Biological Perspectives

Abstract

Annie dreaded what would happen next--she had been down this road many times before. There she was--minding her own business, just wanting to watch a movie like any normal person--when she noticed her breathing was off. Immediately she began to monitor her breathing and soon seemed as if she just could not get enough air. She remembered a recent visit to the ER when the nurse patiently showed her that the oxygen saturation levels were good. She remembered, but didn't help. It wasn't that she believed this time was different--that this time she was going to suffocate. No, that might be a textbook explanation but wasn't her explanation. She just couldn't breathe, and knowing that it was all in her head just didn't seem to help. Soon she would be spiraling into symptoms that, like Old Testament prophet, would beget more apprehension, which would beget more symptoms--palpitations, dizziness, a fear of fainting, trembling, feeling that things around her were unreal, fear of going crazy--which would beget more dread. Worst of all, she feared looking foolish. What if she fainted right there in the movie theater? What if she lost control and started gulping big chunks of air down? What if she...? What would they think of her? ********** Annie's experience may be a little different from others' who suffer from panic disorder, but not too different. For some, panic may occur in specific situations or in certain types of environments while for others these come of the blue. The final common pathway, however, is not unique--it is pure human misery. It is not uncommon to find talented men and women who live truncated lives because of panic attacks, the fear of having a panic attack, and the fear of the fear of having a panic attack. Overview of Panic Disorders Panic disorder is one of the most studied anxiety disorders. While about 25% of Americans suffer from anxiety, only a small subgroup will ever be diagnosed with panic disorder (Dugue & Neugroschl, 2002). Clark (1986) described panic as an intense feeling of apprehension or impending doom which is of sudden onset and which is associated with a wide range of distressing physical (p. 461). These physical sensations include all those exhibited by Annie as well as a number of other symptoms (Table 1). According to established criteria, at least four of these symptoms must occur abruptly and peak within 10 minutes (American Psychiatric Association [APA], 2000). Lifetime prevalence rates for panic disorder are thought to be between 1% and 3.5%, with significantly higher prevalence rates found in general medical settings (e.g., patients with chest pain, asthma, headaches, epilepsy) (APA, 2000; Plewa, 2002). Prevalence is higher for women (2:1). Panic disorder results in considerable morbidity (e.g., 10%-20% attempt suicide, 7%-28% have history of substance abuse) and increased mortality (Malizia et al., 1998; Plewa). A considerable variance occurs among individuals related to frequency of attacks and course of illness. Many, but not all, patients report a lifelong history of anxiety before the actual diagnosis of panic disorder is made. A bimodal distribution of onset can be predicted with first panic occurring during late adolescence or during the mid 30s. The majority of patients report their first panic attack happening out of the blue, but subsequent are often attached to situational or environmental stimuli. Elderly individuals are less likely than younger people to suffer from panic attacks, with a number of competing hypotheses generated from this observation. Individuals with a family history of panic are more likely to suffer from panic themselves than is the general population, suggesting a genetic contribution. Finally, a history of childhood separation anxiety correlates to adult panic disorder. Models for Panic Disorders Historically, both psychologic and biologic models for panic disorders have been advanced in the literature. …