Out of nowhere, your throat tightens. Your head begins spinning, and the voices around you recede as you focus on taking a breath and not passing out.

Your mind is reeling — where is the nearest exit? Will you faint? What is happening to you?

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If you are like 40 million other Americans, you are having a panic attack, a baffling and frightening event for any anxiety sufferer. Panic attacks are the most common mental illness in the U.S., according to the Anxiety and Depression Association of America, and not just that: Anxiety disorders cost Americans more than $42 billion a year.

With 40 million sufferers, panic attacks are most common mental illness in the U.S.

“I thought I was dying when I had my first panic attack,” said business professional Kathy Smith (not her real name) of Chicago. “I was in a grocery store and my chest tightened suddenly, and I couldn’t breathe. It was horrible. I ended up being carted off in an ambulance.”

Ordinary tasks like driving, grocery shopping, and standing in line at a shopping center become gargantuan feats requiring hours of mental preparation. Panic attack sufferers find themselves increasingly isolated. Often they are loath to share with others the symptoms of this vexing mental health issue.

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Why are some people prone to panic? The ADAA reports that anxiety disorders spring from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

“Is a ‘panic attack’ based on fear, or is it anxiety? ‘Fear’ involves an immediate reaction to something that threatens your security or safety, such as driving down a road and suddenly a car heading toward you is careening out of control,” clinical psychologist and psychoanalyst Mary Lamia told LifeZette.

We all have a natural “fight or flight” response, a gift from our forebears who had to react to various environmental threats.

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“Most people who have what they call ‘panic attacks’ are experiencing anxiety — a response to an unknown threat or to something that is not specifically threatening,” she said.

We all have a natural “fight or flight” response, a gift from our forebears who had to react to various environmental threats — animal attacks, human attacks, extreme weather — to survive. In some of us, this fight or flight instinct is triggered when it shouldn’t be, like when we are relaxing, driving, or out in public.

“The problem is, people do not understand anxiety,” Lamia said. “When your brain triggers the emotion of distress along with the emotion of fear, it creates what we call anxiety — a response to a vague, nonspecific threat.”

“However,” she said, “when people do not understand their emotions, or their therapists do not help them to understand them, they become anxious about being anxious. Emotions are instantaneously followed by thoughts (often irrational in the case of panic), and the thoughts then trigger further emotions.”

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Many panic attack sufferers go through months or even years of tests, worried the symptoms are a harbinger of a serious physical problem.

“I drove myself and my doctor crazy,” Kathy Smith said. “I was convinced I had either a heart problem or a brain problem. When he finally sat me down and told me he thought I was having panic attacks, I actually cried — in relief and in shock. So I wasn’t sick. But what was happening to me?”

Common treatment options include anxiety medication, cognitive and behavioral therapy, and hypnotherapy.

A Google search of “panic attacks” returns an avalanche of sufferers who visit online forums and chat rooms, sharing symptoms, experiences, and best practices for finding relief.

Panic attacks are often endured in silence. Those who suffer often find it embarrassing that they cannot control the onset of an attack, which is why panic attacks are so frightening. Some retreat into agoraphobia, preferring to never risk an episode, forgoing social opportunities and relationships.

When treatment is sought, there is every reason to expect recovery. The National Institute of Mental Health reports treatment of panic attacks can bring significant relief to 70 percent to 90 percent of people with the disorder, and “early treatment can help keep the disease from progressing to the later stages where agoraphobia develops.”

Treatment of panic attacks can bring significant relief to 70 percent to 90 percent of people.

Common treatment options include anxiety medication, cognitive and behavioral therapy, and hypnotherapy. Daily relaxation and meditation are also effective in treating panic disorder.

“If people want to recover, or find an effective treatment, they should make sure the therapist has a comprehensive understanding of emotions, the relationship of emotions to thinking, and how each can activate the other in a circular fashion, as in panic symptoms,” Lamia said.

The bottom line? If you feel you may be experiencing panic attacks, see your doctor. After a medical evaluation rules out physiological issues as the cause of your attacks, seek professional mental help. Committing to therapy can make all the difference.

“For me, a combination of medication and therapy was life-changing,” Kathy Smith said. “I am off medication, and haven’t had an attack in two years. I am currently helping several people I know who are suffering from panic, really just by listening and offering encouragement.”