Panic in scuba diving

By Dr. Stefano Casali

The panic attack

Epidemiological studies on the population conducted in the USA have observed an annual prevalence of panic disorders ranging from 0.4 / 100 to 1.5 / 100, while European and Italian ones give an annual prevalence of 1.7 / 100 [7]. A study [8], among those who practice diving, has shown that panic is higher among women (64%) than men (50%),

but that the latter are more (48%) who perceive this event as a threat to their life (in women the percentage is 35%). Even divers with many years of experience can experience a panic attack. A possible explanation is given by the hypothesis that in such situations the diver, losing the familiarity with the objects of the surrounding environment, experiences a form of sensory deprivation. This phenomenon has been called "Blue Orb Syndrome", which has characteristics that bring it closer to agoraphobia that can accompany panic on land. Panic attacks, according to DSM-IV-TR [9], can occur in the context of any anxiety disorder as well as in other mental disorders (social phobia, specific phobia, obsessive-compulsive disorder, post-traumatic stress disorder or separation anxiety disorder) and in some general medical conditions. They are divided into:

A. Unexpected (unprovoked) panic attacks: the diver has no stress factor and feels the "clear sky" attack;

B. Panic attacks caused by the situation (provoked) that occur immediately after exposure to, or awaiting, a stimulus or situational trigger, such as air loss or other equipment malfunctions, disorientation in a wreck or cave, very little visibility or no longer seeing the dive buddy;

C. Situation-sensitive panic attacks, which are similar to the attacks of point b, but are not invariably associated with the stimulus and do not necessarily occur immediately after exposure (eg a panic attack occurs after half an hour when crossed a shark or after having made a descent in the "blue" away from the wall).

It has been observed that anxious individuals, subjected to intense physical exercise while wearing a mask, tear it away from their face if they believe they cannot breathe properly. Scuba divers were reported to have panicked, taking their regulator off and resisting if their partner tried to put it back in their mouths, even though they had charged cylinders and a perfectly functioning delivery system. A simple thought or an association can often start a chain reaction of thoughts, like the following: "I have too much weight - What happens if I go too fast? - I could break a eardrum - No one could be able to reach me in time - I could end up on the bottom more than 25 meters away from the coral reef - I could be hurt - I'm about to drown - Panic! " One question remains: why do some people experience a panic attack, while others only show anxiety and manage the situation rationally? The factors can be different, among which: the specific importance of the external stimulus for the individual involved, the fact that there has been a specific training and the results that the training has had in strengthening the defenses and the adaptability of the individual against unexpected situations.