Did you kiss anyone in Ch4.5? According to that, if you kiss Vic, or Mila, or take part in the four way kiss, you will get a panic attack if you kissed Bella (the idea that you're stressed by being a manwhore). If you've already had a panic attack (if I understand what McPa means to be if panic attacks are greater than 1) you'll also have a panic attack.
You can kiss Bella and not get a panic attack if you don't kiss anyone in that room I guess.
The question then is, can anyone avoid it? You get a panic attack if you go to the gym with Jeff (after), but if you avoid that, you get one anyway. Unless the number means, panic attack potential builds up, and each panic attack reduces the counter. If so, it just means you'll get a panic attack at a different point. I'm not sure there's currently a reason to avoid them, my guess is that it's simply a way to bring an appearance of random panic attacks whenever you're pushing against your antisocial tendencies.
The way it's written (notice foursome is written twice, implying two conditions) suggests IF *this* OR *this* THEN, but I thin the intention is 'IF Bella AND (Vic OR Mila OR 4) OR McPa >1 OR 4' which would imply the 4some kiss would always result in panic. It's poorly written as to intent, because currently kissing Vic would result in panic according to the way it's written there.
The implication is more if you go behind girls backs or play the manwhore, it'll stress you out I think.