Panic in Recreational Scuba Divers

Out of millions of American divers, about 90 die each year. Yet little is known about the precipitating events for many of these deaths. A coroner's report of "drowning" tells us nothing about what led to, or caused, a diver's death. As Alfred Bove states, "panic, or ineffective behavior in the emergency situation when fear is present, is the single biggest killer of sport divers." Our study examined the incidence of panic while diving, the relationship to a history of panic prior to diving, and the results of panic during a dive. We defined a panic experience as "an intense fear of losing control or dying," which is often accompanied by an urge to escape or flee from wherever the attack is occurring." An expected result of a diver's panic attack would be a rapid ascent or another flight response.

The Incidence of Panic and Prediving Panic

We received responses from 12,087 individuals: 76 percent male and 24 percent female.

Similar percentages of males (16 percent) and females (18 percent) reported a history of panic before they took up diving. But significantly more females reported panic experiences while diving (37 percent versus 24 percent of males). Forty-five percent of males and 57 percent of females with a history of panic before they began diving reported panic during one or more dives, compared with only 19 percent of males and 33 percent of females without a prediving panic history. This means that individuals with a prediving history of panic are about twice as likely to panic while diving compared with those without.

Panic During and After Initial Certification Training

Eleven percent of males with prediving panic experienced their first dive panic during training, compared with four percent without a history of panic. For females, this percentage was higher: 21 percent compared with 11 percent without a prediving history of panic. Thirty-four percent of males with a prediving history of panic had their first dive panic after their initial training, compared with only 16 percent without.

For females, the percentage was 35 percent compared with 21 percent of those without a prediving history of panic. For both males and females, the average number of dives during the year before the first panic experience during a dive was 11 to 25 dives, suggesting that recent dive activity made little difference. We found no statistically significant difference in the highest certification level attained between divers with or without panic during diving.

Prediving History of Panic and Number of Panic Experiences During Diving

A prediving history of panic was also associated with having multiple panic experiences during diving. Thirty-eight percent of males and 41 percent of females with a prediving history of panic reported more than one panic experience while diving, compared with only 25 percent of males and 30 percent of females without.

Diver's Perceptions and Consequences of First Panic Experience During a Dive

Males and females differed in their perceptions and reactions to their first panic during a dive. While females were more likely to panic during a dive (37 percent versus 24 percent), more males perceived their first panic during a dive as life-threatening (37 percent versus 27 percent). Most divers who panicked reported remembering from their training how to deal with panic and used that training (81 percent of males and 73 percent of females). More females than males reported recognizing offers of help during their first dive panic experience (67 percent versus 38 percent). Fifteen percent of both males and females made a rapid or uncontrolled ascent during their first panic while diving. But, within that 15 percent, only five percent of males and four percent of females reported symptoms of DCI, and only one percent of males and two percent of females underwent recompression.

What the Panic Survey Tells Us About Diver Training

The data suggest that training is largely effective and support current training protocols. Panic arises when individuals lack solutions to a critical problem and most respondents drew upon their training. All divers benefit from repetitive skill practice. The more familiar divers are with skills the more likely they are to respond appropriately to panic. Repeated practice in confined water, including spontaneous drills, raises the response availability level.

Females were almost twice as likely to recognize help than males. The data don't show why, but cultural influence is a reasonable speculation. Male self-reliance is common in many cultures. Asking for help may threaten male self-image, or males may be conditioned to not readily look for assistance. Emphasizing diving as a team activity may help make males more receptive to external assistance and may offset self-image issues by asking for and accepting help -- the characteristics of a good diver.

The authors of this study are David F. Colvard, M.D., and Lynn Y. Colvard, Ph.D. He is a board-certified psychiatrist in private practice in Raleigh, N.C. He has been diving since 1971 and is an active divemaster. She is a research biochemist, a medical writer for a clinical research organization, and a certified diver. The paper was first presented to the Annual Scientific Meeting of the Undersea and Hyperbaric Medical Society last year in La Jolla, CA, and published in the Winter 2003 issue of the Undersea Journal. Copies can be obtained by contacting Dr. Colvard at dcolvard@pop.mindspring.com. This survey has limitations -- it was not random, and it may tell us nothing about divers who drop out or die. If panic dives led many to drop out, then we must interpret this survey's results conservatively. Second, the survey was retrospective and subject to convenient and favorable revision of memories by participants. The data were self reported.