the "good internal object" disappears. Panic is therefore often associated with primitive anxiety — anxiety rooted in early emotional experiences, frequently felt as a fear of disintegration or annihilation (Klein, 2005). Anxiety in this context is experienced as a sense of:
Disintegration – a sense that the inner world is falling apart
Annihilation – fear of internal or external "destruction"
Loss of control – a sense that nothing can be managed
Psychic death – a feeling of total inner catastrophe (Brener, 1975).
Wilfred Bion (1962) adds that when raw anxiety cannot be endured and processed into a more comprehensible and bearable form, it manifests through intense bodily reactions that the person perceives as catastrophic.
How to Support Someone During a Panic Attack: Presence Instead of Pressure
A panic attack can be distressing both for the person experiencing it and for those around them. Appropriate support can help symptoms subside more quickly.
Practical guidance:
Stay calm — Maintaining a calm presence can help the person feel safer and more grounded. Short, clear sentences are helpful — for example: "Everything is okay, I'm here." or "Try to breathe slowly with me."
Avoid intrusive questions — Questions like "Are you okay?" or "Are you calming down?" can feel like pressure during a panic attack. It is better to focus on supportive words and actions rather than continual questioning.
Acknowledge their experience — Rather than minimising what they are going through, try saying something like: "I understand this feels frightening, but you are safe."
Support their breathing — You can count together or guide attention to slow, deep breathing: "Breathe in… 1, 2, 3, 4… Breathe out… 1, 2, 3, 4."
Offer a quieter space — If possible, moving to a calm place, away from noise and crowds, can help the nervous system settle.
Use grounding objects — You might suggest that the person touch or hold an object nearby — such as a chair, keys, or a phone. This often helps establish contact with reality and reduce tension.
Redirect attention — Helping the person focus on a specific task — such as counting, reciting a poem, or naming objects nearby — can distract the mind from panicked thoughts and support a sense of control.
Avoid physical pressure — Pulling, shaking, or gripping someone is generally unhelpful unless there is an immediate risk of harm.
After the attack — When the panic subsides, stay with the person and offer support. Listening and being present without judgement are valuable for recovery (Barlow, 2002; NIMH, 2022). Presence and attentiveness, without pressure or intrusive questions, help the person feel safe and supported, which can reduce the intensity of symptoms.
How Can Psychotherapy Help?
Understanding the causes — The psychotherapist helps the patient connect panic attacks to specific inner conflicts, traumatic experiences, or unconscious fears.
Creating a safe space — The therapist functions as a "good internal object," allowing the patient to express their anxiety without fear of rejection.
Overcoming bodily anxiety — Through therapy, the patient gradually learns techniques for managing physical reactions, such as breathing, grounding, and symbolising emotions.
Long-term stability — The goal is not merely to suppress the symptom but to build a stable inner world that reduces the risk of recurring panic attacks.
Conclusion
Panic attacks can be terrifying, but they are understandable and treatable. Through psychotherapy, a person can learn what lies behind these sudden episodes of anxiety, restore their inner sense of security, and develop the skills to cope with moments of crisis. It is not necessary to live in fear — with the right support, panic becomes a manageable experience.
References
Abraham, K. (1924). Notes on the theory of panic attacks. In P. Gay (Ed.), Psychoanalytic writings of Karl Abraham (pp. 45–62). London, UK: Hogarth Press.
Vasilev, S. (2021). Contemporary Kleinian Psychoanalysis. Sofia: Kolibri. [in Bulgarian]
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York, NY: Guilford Press.
Bion, W. R. (1962). Learning from experience. London, UK: Heinemann.
Bion, W. R. (2023). Second Thoughts. Sofia: Riva. [Bulgarian translation]
Brener, C. (1975). Panic: Psychological and psychodynamic perspectives. New York, NY: Jason Aronson.
Freud, S. (1992). Beyond the Pleasure Principle. Sofia: Nauka i Izkustvo. [Bulgarian translation]
Freud, S. (1995). Anatomy of Feelings. Sofia: Evraziya. [Bulgarian translation]
Klein, M. (2005). Love, Envy and Gratitude. Sofia: Lik. [Bulgarian translation]
National Institute of Mental Health. (2022). Panic disorder. https://www.nimh.nih.gov/health/topics/panic-disorder
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470. https://doi.org/10.1016/0005-7967(86)90011-2