Like Prince Harry I know the terror of panic attacks

It’s a terror so great it’s hard to accurately describe in plain black and white. Everyone experiences them slightly differently but, for me, they felt like I was drowning, sinking deep underwater and unable to breathe. Every nerve strains, your heart pounds ferociously, hurting, and — and this is common, as Alison Hammond discovered this month — it feels as though you’re having a heart attack.

Some believe they are dying. Others sweat, shake, feel dizzy or sick, a few hallucinate. The worst of it is there’s no real threat — nothing to threaten your survival or that warrants such a bizarre and unwelcome body and brain reaction. And, on many levels, you know it. In short, you are having a panic attack.

This week Prince Harry spoke out about the panic attacks he experienced while performing royal duties, alongside his issues with grief, anxiety and depression following the death of his mother, Princess Diana. Speaking to neuroscientist Dr Mary-Frances O’Connor for her education series, Masterclass, in an episode entitled Redefining Grief: Building Resilience Through Loss, ahead of today’s World Mental Health Day, the Duke of Sussex described the panic that arose from taking part in public engagements, and specifically from putting on a dress shirt.

“The tightening of the collar literally felt like I was suffocating, and I would be experiencing panic attacks just in the car on the way to work,” he said. “And that’s when I realised, okay, there’s something bigger, there’s something else that you need to look into here.” After leaving the UK and relocating to Canada, briefly, before heading to California, he had an enormous adrenaline crash — “something that I’d never experienced before’” — and slipped into two weeks of depression. Earlier this month, ITV’s Alison Hammond was rushed to hospital while live on air for This Morning due to heart palpitations and a suspected heart attack. She resurfaced on Instagram the next day saying it had been “a little panic attack” and that it was the scariest thing she’d ever been through. Others, such as Zoe Ball, Will Young, Alexandra Shulman and Joe Lycett, have all spoken out about experiencing them. Although we’d like to pretend they don’t exist, panic attacks are common, caused by the brain’s alarm system — our fight-or-flight response — triggering an almighty surge of fear, and stress hormones that can last up to twenty minutes in some cases.

Studies show they will affect more than one in ten of us in our lifetime and some things can make you more susceptible, including a family history of panic, hypersensitivity, exposure to trauma, other health conditions such as low blood sugar (hypoglycaemia), phobias and hormone fluctuations.

In rarer cases people have repeated panic attacks (often occurring out of the blue), known as panic disorder, a condition that affects roughly one per cent of the population and can lead to avoidance of certain places or situations. That is why a third of those with panic disorder have agoraphobia, a fear of being somewhere you cannot escape from or get help, often choosing to not leaving the house or daring to set foot in a supermarket. Contrary to the belief of many, panic attacks are neither self-inflicted nor manufactured for attention. “They are extremely debilitating and very hard to predict and control,” explains Oliver Robinson, professor of neuroscience and mental health at University College of London.

Mental health is highly stigmatised because we all make a false dichotomy between brain and body. This leads us to think that things that are ‘all in the mind’ are things that we can control. But just as you can’t control whether or not you get cancer, a cold or other ‘bodily’ illnesses, you can’t control your mental health. While we don’t understand the exact neurological mechanisms of panic, experts know certain brain regions light up, including the medial prefrontal cortex (responsible for emotional processing and decision-making), amygdala (responsible for processing fear) and insula (linked to sensory experience and emotion).

“This network will feed into the rest of the body and do things like promote an increase in heart rate or increase respiration which will in turn feedback into the brain in a kind of reciprocal loop,” ,” explains Professor Robinson, adding that the good news is that there are things you can do to moderate and mitigate panic attacks.

“As for any type of illness, of course, there are things you can do that promote health and reduce risk of relapse.”

My panic attacks began in the face of prolonged insomnia. At worst, I’d have multiple panic attacks a night. In 2019, not long before being diagnosed with generalised anxiety disorder (GAD) and post-traumatic stress disorder (PTSD), I’d find myself alone at night — I’d removed myself from my husband and our small child into a loft bedroom — screaming into a pillow so I wouldn’t wake anyone up. For months (if not years) sleep had become increasingly less possible and I was getting sicker with various maladies - flu, infections, gastro-issues — as my immune system faltered after another night of three hours sleep.