ANXIETY/PANIC DISORDER

Anxiety/panic disorder

Anxiety/panic disorder

Introduction

A panic attack is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. In addition, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present. Panic disorder involves the presence of recurrent and unexpected panic attacks, followed by at least a month of persistent concern about another panic attack, or worry about the possible effects of having another panic attack.

The combination of unexpected attacks and persistent anxiety about recurrent episodes of physiological dysregulation, termed fear of fear or anxiety sensitivity, distinguishes panic disorder from other anxiety disorders in which panic episodes occasionally occur. Anxiety sensitivity is defined as fear of anxiety symptoms, which arises out of the belief that those symptoms are harmful. For instance, individuals with high anxiety sensitivity may believe chest pains signify an impending heart attack, whereas individuals with low anxiety sensitivity will regard such pains as merely unpleasant. To meet the criteria for panic disorder, the symptoms cannot be due to the direct physiological effects of a substance, a medical condition, or another mental disorder.

There are three types of panic attacks. An unexpected panic attack is a sudden, surprising, spontaneous, quick increase of panic symptoms and sensations that seem to arise without an obvious situational trigger or external stimuli. A situationally bound attack is one in which a sudden surge of fear of terror is triggered by exposure to a situational trigger. Situational triggers can either be external, (i.e., a phobic object or situation) or internal (i.e., physiological arousal or sensations). These attacks are characteristics of specific phobias and occur whenever the situational trigger is present.

The third type of panic attack, a situationally predisposed attack, differs from a situationally bound attack in that exposure to a situational trigger increases the likelihood of panic but does not invariably precipitate it. Concerns about having another attack, or the impact of such, are often linked to the avoidance of specific situations or places. When the avoidance behavior meets the criteria for agoraphobia (i.e., avoidance of open spaces), panic disorder with agoraphobia is diagnosed.

An emerging body of research suggests that separation anxiety or experiences of separation from significant attachment figures in childhood may be linked to the development of panic disorder (Mattis & Ollendick, 1997). One line of research was stimulated by Klein's (Gittelman & Klein, 1985; [Klein, 1964] and [Klein, 1980]) proposal that separation anxiety during childhood is a precursor of panic disorder (PD) and agoraphobia. This “separation anxiety hypothesis” was based on observations that some adults with PD reported a history of separation anxiety as a child. Research on the separation anxiety hypothesis suggests that separation anxiety disorder (SAD) and (PD) may be related in a number of ways (Black, 1995; Gittelman & Klein, 1985; Shear, 1996).

Several studies have confirmed that a history of separation anxiety is present in a significant number of adults with PD and agoraphobia (Breier, Charney, & Heninger, 1986; Klein, ...