Panic Disorder

Criterion A

Recurrent, unexpected panic attacks, at some point panic is unexpected

Criterion B

For at least 1 month at least 1 panic attack, person experiences 1 or both of the following:

• Concern or worry about additional attacks or their consequences

• Significant change in behavior related to attacks

• Need to differentiate what occurs during and after an attack

• Panic can be a self-perpetuating cause

Criterion C

Can’t be explained by something else

Criterion D

Not due to other stuff

Agoraphobia

Behavior change due to panic, phobic avoidance of places from which escape difficult if panic attack occurs

• Fear other people’s reaction to your fear

• Malls, cars, subways, restaurants, wide streets

Who gets panic disorder?

• Age of onset: mean age 20-24

• Range wide: late teens-early 40’s

• If age of onset <20, 1st degree relatives 20 times more likely to develop PD

Biological Treatment

• Tricyclic antidepressants, no idea why they work

• SSRI’s, SNRI’s preferable

• 5-HT1a Agonists

• Sometimes high-potency benzodiazepines (Xanax, not Valium)

• 50-60% of people who take them get better

Psychodynamic Theory

• No good psychoanalytic theory

• Freud conspicuously silent

• Psychoanalysis-poor outcomes

Modern Psychodynamic Treatment (Panic-Focused Psychodynamic Therapy)

• Symptoms of panic are symbolic and due to something deeper

• Panic symptoms symbolize deeper psychological meanings (e.g., abandonment, separation, autonomy)

• 24 sessions over 12 weeks, focus on insight into meanings of symptoms

• Outcome measured by symptom reduction

• 73% had significantly symptom reductions

Learning Theory

• Catastrophic misinterpretation of bodily sensations

  1) Unexpected physical sensation

  2) Catastrophic interpretation of that sensation

  3) High vigilance for future sensations leads to more sensations

  4) Phobic avoidance of sensations and situations classically associated with them

Learning Treatment: Panic Control Treatment

• Behavioral component: exposure to individual symptom’s of panic

• Interoceptive conditioning: elicite bodily sensations

• Cognitive component: use cognitive therapy to readjust thoughts

• Elicit and correct catastrophic automatic thoughts associated with panic symptoms

• Effective in 80-90% of patients

• 6 month relapse rates ~ 8%