Psychological Mechanisms and Physiological Consequences of Panic Attack in Recreational Scuba Diving

Recreational scuba diving has become increasingly popular in recent years. With the increasing number of participant, the risk associated with the sport needs to be addressed. Some authorities suggest it should be classified as a high-risk sport while others suggest that the dangers of the activity have been down-played due to the commercialization of the diving community. Panic is an important topic in assessing the risk to recreational divers. The National Underwater Accident Center, NUADC, for the period of 1976 to 1988 indicated that 19% of diving fatalities reported involved probable panic. Furthermore, in a sample of 245 male and female divers, 54% experienced panic or near-panic behavior while diving on one or more occasion. The physiological consequences of a panic attack while diving can be deadly. Instructors, physicians and dive students should be made aware of the risk to persons prone to panic attack. Instructors need to be trained in recognizing the manifestations of frank panic during instruction and discourage these students from continuing. More subtle cases of panic disorder must be screened out by a physician while performing a medical clearance physical for a recreational diving student. The physician can make subtle inquiries and through the answers screen out potentially panic prone divers. Such questions as “How many visits to the emergency room have you made?” as opposed to “Have you ever visited the emergency room?” will elicit a more complete history versus a blanket denial of previous illness or injury. The nature of the E.R. visits will often be revealing to the astute physician. Persons with histories of asthma attacks or hyperventilation syndrome may indicate an underlying panic disorder. The students themselves need to be warned of the hazards of diving if panic prone. The idea needs to be stressed in scuba diving books and manuals much more than it is currently. For example, one of the most popular scuba diving books, The Encyclopedia of Recreational Diving, does not cover panic or the problems that can result due to panic. If this concept is made clear to students while in class, those prone to panic episodes may then self-screen themselves and discontinue a scuba class thereby avoiding injury or death. Scuba diving should be considered a high-risk sport and participants screened for such activity. Not only does a panicked diver put himself in jeopardy, he risks the lives of others in a group with the loss of cognitive abilities seen during panic. Individuals with elevated anxiety levels are more likely to experience a panic episode while diving due to the number of stressors involved in the sport. These persons should be selectively screened out and encouraged to find other avenues for recreation.