Exploring the physiological + psychological similarities between anaphylaxis + panic attacks, and how the perceived gap in professional literature may perpetuate somatic trauma responses in the food allergy community.
“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”
The Body Keeps The Score, Bessel van Der Kolk
Introduction
In April of 2021, I openly shared my personal battle with mental health in a blog post titled, Invisible Consequences of Anaphylaxis. Honoring my mission to normalize mental illness in the food allergy community, I am leaning into the academia in order to illuminate a perceived gap in psychological literature + research.
As a licensed mental health counselor + clinical psychology doctoral student, I apologize in advance for any scientific jargon throughout this read. But let me geek out for a bit! Understanding the physiological mechanisms behind my somatic trauma responses brought an important sense of awareness + acceptance to my own personal mental health concerns – An understanding that I hope to be able to share with you, too.
Fight or Flight Response
Before we get ahead of ourselves – Let’s get down to basics.
Many of you have likely heard of our body’s natural defense system. The Fight or Flight Response is our body’s innate acute stress response activated by the sympathetic nervous system. When we find ourselves in physical or emotional danger, research suggests that our body has four options…
- Fight = Imagine being pulled into a strangers car. Just like every defense class has preached, fighting off your attacker gives you the best chance at survival.
- Flight = Perhaps a toddler wanders towards a busy street… Your instincts kick into high gear and you bolt to pick them up.
- Freeze = A burglar enters your home and there’s no exit in sight? You hide quietly in the closet without making a peep.
- Fawn / Appease = To avoid any further conflict, you comply with the demands of an attacker.
The natural instinct of the human body to defend itself against harm happens without conscious thought. The human body responds instantaneously and automatically to danger by bypassing the prefrontal cortex (The part of our brains that plan, organize, and makes decision). In other words, the Fight or Flight Response is involuntary – We rely on our innate reflexes to protect us.
In order to muster up the strength + stamina needed to survive an emergency situation, the adrenal glands flood the body with hormones, such as epinephrine, norepinephrine, and cortisol. The triggering of our internal alarm system through the release of these chemicals gives the body the necessary energy + alertness to ward off danger. The adrenaline circulating throughout the bloodstream quickly results in physiological changes, including…
- Increase Heart Rate
- Quick, Shallow Breathing
- Digestion Slows / GI Disturbances
- Nausea
- Dilated Pupils
- Tensed Muscles
- Sweaty Palms
- Auditory Exclusion / Temporary Hearing Loss
- Dizziness
If you have experienced these sensations before (Maybe at a Halloween haunted house, or when you couldn’t find your parent at the grocery store) – Good. Your body is working exactly the way it is supposed to.
Panic Attacks
The Diagnostic and Statistical Manual of Mental Disorders defines a panic attack as, “An abrupt surge in intense fear or intense discomfort that reaches a peak within minutes” (APA, 2013, p. 214).
Panic attacks biologically operate through the same Fight or Flight response system, but occur without the presence of actual or threatened danger. Researchers have identified two types of panic attacks – Expected panic attacks that result from a specific trigger (Public speaking, air travel, interviews, etc) and unexpected panic attacks that occur without an obvious trigger (Nocturnal panic attacks).
According to the American Psychiatric Association (2013), at least four of the following symptoms must be identifiable to be considered a panic attack…
- Palpitations, Pounding Heart, or Accelerated Heart Rate
- Sweating
- Trembling or Shaking
- Sensations of Shortness of Breath or Smothering
- Feelings of Choking
- Chest Pain or Discomfort
- Nausea or Abdominal Distress
- Feeling Dizzy, Unsteady, Light-Headed, or Faint
- Chills or Heat Sensations
- Paresthesias (Numbness or Tingling Sensations)
- Derealization (Feelings of Unreality) or Depersonalization (Being Detached from Oneself)
- Fear of Losing Control or “Going Crazy”
- Fear of Dying
According the Diagnostic and Statistical Manual of Mental Disorders, approximately 11.2% of adults in the United States will experience a panic attack in any given year (APA, 2013, p. 215). Studying that subset of the population, researchers were able to find predisposing factors that make individuals more likely to experience panic attacks throughout their lives. For example, children with neurotic or anxiety sensitive temperaments are at higher risk for panic attacks later in life (APA, 2013, p. 216).
Panic attacks can be also be a, “Direct physiological consequence of another medical condition,” including cardiopulmonary conditions like asthma (APA, 2013, p. 213). Most notably for the food allergy community, Panic Disorder (F41.0) has often been found to be co-morbid with both asthma and irritable bowel syndrome (APA, 2013, p. 214).
Anaphylaxis
Unfortunately, we are all too familiar with this one.
Anaphylaxis is a, “Severe and potentially life threatening allergic reaction… which can occur within seconds or minutes of exposure to something you are allergic to” (Mayo Clinic, 2021). According to the Cleveland Clinic (2021), the activation of mast cells and basophils during anaphylactic shock releases specific mediators that may eventually result in…
- Shortness of Breath
- Difficulty Swallowing
- Swelling
- Chest Tightness
- Hives / Rash
- Wheezing
- Clammy Skin
- Increased Heart Rate
- Low Blood Pressure
- Dizziness
- Nausea
- Vomiting
- Diarrhea
- Feelings of Doom
Sound familiar?
The bolded anaphylactic symptoms above represent the identically described symptoms in the definitions of the fight or flight response + panic attacks from earlier in this post.
The eerily similar physical symptoms that accompany our natural stress response make distinguishing an anaphylactic reaction from a panic attack incredibly challenging – Particularly for the traumatized brain.
Trauma
The American Psychiatric Association (2013) defines a traumatic event as, “Exposure to actual or threatened death, serious injury, or sexual violence” through direct experience of the traumatic event, witnessing the event in person, repeated exposure to adverse details of the event, or learning that the traumatic event has occurred to a loved one (APA, 2013).
Some of the more commonly recongizable examples of traumatic events include physical assault, severe motor vehicle accidents, natural disasters, and exposure to war.
Although seemingly less researched across the psychological landscape, certain medical incidents are also considered traumatic events. Clear as day on page 274 of the the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association distinctly states, “Medical incidents that qualify as traumatic events include sudden, catastrophic events… [such as] anaphylactic shock” (APA, 2013, p. 274).
*DISCLAIMER: Not every traumatic event (Ex. Anaphylactic shock) results in a diagnosable disorder. Please seek consultation from your doctor or a licensed mental health professional for more information.
The Trauma Response
“Being frightened means that you live in a body that is always on guard.”
The Body Keeps The Score, Bessel van Der Kolk
Although our natural Fight or Flight Response is designed to activate in response to actual danger, a traumatized brain can trigger warning signals even when no such threat is actually present. Because it struggles to differentiate between safe and unsafe situations, the traumatized brain defaults to preparing for battle – A body that has been hurt in the past is continuously on high alert to prevent it from happening again.
Deep within our temporal lobes, a hypersensitive amygdala (The fear center of our brains associated with emotion and memory) inside of a traumatized brain prematurely initiates the acute stress response, regardless of whether or not the body is in actual danger. Remember – the Fight or Flight Response happens automatically + unconsciously by bypassing the prefrontal cortex. The amygdala is not seeking out approval from our conscious awareness that knows we are safe – Instead, the amygdala is part of the traumatized brain that is eager to defend itself.
The body and the brain are no longer in sync; Our external reality is not matching our internal experience – That’s thanks to trauma.
Linked on my Amazon Storefront, The Body Keeps The Score by Bessel van Der Kolk beautifully articulates how the traumatized brain + body live in a constant state of hyperarousal. His novel was a fundamental piece in the acknowledgment and acceptance of my own mental health journey.
Anxiety, or Anaphylaxis?
“Okay, Alyssa. It’s clear you have done your homework. But what does this actually mean for the food allergy community?” I’m glad you asked.
Picture this. You are safely eating a home-cooked meal in the comfort of your own kitchen. Your ingredient labels were triple checked + there is no risk of cross contamination when preparing food in your own pans. Bite by bite of your dinner goes down fine until… Is that a lump in my throat? Now that you say it – my stomach feels a little nauseous, too. It escalates as you become aware of your short, shallow breaths. Your heart pounds as your chest tightens. Sweaty hands search for an auto injector. The sensation of choking on a swelling throat reminds you of the emergency room visit after your first allergic reaction. But these anaphylaxis symptoms – Difficulty breathing, increased heart rate, chest tightness, dizziness, sweating, nausea, vomiting – directly mirror those of anxiety. In your hyper vigilant state, it feels impossible to differentiate. But you are not in anaphylactic shock – You are panicking.
It is common for the general public to confuse panic symptoms with a more severe medical emergency, like heart attacks, asphyxiation, or even being on the brink of death; That is anxiety talking. However, throughout the food allergy community, this issue is exacerbated for those who have previously suffered a traumatic anaphylactic reaction, given the distinct similarities between the trauma + the somatic trauma response. Although our acute stress response is initially unconsciously activated, it is consciously perpetuated by continued anxiety + fear about the sudden distressing physical symptoms.
Because what happens when you panic about panicking? You panic.
Personal Experience
“Being traumatized means continuing to organize your life as if the trauma were still going on – unchanged and immutable – as every new encounter or event is contaminated by the past.”
The Body Keeps The Score, Bessel van Der Kolk
My food-induced panic attacks were initiated after an anaphylactic reaction in June 2014. My traumatized brain + body gathered the troops to fend off non-existing threats at almost every meal. The rapid heart rate, short shallow breaths, clammy skin, and nausea I anxiously sat through at the dinner table was practically indistinguishable from those same sensations I had felt headed to the emergency room with an anaphylactic reaction. Refusing to be vulnerable to another threat, my survival instincts were locked into overdrive. Allergen or not, danger or not, my physical body was perpetually ready to fight.
A mental health provider once powerfully validated the juxtaposition between my debilitating internal experience and my seemingly collected external appearance; Acknowledging the pure exhaustion of living inside of a traumatized body. Family + friends struggled to comprehend my persistent anxiety when there was not a visible reason to sound my internal alarms system. But my disconnected mind and body blindly refused to let its guard down + involuntarily suffered the physical fight or flight sensations on a day to day basis.
Despite it all – there is help. After years of trauma informed cognitive behavioral therapy, prescription antidepressant medication, and continued self care + compassion, redefining my sense of safety has allowed me to better manage panic attacks, fainting spells, and anxious thoughts.
Beyond the scientific review of the physiological + psychological impacts of anaphylaxis in this article, my blog post The Invisible Consequences of Anaphylaxis instead intimately explores my personal mental health recovery journey + continued relationship with food anxiety.
Our Community
Through it all, the All Things Allergies community reminds me that I am not alone. The young girl who grew up suffering from mysterious fits of anxiety now reads comforting message after message of similar stories from her followers.
For years, I endured panic attacks without the vocabulary to label them. For longer, I was blind to the invisible consequences of anaphylaxis that perpetuated my somatic trauma responses. Although an explanation would not have been a cure, the capacity to make sense of my symptoms would have jumpstarted my mental health recovery journey.
So, if I can help normalize + verbalize this experience for just one other allergy kid, then I am very proud to be becoming the very woman that I needed as a little girl.
Future Directions
Despite the American Psychiatric Association’s clear recognition of anaphylactic shock as a traumatic medical event, the intersectionality between food allergies and mental health is lacking the proper diagnostic tools, well funded research efforts, and evidence based intervention protocols to effectively treat patients with co-occuring allergies and mental health disorders. So, when my dissertation chair matching process comes along this fall, I intend to propose this perceived gap in psychological literature as my area of focus throughout my doctoral education. Anxiety, or Anaphylaxis? is just the beginning.
Hey professor, if you are reading this blog post, can it count as extra credit?!
Mental Health Resources
You are not alone. Please see my blog post, The Invisible Consequences of Anaphylaxis, for additional mental health resources, publications, and help lines.
Disclaimer
This post is intended for educational purposes only, and should not be substituted for medical or professional advice. Please contact a licensed medical or mental health professional with further inquires.
References
American Psychological Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing: Washington, DC.
Cleveland Clinic (2021). Anaphylaxis. Retrieved from https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis
Mayo Clinic (2021). Anaphylaxis. Retrieved from https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468
Van Der Kolk, B. (2014). The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York: Penguin Books.
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