Diving is fun and adventurous. It is exhilarating and, for some even a form of meditation. There is a shadow side of diving that isn’t often talked about, we often skim past it with phrases like ‘in the unlikely event’ and ‘Stop. Breathe. Think. Breathe. And Act.’ During my diving career I have experienced everything from a slight anxiety to full on panic episodes. As an Instructor I have seen students and fun divers in similar situations. While some people manage to bring themselves back from the edge, others escalated to a full panic experience. I remember some of my very first dives on a rubber duck in Southern African waters where I was right on the edge of panic but unable to speak out about it because of how I thought others would perceive me… So let’s talk a little bit about panic, shall we?
In 2003 the Undersea Journal published research by David and Lynn Colvard on panic among recreational scuba divers. The study mentions that researchers are of the opinion that a panicked response to stress plays a large role in dive fatalities. This is echoed by a quote from Alfred Bove (Author of Medical Examination of Sport Scuba Divers) who stated that “panic, or ineffective behaviour in the emergency situation when fear is present, is the single biggest killer of sport divers.” Unfortunately we cannot know this for sure, but what do we know about panic and diving?
What does the research say?
The Recreational Scuba Training Council’s (RSTC) 1998 guidelines for the Recreational Scuba Diver’s Physical Examination listed ‘a history of panic disorder’ as a no-go zone for divers, meaning individuals with a history of panic disorder were seen as medically unfit to dive. In 2001 the guidelines were changed to include a ‘history of untreated panic disorder’ as a high risk condition for diving but also acknowledging that it could be treated and thus pose a lower risk to diving activities.
What causes panic attacks?
First we need to define what a panic attack is. For their research David and Lynn defined it as “an intense fear of losing control or dying”. They linked this to the definition of a panic attack found in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders which defines an attack as “a discrete period of intense fear or discomfort that is accompanied by at least 4 of 13 somatic or cognitive symptoms… often accompanied by a sense of imminent danger or impending doom and an urge to escape…or desire to flee from wherever the attack is occurring.”
For divers this could turn into an uncontrolled ascent or other kind of ‘flight’ response like disconnecting from the situation. David and Lynn found that 15% of divers who experience their first panic while diving engaged in a rapid or uncontrolled ascent. While this number seems relatively low, it is based on a survey of current divers. To date there is no information on how many divers stopped diving due to experiencing panic. We also cannot established how many diving fatalities are as a result of panic as the primary cause of death in these cases are often contributed to drowning with little information on the events leading up to the death of the diver.
Women, and especially women who have a history of panic attacks tend to experience more panic attacks than men. On the other hand, the men who participated in David and Lynn’s research viewed their first panic during a dive as life-threatening. They also found that women tend to accept help more often than men and contribute this to the possibility that in many cultures men are conditioned to be self-reliant.
People who have a history of panic attacks above water are about twice as likely to panic while diving as someone who have never experienced a panic attack before. They are also more likely to have more than one panic experience while diving.
Things that could trigger a panic attack are unique to every individual. What we do know is that it is not dependent on when last you dived, nor is it based on your certification level.
The good news is that David and Lynn found that most divers who had experienced a panic situation while diving remembered and used their training on how to deal with a panic situation. They also found that the majority of divers who experienced a panic situation while diving went for additional training afterwards.
Panic happens when an individual does not have any solutions for a serious problem. The quality of diver training will help with providing divers the skills they need in these situations. Repeating and practicing skills to become familiar with them can change the way a diver reacts in a panic situation. Furthermore, by continuing their diving education divers increases the amount of skills they are able to rely on when they do feel panicky.
One surprising thing that I found with David and Lynn’s research was that they had many respondents offering additional information (more than what was asked in the initial survey). The researchers also noted how divers were very willing to talk about their experiences with panic while diving, that these divers wanted to give as much information and help the researchers understand what it was like. This makes me think that it is time that we start to open up discussions around panicking in the dive community. To create a safe space for people to speak about their experiences with no judgement – and also to learn from others and to collaborate to make diving a safer sport for all.
How to recognise a panic attack:
A panic is a distinct episode of experiencing fear and discomfort with four or more of the following symptoms present, developed quickly and reaching a peak in about 10 minutes:
1. palpitations, pounding heart, or accelerated rate
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself )
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flashes
* A version of this article first appeared at www.scubadiverlife.com