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The Difference Between a Panic Attack and Trauma Flashback (and How to Deal With Them)

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Panic attack vs. flashback — or is it both?

I had a medical procedure, recently. I had been waiting for it since March. I knew it would be invasive and tried to stay in the present and talk myself through it.

• What is PTSD?

However, I wasn’t able to complete it awake and an alternative choice was offered to me, when I spoke plainly and candidly as I told the surgeon. “I have a history of trauma. You cannot put anything down my throat. I cannot do this without sedation. Is there another way?”

I am grateful she respected my wishes. I am also grateful she acknowledged why it would be so hard for me, and that I wasn’t alone. In fact many patients had expressed similar sentiments with much regularity.

I think when people hear the word flashback, they often think it means remembering something bad.

It’s more than that. It is rather a reaction to the memory, that has been manifested often for years in the body.

For myself, a trauma flashback reaction begins with ringing in my ears, tunnel vision, a lump in my throat, difficulty swallowing and breathing, feeling light headed, nauseous, profuse sweating, an accelerated heart rate akin to being on a treadmill, restless legs and trouble remaining seated — a prompt from my primal brain to fight, flee or freeze. But these are only the physical manifestations.

Mentally: Often the fear becomes so intense that people dissociate and are unsure of where they are or what they are doing or will forget what they were doing before it happened. It can be hard to distinguish between trauma time and the present when a flashback is occurring! The brain experiences something that connects a dot.

For myself, sometimes that can be when there is someone who looks like a past offender or may be related to them, the smell of certain alcoholic beverages on someone’s breath, certain air fresheners or a person’s cologne, the color yellow. In my experience, these can open up a carefully secured file in my brain of old memories that make it feel like it is happening now — all over again.

A flashback is not just remembering a traumatic event. It is being forced to re-live and re-experience it over and over and over again. It is not the same as anxiety or a panic attack — I have both of those as well!

The key difference is that generalized anxiety is the fear of the unknown and post-traumatic stress disorder (PTSD) is the fear of what we already know!

A lot of people confuse panic attacks with flashbacks.

Panic attacks can evoke almost all the same physiological responses and they are scary AF, but they are not always associated with memory or past trauma. Often, they are stressed-induced or the reason is subconscious and the person is unaware of the trigger. Or they can come on out of nowhere, usually in the worst places possible, like events and in the checkout line at the grocery store. (From experience, it does get you to the front of the line quickly.) Thankfully they often pass faster than flashbacks as well, but it sure as hell doesn’t feel like it at the time. Many people compare a severe panic attack to their thoughts of what dying might feel like. I concur.

Here are a few things describing the difference between them and how to deal with them.

In a panic attack, people tend to need to reduce their amount of external stimuli. They may feel the need to leave where they are and get to a safe place like a bedroom or their car or a washroom. Often they need a quiet space where they can use deep diaphragmatic breathing, deep enough to pull the belly in and exhaling long enough to puff the belly out.

Some use a grounding object like a ring they spin on their finger, a rock in their pocket to run their fingers over its edges. Or they can implement self talk as assurance: “I’m in the Walmart parking lot — I’m safe. It’s just a panic attack. This will pass. Breathe. Relax your shoulders. Open and close your fist. Focus on your safe place.” Some close their eyes, some do not as it can increase dissociation from the present (I don’t). For myself my safe place is on a beach at sunset hearing the waves kiss the shore. If none of those things work and you have medication — you may or may not need to take it and do so with zero shame!

Flashbacks often (not always) require the opposite approach — the need to increase external stimuli to bring one back into the present. The mind has dissociated and does not know the day nor the hour.

It is reliving an event that has already happened and belief we are back there, frozen in time.

During severe trauma many people go blank, their mind leaves their body and completely dissociates from the experience. This is the freeze response and a highly adaptive brain response in order to survive such fear or threat of danger. Later in flashback mode, some will freeze again and feel immobilized once more.

Or others will have a need to do the opposite of what they did in trauma time — fight or flee, and this can range in anything from an angry outburst to stripping off layers of clothing that feel confining. It can be feeling the need to escape, whether that is literally leaving the triggering situation or using substances to do so.

Flee and freeze can become familiar ways to cope, but they’re not functional and can be maladaptive when we are not in imminent danger. We end up running and hiding from any experiences, places or people that might remind us of that trauma and eventually become afraid of things we do not need to fear. It can also become an automated response to want to numb and separate from those thoughts by always doing and having a mind full, which keeps us from being mindful!  Often sensory overload can help bring someone out of a flashback is something external and activates our senses to bring us back to the present.

If you have people in your life who know you have PTSD, tell them ahead of time what works and what doesn’t. It can be frightening for them as well if they don’t know what is happening. Just ask my friend who found me hiding and crying inconsolably like a child when I was 45, under a kitchen table, clinging to it’s legs for protection, once upon a time.


Turning on the radio and cranking up the volume brings people back into the present.

Some people carry aromatherapy or use strong aromas like basil or lavender to smell something now — in this moment, that could override the smells associated with a traumatic experience.

Taste: Carry disgusting cough drops and suck on something unfamiliar or sour like a lemon drop or something salty like a pretzel — something you did not taste during the time of the traumatic event. Taste is a powerful resource.

Touch: When I did my PTSD program, nurses and doctors would often use an ice pack on the back of the neck to bring someone into the present. It is using the startle reflex in reverse. I’ve heard some now consider this barbaric. I’m not suggesting throwing someone in a bathtub of ice cold water, but a freezie or an ice cube in the hand, or splashing your face with cold water can work wonders.

Sight: Try and get back to the moment by counting the number of things around you that are a certain color, so your focus shifts to your current location you, in the here and now. This is probably the easiest way to re-orientate one’s self if you are out in public. Choosing to find and scan for a certain color or item engages the cognitive parts of our brain and diminishes the activity in our fear response centre. Logic and fear exist in different parts of the brain.

Enlist the help of those you trust and be honest about the best ways to help you if you have a panic attack or flashback, no different than what you might tell someone to do if you had a chronic health condition.

The more knowledge people have the more they know and the more they can help and be honest. If you don’t want them to speak to you or touch you but just be there — say so, just like I would hope someone would share where their epipen or medications or inhalers are — so if something was to happen they can help.

We need to start normalizing these conversations about mental health.

Photo by Linda Xu on Unsplash

Originally published: August 19, 2020
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