Phobic fear and panic attacks: The same emotional states triggered by different cues?

Abstract

In this review, Simple Phobia (SP) fear and Panic Disorder (PD) panic attacks are compared in terms of symptom profile, unpredictability, and suddeness (the features specified by the DSM-III-R to be characteristic of PD). These comparisons were made to determine whether empirical evidence supports the diagnostic and conceptual distinctions drawn between PD panic attacks and SP phobic fear. Many similarities were noted. Simple phobics (SPs) report the experience of panic in response to their feared objects, and that the attacks are sometimes unexpected. Furthermore, SPs frequently worry about experiencing panic attacks (or their perceived consequences), although the worry is limited to the context of their phobic object. SPs and panic disordered individuals tend to report similar symptoms when fearful. No evidence was available concerning suddenness of fear. It is proposed that PD panic attacks are always cued, although the individual is not always aware of the cue. Furthermore, it is suggested that phobic fear and panic attacks differ only in terms of the specific triggering cue: specifically, that internally generated cues, such as certain bodily sensations and cognitive images, are more salient for PD than for SP, on average. In addition, internal fear cues tend to occur less predictably and are more inescapable than external feared objects or situations. It is for these reasons that persons with PD experience panic attacks that seem to occur for no apparent reason and pervasive apprehension about the recurrence of panic, in contrast to the circumscribed nature of phobic fear.