Concern about being unable to escape or get help in the event of panic symptoms or other unpleasant physical symptoms (e.g., incontinence, vomiting, falling)
Avoidance can be persistent
Use and abuse of drugs and alcohol
Interoceptive avoidance
Statistics
2.7% (year)
4.7% (life)
Female: male = 2:1
Acute onset, most common in young adulthood (e.g. ages 20-24)
Special populations
Children
Hyperventilation is a common symptom
Earlier cognitive development > fewer cognitive symptoms (e.g. less fear of dying)
Elderly
Health focus is more common
Changes in prevalence – decreases with age
Diagnostic Criteria for Panic Disorder
Recurrent unexpected panic attaches
At least one attach has been followed by significant worry or maladaptive change in behavior
Not attributable to substance use
Not better explained by another mental disorder
Diagnostic Criteria for Agoraphobia
Marked fear/anxiety for two or more: public transportation, open spaces, enclosed spaces, standing in line, being outside the home alone
Avoids these situations
Situations always provoke fear
Anxiety not proportional to real danger
Significant distress
Anxiety is excessive
Not better explained by another mental disorder
Gender and Culture
Social/gender roles
~75% of those with agoraphobia are female
Cultural factors
Similar prevalence rates across cultures
Variable symptom expression
Somatic symptoms more emphasized than emotional symptoms in developing countries
Nocturnal Panic
60% with panic disorder experience nocturnal attacks
Occur in non-REM sleep
Occur during delta/slow wave sleep
Caused by deep relaxation,
Sensations of “letting go” are anxiety provoking to people with panic attacks
Sleep terrors
Isolated sleep paralysis
Causes of Nocturnal Panic
Generalized biological vulnerability
Alarm reaction to stress
Cues get associated with situations
Conditioning occurs
Generalized psychological vulnerability
Anxiety about future attacks
Hypervigilance
Increase interoceptive awareness
Panic Treatment
Medications
Multiple systems affected by medication
serotonergic
noradrenergic
GABA
Benzodiazepines (e.g. Ativan)
SSRIs (e.g., Prozac and Paxil)
High relapse rates after discontinuation of medication