Are all the causes of panic attacks real?

Yes - I Think: I'm not entirely sure what you mean by "real." to me, if a person has panic attacks, and if there are certain reasons or triggers for these, then there is certainly a real connection between those events and the panic attacks. It would help me answer the question better if i more clearly understood you question.

Panic attacks: Etiology of panic attacks can be real or perceived threat to safety, whether it is actual scary encounter such as sudden exposure to feared object or event, or it can be an event that triggers fears from past exposure (flashbacks) that trigger our alarm system to react with panic.

No: Panic attacks occur when our brain believes we are in danger, and engages the fight or flight response. Perceived threats can be real (shark attack) or imagined (monsters under the bed). Learning relaxation strategies is helpful, as are soothing self talk and distraction. Here is a relaxation link to get you started: http://tinyurl.Com/bnod.