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Adrenaline has many triggers—Studying them helps stop my jitters.
A surge of adrenaline produces all symptoms of panic and anxiety. But, you 
may wonder, what causes the surge of adrenaline? Whether your 
symptoms started all at once or developed gradually, you can reattribute 
their source to one or more of the following factors:

Your physical predisposition: Each person has his or her own unique 
chemical balance. Research shows that people who suffer from panic have 
other family members with the same problem. This suggests that they may 
inherit a body chemistry that makes them prone to anxiety. People with a 
sensitive temperament have low levels of the neurotransmitter GABA that 
inhibits reactions of the nervous system. When people have too little GABA, 
they are on alert, overreact, and have difficulty calming down. Sensitive 
people can be nervous, cautious, and shy and may abuse substances 
(such as alcohol) that increase levels of GABA. By contrast, people who “go 
crazy” or have psychotic breaks have a completely different chemical 
balance. They may have high levels of the neurotransmitter dopamine and 
low levels of MAO.2 Worry and panic will make you feel miserable but 
cannot drive you crazy.

Stress: Pronounced anxiety often occurs first during a period of high 
physical or emotional stress. Physical conditions such as broken bones, 
long illness, operations, and strenuous dieting can “shock” the nervous 
system. Constant conflict, doing things you dread, or trying to accomplish 
too much in too little time places demands on the body. Under such 
conditions, the nervous system is persistently alerted and nerves “fire” all 
the time. During this state of sensitization, usual emotional responses are 
intensified. Ordinary fears feel like panic. Old conflicts rise to the surface. 
Typical ways of coping may no longer work. Once you become sensitized, 
the condition often perpetuates itself unless you understand what is 
happening. Thus, people who are not sensitive by temperament can 
become sensitized during stressful times.

Past experience: Your upbringing and early experiences can give you 
personality characteristics that make you more vulnerable to the demands 
of life:

• Overprotected children can develop vivid and fearful fantasies. 
  Imagination is usually worse than the truth. A habit is developed of 
  anticipating, dwelling on, and reacting to imaginary dangers. These 
  thought habits might not be obvious until the first panic attack.

• Overcontrolled children may be raised with constant criticism, 
  standards for perfection, and expectations to conform. As adults, 
  they strive to appear “normal,” calm, unperturbed, and perfect. Any 
  situation that triggers “deviant” reactions is particularly upsetting.

Both types of people approach life with a controlling attitude. They need to 
manage their surroundings and their own internal reactions in a way that 
reduces “danger,” “differentness”, or “failure.” Often, people who develop 
panic attacks have been very competent or outgoing, but can no longer live 
up to their own standards in the face of overwhelming stress.

Emotional difficulties: When emotional disorders go untreated for long 
periods of time, they can lead to panic disorder. Often, people are not even 
aware that they have a problem until they start having anxiety attacks. They 
may think it is normal to be fearful of giving speeches, (obsessively) tidy, or 
moody.

• Social phobias make people have excessive, unreasonable fear that 
  others will notice some particular action of theirs. They may imagine 
  that everyone is scrutinizing them and that people will notice all their 
  flaws. When socially phobic people cannot avoid situations that 
  cause them difficulty (talking in public or being in large gatherings), 
  they may have panic attacks.

• Obsessive-compulsive disorder (OCD) causes people to have 
  repetitious, uncomfortable thoughts that are hard to turn off. 
  Common fears are of harming others, threats to self or loved ones, 
  being immoral, not having enough, disorder, germs, and making 
  mistakes. Panic can occur when anxiety-reducing rituals cannot be 
  used or fear triggers avoided.

• Depression is often linked with panic. The major symptoms of 
  (biochemical) depression include loss of energy and interest, 
  withdrawal, poor concentration, and indecisiveness. The simplest 
  tasks can seem overwhelming. During times when life becomes so 
  difficult, a person can be prone to having an anxiety attack.

A physical problem: Because panic feels so awful, sufferers imagine they 
have serious illnesses. Doctors can easily conduct tests to find out if dull, 
radiating chest pains are caused by heart disease. Other very rare 
conditions are also readily diagnosed: (1) epileptic seizures proceeded by 
an “aura” or strange aroma can cause attacks of immense fear; (2) strokes 
may be the cause anxiety if it is accompanied by confusion, difficulty 
speaking, or loss of movement; and (3) growths on the adrenal glands can 
cause anxiety during mild exercise, cold weather, or minor upsets. If any 
physical problem is present, it much more likely to be one of the following 
nonthreatening conditions. Seek diagnosis, get treatment, and reattribute 
anxiety to:

• Inner ear problems when loud noises, fluorescent lights, freeway 
  driving, steep hills, or cloudy days seem to cause tension, dizziness, 
  nausea, diarrhea, blurred vision, or headaches.

 

• Hypothyroidism when tension is due to fluid retention from reduced 
  thyroid activity.

• Hyperthyroidism when shakiness, palpitations, breathlessness, 
  chronic tension, perspiration, and restlessness are accompanied by 
  increased appetite with weight loss.

• Allergies when panic attacks seem more likely to occur during certain 
  seasons or after eating particular foods. Allergens both stress the 
  inner ear and cause a surge of adrenaline, which leads to tension, 
  shakiness, and palpitations.

• PMS when symptoms occur before menstruation. The female 
  hormone progesterone rises to its greatest levels a week before 
  menstruation and can increase the sensitivity of certain chemical 
  receptors, causing tension, restlessness, jitters, and irritability.

• Low blood sugar when fatigue, palpitations, trembling, dizziness, 
  blurred vision, or sweating happens before breakfast or a few hours 
  after meals and eating something with sugar relieves symptoms.

• Anemia when increased respiration and heart rate are due to the 
  body’s effort to produce more (iron-carrying) red blood cells.

• High blood pressure when occasional palpitations, tension, dizziness, 
  and fatigue are caused by clogged arteries that require the heart to 
  use more pressure to pump blood.

• Mitral valve prolapse (which may not even need treatment) when 
  dizziness, chest pain, faintness, and palpitations are caused by a 
  ballooning of a valve during heartbeats.

References

See Jeffrey M. Schwartz’s “4-R’s of recovery” for OCD found in Brain Lock 
(HarperCollins, 1996).

See Mastering Your Mood by Melvyn Kinder (Simon & Schuster, 1995).