Fans of NBC’s family drama This Is Us may have noticed that Randall Pearson (played by actor Sterling K. Brown) seemed a bit off at the end of last week’s episode. Of the three Pearson siblings, Randall is usually the one who seems to have everything together — but his shaking hand was a clear sign that something wasn’t quite right. Sure enough, we learn that Randall has been coping with anxiety since he was a child and experiences crippling panic attacks when overwhelmed.
Panic attacks are characterized by a surge of intense discomfort and fear, explains James Murrough, MD, an assistant professor of psychiatry and neuroscience at the Mount Sinai Hospital in New York City. He tell us that Randall’s character exhibits signs of panic disorder, a form of anxiety in which patients experience recurrent panic attacks throughout their life. It’s common for panic disorder to start in childhood, Dr. Murrough says—and in a flashback scene, we see young Randall experiencing an attack while doing homework. (His brother Kevin ignores Randall instead of offering support.)
Panic disorder patients typically suffer their first attack out of the blue, but after that, stress can be a trigger, says Dr. Murrough. And there’s no denying that Randall has a lot on his plate: He tracked down his biological father, William, after 36 years, only to learn that the man is dying of cancer. Shortly after, he finds out that his mother Rebecca (Mandy Moore) knew who William was all along and didn’t tell him. Plus, he’s dealing with pressure at work and is struggling to devote enough time to his family. That this all culminates in a panic attack is unsurprising, says Dr. Murrough.
Anxiety is a mental health disorder, but the symptoms of a panic attack are very real. During Randall’s present-day attack, he’s shown shaking, sweating, hyperventilating, and having difficulty breathing.
“This was a pretty accurate portrayal,” Dr. Murrough tells Health. “When you’re experiencing a panic attack, it can feel like you’re dying or losing your mind.
“The blurred vision that Randall experiences is also important: “The blurring of his vision gave the feeling of detachment or unreality,” says Dr. Murrough. “De-personalization or feeling disconnected from your body is another common symptom of a panic attack.”
Watch the full scene below:
On social media, viewers applauded the show’s portrayal of anxiety (and the fact that Kevin finally showed up for his brother when he needed him most).
Because the symptoms of a panic attack can be so scary (Dr. Murrough says it’s not uncommon for patients to think they’re having a heart attack), many first-time sufferers end up in the hospital. If their doctors determine they’re experiencing anxiety, psychotherapy or medications may be recommended.
It’s also important for the patient’s family to understand the disorder. While we can probably all agree that young Kevin was kind of a jerk to his adopted brother, it’s not always easy to know how to comfort a loved one with anxiety.
“The person who witnesses a panic attack for the first time may also be alarmed,” says Dr. Murrough.
But Kevin got it right—at least the second time.
“Reassurance is important,” says Dr. Murrough. “Telling them that they’re going to get through it, and being there for them as it runs its course.”
This article originally appeared in People.com