Panic Attacks and Emetophobia
Why You Panic When You Feel Nauseous
Part 2 - Understanding Panic Attacks and Why They Happen
For someone with emetophobia, panic attacks can feel particularly frightening because the symptoms of anxiety and nausea can convince you that you are going to be sick.
This free CBT guide explains why this happens, what keeps the panic cycle going, and how to stop fear of the symptoms from controlling your life
What Causes Panic Attacks?
What Is a Panic Attack?
A Panic Attack is when you get a intense rush of physical sensations which cause you to spiral, and become highly anxious and panicked. Panic attacks occur when someone gets an uncomfortable physical symptoms they either misinterpret as dangerous, or interpret as the first sign of a panic attack occurring. When you have emetophobia, it is likely that you notice feeling nauseous, which convince you that you are at risk of being sick.
The Panic Cycle: How Panic Attacks Develop
A panic attack always starts with a trigger. This can either can be an internal or external trigger.
Internal triggers are things that occur inside of your body. These are troublesome symptoms such as nausea, a heart flutter or changing in your breathing or a scary mental image or thought. These symptoms are usually caused an external event or underlying stress in your life. However, most people usually miss the cause of the symptoms and so it seems your symptoms comes out of nowhere.
External triggers are stressful events or situations that you perceive through your senses (sight, sound, situation) before the physical symptoms even begin. Examples can include crowded places, feeling stuck, or being in a stressful situation.
These triggers or symptoms are perceived as some sort of threat. For example:
Triggers: You might fear being sick, feeling trapped or that the situation is unpleasant or hard in some way.
Symptoms: You might fear nausea, dizziness or lose bowls as you think it might mean a stomach bug and sickness.
When you perceive a threat, your anxiety system turns on and this naturally leads to the emotion of anxiety. Anxiety is an emotion that occurs when your bodies thinks that they are in a threatening situation. It reacts to the perception of danger. So you can feel anxious even when there is no real danger.
This chain makes sense for real external dangers. For example, if you come across a dangerous predator, it makes sense that your anxiety system responds to the threat with anxiety.
Our anxiety system comes with a whole range of physical symptoms that can feel incredibly intense. Such as:
Nausea.
Dizziness and feeling faint.
Lose bowls.
Palpitations, pounding or racing heart.
Sweating.
Shaking.
Shortness of breath.
Feelings of choking.
Chest pain.
Chills or feeling hot.
Numbness or tingling.
Feelings of unreality or feeling detached from oneself.
These symptoms are completely normal and people don’t typically worry about them when they make sense. For example, being short of breath or having a racing heart doesn’t often bother people working out at the gym because they know why they are feeling that way, The same applies to other symptoms. For example, if someone just jumped out and scared you, it makes sense your breath is fast, or if you just ate to much, it might make sense you are feeling full or nauseous. However, when someone misses the original cause of their anxiety or misinterprets why they are having these symptoms it can lead to a panic attack.
These interpretations are incorrect but feel very convincing in the moment. The problem with these misinterpretations is that it causes the symptoms of anxiety to be registered as a danger. Often, they are seen as a life threatening danger or that something awful is about to happen (being sick). This sense of danger increases your anxiety system further, which then intensifies those same physical symptoms you are misinterpreting in the first place. This escalation of symptoms then gets used to validate the original misinterpretation (e.g. ‘Now I feel really nauseous! I know I am about to be sick!’). This then further increases your anxiety and the cycle continues until you have a panic attack.
Essentially, panic attacks are when you become anxious about having anxiety symptoms because you don’t recognise them as normal symptoms. This causes a feedback loop of anxiety even when there is no real problem.
If you have had panic disorder for a while, it is also possible to interpret these symptoms as the start of a panic attack or that the situation you are in must be dangerous. Because a panic attack is a truly awful experience, having a panic attack itself be seen as a threat. This interpretation alone can be enough of a threat to start and get you trapped into this cycle.
This cycle can be seen here at the end of this diagram. Anxiety leads to physical sensations, which leads to an interpretation, causing more anxiety and the loop intensifies.
When some one has a panic attack they often don’t notice their original trigger, and their physical sensations are often the first thing they notice. Due to this, people can start to make assumptions and interpretations about what is happening to them and where these symptoms are coming from. As these symptoms appear to come out of nowhere, people often misinterpret them as dangerous. For example:
Nausea can be misinterpreted as a sign of impending vomiting.
Heart palpitations can be misinterpreted as a heart attack.
Dizziness can be misinterpreted as fainting.
Numbness can be misinterpreted as a stroke.
Tingling or vision changes can be misinterpreted as a brain tumour.
This effects gets added to by something called ‘emotional reasoning’. This is a thinking error when someone uses their feelings as evidence of a problem (i.e. I feel their must be a problem, therefore, their must be a problem). This can increase the perceived threat in a situation.
What Is the Anxiety Fight or Flight Response?
Why Does Anxiety Feel So Intense?
The reason anxiety feels so intense goes back to the purpose of it. Anxiety is a warning alarm that you have perceived a danger. Regardless of if the danger is real, imagined or incorrect, your body wants you to react to it.
This makes sense when you think about it. Imagine you are on the Serengeti in Africa and you hear a sound behind you that might be a lion. It is safer to start running and be wrong, than it is to wait, turn around and check if the sound behind you is a lion. Acting first saves your life and if you are wrong you only wasted a bit while energy running away, while not reacting is a mistake that could cost you your life.
If your alarm system was easy to ignore, it might make the wrong choice. If anxiety did not feel bad, we would most likely just ignore it. This is the same reason fire alarms are so loud. So you can not ignore them. The second reason anxiety feels so bad is due to something called the fight or flight system.
How Does the Fight or Flight Response Work?
The fight or flight system is your bodies natural response to dangerous situations. Your anxiety system realises hormones to put your body into overdrive so that it is best able to run away from a danger or to fight it. Think of the fight or flight system like a special temporary ‘power up’ button that you can press in a video game when you fight a boss. This power up button does a whole lot of changes in your body which push you into peak performance. That way you will be able to handle the threat. These changes although helpful can feel really intense, uncomfortable and are not pleasant. These changes are not what your body is used to and are only designed for a short term use.
These bodily changes include:
Nausea or feeling sick
Feeling hot or flushed
Dizziness or light-headedness
Butterflies or churning stomach
Racing or pounding heart
Faster or shallower breathing
Feeling short of breath
Sweating
Shaking or trembling
Muscle tension
Weak or shaky legs
Dry mouth
Dilated pupils or changes in vision
Feeling cold or having chills
Chest tightness
Headache or pressure in the head
Palpitations
Urgency to urinate or have a bowel movement
Jaw or teeth clenching
Racing thoughts
Difficulty concentrating
Mind going blank
Feeling confused
Increased awareness of bodily sensations
Difficulty thinking clearly
Feeling that something bad is about to happen
Intrusive thoughts about the perceived threat
Goosebumps
All of these symptoms are normal and make sense given the situation. They are all helpful or a by-product of an other benefit. The thing about your anxiety system is that it reacts almost the same to any threat, regardless of it is it physical or not. So if you are extremely stressed about a bill, exam or deadline, your body just see’s a threat. And it only knows two ways of dealing with threats. Run away or fight it. Neither of these are correct for the situation, but it doesn’t matter. Your body reacts and these symptoms occur to power you up. The problem for those with emetophobia, panic attacks or agoraphobia is that you can start to see certain symptoms that anxiety causes as a threat. Which causes your fight and flight to activate it response to its own symptoms. Causing a feed back loop.
To get better we need to stop misinterpreting these symptoms as dangerous. The bests way to achieve this is to understand how these symptoms are benefits or harmless side effects.
Want a complete CBT guide to panic disorder and agoraphobia?
My 70-page CBT guide takes you through the same principles used in therapy, including understanding panic, identifying catastrophic thoughts, reducing safety behaviours and gradually facing your fears. Also including tips on better sleep and relapse prevention.
Are panic attacks disrupting your life? This powerful, yet easy to follow eBook offers a proven roadmap to preventing panic attacks. Developed using my years of practice as a Cognitive Behavioural Therapist (CBT).
What’s Inside:
70 page PDF: A complete guide written by a BABCP qualified CBT therapist.
4 Transformative Strategies: Learn how to manage panic, reduce avoidance, improve sleep, and prevent relapse.
Step-by-Step Worksheets: Practical exercises to help you track progress and apply techniques in real life.
Goal and Recovery Focused: Set meaningful goals and measure your recovery with clarity.
Relapse Prevention Toolkit: Stay on track long-term with personalized strategies for lasting change.
Why It Works:
This guide doesn’t just explain panic, it helps you rewire your response to it. By understanding the biology behind anxiety and applying CBT therapy principles, you will learn to break the vicious cycle of fear and avoidance causing your panic attacks to occur in the first place. Whether you struggle with Panic Disorder, Agoraphobia, or anxiety-triggered insomnia, this book is a must have.
Paperback available on amazon:
Fight or Flight Symptoms During Anxiety and Panic Attacks
The fight and flight system has a whole load of changes it can cause. Not everyone will personally notice or feel each and every symptom each time they are anxious or panicking. Typically people notice the symptom they fear the most and barely notice the ones they are not afraid of. Each symptom is either deigned to save your life by allowing you to run, fight, hide or think about threats better, or are a side effect of something else that is doing one of those things.
Why Do I Feel Nauseous During a Panic Attack?
Imagine you were on a trip without a phone charger and you want your phone to last the day. The first thing you do is to swipe off apps you don’t need, turn off your Bluetooth, or maybe turn of your internet to make your battery last longer. Your body does the exact same thing when anxious, it reduces any systems which are not needed in that moment such as your digestive system. When your digestive system is paused, your body naturally doesn’t want you to eat so it sends you a powerful signal telling you to stop eating. This signal is nausea. Often this nausea gets misinterpreted as the chance of vomiting. However, this nausea in reality is simply your body's way of pausing digestion so it can focus all of its energy on keeping you safe.
Why Do I Feel Dizzy During a Panic Attack?
Dizziness often gets misinterpreted as linked to fainting. However, it is almost impossible to pass out due to a Panic Attack. The Fight or Flight response increases blood pressure, making it impossible to faint. This response is intended to help you respond to potential danger, so passing out would go against this. The only exception is if someone has a specific phobia of blood, injury, or needles, which can cause blood pressure to drop and cause fainting.
The reason why dizziness occurs during a panic attacks is due to changes in blood oxygen and carbo dioxide levels that is caused by rapid breathing. This breathing is designed to get more oxygen into the blood stream but causes the side effect of dizziness.
Why Does Everything Feel Unreal During a Panic Attack?
During a panic attack it is common for people to feel as if they, others or the world is not real, strange or that they are outside of their body. This is called Derealisation and Depersonalisation and often gets misinterpreted as a sign that you are going crazy. However, both these symptoms are deigned to keep you safe. Your brain temporarily alter how you experience yourself and your surroundings. This emotional detachment, makes frightening situations feel less intense and allowing you to continue functioning and thinking. This also aids if you decide to hide from a threat instead of fighting or running away as it helps you stay inactive and still. Also, the body becomes highly focused on the environment to scan for threats. This can make you feel outside of your own body. Adrenaline and racing thoughts can add to this feeling.
Why Do I Get Racing Thoughts During a Panic Attack?
Racing thoughts can often get misinterpreted as a sign that you are going crazy. However, racing thoughts are actually caused when your body floods your system with adrenaline. Adrenaline is designed to prepare your muscles to run or fight, but it also accelerates your mental processing, making your thoughts feel like they are spinning out of control. This can allow you to think about threats faster.
Why Do I Feel Like I Can't Breathe During a Panic Attack?
During a panic attack, breathing speeds up, muscles tighten and your heart rate increases. People often start to slouch or bend over slightly due to their panic. These add up to cause you to feel like you are not getting enough oxygen in and often gets misinterpreted as not being able to breathe or that you might suffocate. However, this is just a sensation. In reality your body is getting in enough oxygen. These changes are designed to increase the amount of oxygen so muscles have enough to run or fight the threat.
What About The Other Symptoms Panic Attacks Cause?
There are a lot of different symptoms that anxiety can cause that are very safe but often get misinterpreted. if you experience any other symptoms, try googling why they occur. A full list of symptoms and misinterpretations can also be found in my book.
Why Does Fear of Another Panic Attack Cause More Panic?
If you have had panic disorder for a long time, you might start to logically realise that these symptoms are not dangerous and instead now simply fear having a panic attack. These anxiety symptoms start to get misinterpreted as a sign of a panic attack starting. This then becomes a self-fulling prophecy. Because you believe these symptoms are a sign of a panic attack, you raise your own anxiety and start the cycle and create a panic attack. Having a panic attack becomes its own misinterpretation.
So you might be wondering how it is a misinterpretation, if it does actually lead to a panic attack.
It is important to realise that these symptoms on their own can never lead to a panic attack. They are just symptoms of your fight and flight response. A panic attack is created from the interpretation of these symptoms. If you interpret them as a sign of a panic attack you raise tour anxiety and cause the sensations to escalate. If you don’t have this misinterpretation your anxiety doesn’t increase into a panic attack.
Fear of What Might Happen During a Panic Attack
Sometimes your misinterpretation might not be about the symptoms themselves but the consequence of having a panic attack. For example, you might have fears about how others will react to you having a panic attack (e.g. people might stare, my boss won’t be happy, others will panic and call an ambulance, or it will be embarrassing). These thoughts raise your anxiety, which trigger more symptoms which then validates that you will have a panic attack and that these fears might happen. Creating a panic attack.
What do night time Panic Attacks happen?
Some people report waking up having a panic attack or get ‘panic out of the blue’ without a trigger. However, research has shown that this is not true. Usually something activates your fight or flight response while asleep. This could be a bad dream or underlying stress. So you wake up and notice a anxiety symptom. Then you instantly make an interpretation of what these symptoms mean. As you were asleep, you are unaware of the real trigger, and so it is easy to misinterpret what is happening as a medical problem or the start of a panic attack. This then triggers the cycle and your anxiety gets worse, which then validates your misinterpretation and a panic attack occurs.
How to Reduce Panic Attacks Using a CBT Panic Diary
One of the best ways to stop panic attacks is to start to realise that our interpretations of these symptoms are highly inaccurate. This can be achieved by keeping a diary of each panic attack you have. This allows you to start seeing your misinterpretations and how inaccurate they are in real time. If you can start to change the misinterpretation in the moment, your anxiety has nothing to feed off and it interrupts the panic cycle.
How to Keep a Panic Attack Diary
A panic diary is really simple. It is just a chart where you can start to collect data. It is best if you can fill out this diary during a panic attack or at least shortly after it ends.
The diary should captures a few key bits of information:
The date and triggering situation : Write down when your panic attacks occur and what was going on just before it started panic attack. This can help you see patterns or triggers you may not be aware of. This is important because panic attacks occur when you miss the real trigger for the anxiety. Sometimes a trigger can just be underlying stress, deadlines or even bad dreams.
The symptoms you fear: Write down the symptom/s that worry you the most. These are the ones you are misinterpreting.
Your anxious interpretation: Write down what you think that symptom means. Often this misinterpretation is a risk to yourself (being sick, heart attack, or another medical problem) or can even be that the symptom must mean you are about to have a panic attack or that you won’t cope staying in your situation with these symptoms.
Your coping behaviours: Write down what actions you take to cope in that moment. Write down anything you do to 1) stop the anxious outcome you are predicting, and 2) what you are doing to prevent or stop your anxiety. This part is important and will be used later on when we talk about something called ‘safety behaviours’.
An alternative explanation: After this, consider what the logical alternative explanation is for those symptoms you fear if it was just the fight or flight response. Do not just write down ‘anxiety’ or ‘the fight or flight response’. but instead write down how this symptom is meant to be helpful, designed to keep you safe or is a side effect of something else that is helpful. If you are not sure on how your symptom is meant to be helpful, google it or read that section in my book.
Hindsight review: After your panic attack is over, fill out the last column. Who was right, your anxious interpretation or the alternative explanation?
Here is an example chart:
Try filling this out for a while. The whole point is to help you change how you view these symptoms. If you stop catastrophising them, your anxiety cant grow and panic attacks can not occur. Once you have done this for a few weeks and learnt something about your thoughts, move onto part 3.
Night-Time Panic Attacks: Why Do They Happen?
If you get night-time panic attacks try and catch the misinterpretation in the seconds in-between waking and the panic attack starting.
Once you done this for a week or two, move onto part 3
Your free CBT Panic Recovery Programme
A step by step guide to understanding panic attacks, breaking the cycle and reducing avoidance.
Want a complete CBT guide to panic disorder and agoraphobia?
My 70-page CBT guide takes you through the same principles used in therapy, including understanding panic, identifying catastrophic thoughts, reducing safety behaviours and gradually facing your fears. Also including tips on better sleep and relapse prevention.
Are panic attacks disrupting your life? This powerful, yet easy to follow eBook offers a proven roadmap to preventing panic attacks. Developed using my years of practice as a Cognitive Behavioural Therapist (CBT).
What’s Inside:
70 page PDF: A complete guide written by a BABCP qualified CBT therapist.
4 Transformative Strategies: Learn how to manage panic, reduce avoidance, improve sleep, and prevent relapse.
Step-by-Step Worksheets: Practical exercises to help you track progress and apply techniques in real life.
Goal and Recovery Focused: Set meaningful goals and measure your recovery with clarity.
Relapse Prevention Toolkit: Stay on track long-term with personalized strategies for lasting change.
Why It Works:
This guide doesn’t just explain panic, it helps you rewire your response to it. By understanding the biology behind anxiety and applying CBT therapy principles, you will learn to break the vicious cycle of fear and avoidance causing your panic attacks to occur in the first place. Whether you struggle with Panic Disorder, Agoraphobia, or anxiety-triggered insomnia, this book is a must have.
Paperback available on amazon: