What are panic attacks and what causes them? A look at the issue

"People with panic disorder are especially sensitive to changes in their bodies," explains Stewart Shankman. © 9nong/Istock.com

TORONTO -- Supreme Court Justice Clement Gascon, who briefly went missing in Ottawa last week, recently explained that his disappearance was caused by a panic attack. Here's a look at the science and the stigma around the issue:

WHAT IS A PANIC ATTACK?

Andrew Jacobs, a psychologist with the Royal Ottawa Mental Health Centre, said panic attacks are "a sudden surge in anxiety or an uncomfortable feeling that go from zero to 60 within a few minutes." Panic attacks are defined by a certain set of symptoms that can include increased heart rates, nausea, dizziness, shortness of breath, sweating and a fear the person is dying. Jacobs said a person must experience four out of 13 symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders.

WHAT CAUSES AN ATTACK?

The Canadian Mental Health Association says panic attacks can be brought on by stress, fatigue or even excessive exercise. Jacobs says there are two types of panic attacks: cued and uncued. "Cued attacks happen as a result of someone already being very worried or fearful of something that can escalate into panic," he said. "Uncued, which feels like the panic attacks come literally out of nowhere -- it can even happen in the middle of sleep." Gascon said in his statement that on the afternoon he went missing, he was affected by both a change in medication and a "heart-rending career decision." He announced in September he plans to retire.

HOW DOES A PERSON COPE WITH A PANIC ATTACK?

There are many options for treating anxiety and panic attacks, including medication and counselling. One in particular is called cognitive behavioural therapy, or CBT. According to St. Joseph's Healthcare in Hamilton, CBT can include such methods as confronting a feared situation, as well as breathing techniques and replacing anxious thoughts with realistic ones. In Gascon's case, he said his recent episode had been "taken care of and treated with the necessary medical support."

CAN YOU RETURN TO WORK AFTER A PANIC ATTACK?

Gascon said in his statement that he is "fully capable" of performing his duties as a judge, and Chief Justice Richard Wagner said in his own statement that Gascon continues to have his "full support and confidence." Jordan Friesen, the national director of workplace mental health at the Canadian Mental Health Association, said it should be "relatively simple" for Gascon to return to work, given that panic attacks tend to be time-limited. "I think the question becomes, for him and for his employer, is to understand what to do if a situation like that happens again," said Friesen. "My hope would be that if he's experiencing symptoms of a panic attack again that he's able to go and identify this to his employer and seek appropriate support -- much like you would if you were at work and started feeling ill with the flu."

HOW HAVE ATTITUDES TOWARD MENTAL HEALTH IN THE WORKPLACE CHANGED OVER THE YEARS?

Last year, the family of late Supreme Court justice Gerald Le Dain went public with the story of his departure from the court in 1988, saying then-chief justice Brian Dickson forced Le Dain out after he was hospitalized with depression. A former top aide to Dickson had previously written that the decision was made because the Supreme Court had a heavy load at the time and could not handle being short a judge, but Le Dain's family told CBC he would have returned after a short time off to recuperate. In contrast to the way Le Dain was allegedly treated, the response to Gascon's public statement has been overwhelmingly positive. Wagner said Gascon's explanation took courage, while Independent MP Jody Wilson-Raybould thanked him for sharing his struggle. Doron Gold, a former lawyer who now works as a psychotherapist with Homewood Health, said the response illustrates the way attitudes have shifted -- though he added there's still much work to be done. "Things are so much better than they used to be, and they're so far away from where they should be," said Gold.