Journal of Psychological Abnormalities

About the Causes of Panic Disorder

Carlos Joseph^{* *}Correspondence: Carlos Joseph, Editorial Office, Journal of Psychological Abnormalities, Brussels, Belgium, Email:

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Introduction

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM) III was not published until 25 years ago, reports of clinically similar syndrome (such as Da Costa's warrior’s heart, Wheeler's neurocirculatory asthenia, and Lewis's effort syndrome) have been reported far earlier. These accounts highlighted symptoms of severe exhaustion, which are not currently included in the diagnostic criteria, along with paroxysmal autonomic nervous system arousal and catastrophic cognitions. The military environments in which these disorders emerged suggested that stress and trauma played a significant role. This suggests a potential area of causation overlapping with post-traumatic stress disorder, another anxiety disease that frequently includes panic episodes. The most extensive research has been done on panic disorder out of all the anxiety-related syndromes. This research has led many physicians to believe that medication therapy is the preferred method for treating panic episodes, while behavioral techniques are crucial for treating any possible agoraphobic avoidance. This premise implies that without agoraphobic avoidance, behavioral treatments for panic disorder would be useless. 11 patients with panic disorder and 9 patients with generalized anxiety disorder were divided into treatment or wait-list groups in the first controlled trial. None of the DSM-III panic disorder patients avoided public spaces more than minimally. EMG biofeedback, progressive relaxation training, and cognitive therapy tailored to treat panic disorder were all used in the course of treatment.

The treated participants significantly improved over the controls, and additional therapeutic benefits were observed during the follow-up period. Additionally, Beck compared the outcomes of his most recent clinical series to those of a wait-listed group. It is important to distinguish between the worry experienced by patients with panic disorder about the possibility of attack recurrence or its consequences and the six months or longer of worry about a variety of other life issues necessary for the diagnosis of generalized anxiety disorder.

Although the descriptions of panic disorder in DSM III,1 DSM III R,5, and DSM IV,6 differ slightly, the core components of the condition are similar to the ICD-10 description. Currently, diagnosing panic disorder requires the presence of recurrent panic attacks along with any of the following: concern about the possibility of future attacks, the development of phobic avoidance staying away from places or situations where the person fears could trigger a panic attack, where escaping or getting help in the event of an attack would be unlikely or difficult (for example, driving on a bridge, sitting in a crowded movie theatre), or any other change in behavior as a result of the condition. The nosological status of agoraphobia without panic attacks, which is infrequently observed in clinical settings, is still up for debate.

Nearly one-third of patients with panic disorder experience agoraphobia before the start of panic, indicating that not all agoraphobia is a result of panic. Additionally, some cases of agoraphobia without panic attacks may be causally different from agoraphobia with panic attacks, indicating that agoraphobic behavior may have developed in response to a physical condition (such as vestibular disease or postural instability brought on by Parkinson's disease) that reduces a person's sense of competence or safety when performing daily tasks.

Conclusion

There were certain patterns or variances between groups. In general, fewer patients in the relaxation group who completed the exam reported having completely overcome their panic at the post-test. On this metric, only the E & C and combined groups considerably outperformed the WL group. On the other hand, the R group alone had considerably higher scores on the psychosomatic symptom checklist. The two groups receiving relaxation experienced greater decreases in the daily anxiety average. This explains why a slightly (but not substantially) larger proportion of patients in the relaxation group had high end-state functioning status at post-treatment. This implies that, compared to the other treatment scenarios, relaxation, as applied in this treatment procedure, is a less targeted treatment for panic episodes. The majority of patients increased rather than decreased their daily anxiety at the follow-up examinations, indicating that despite the excellent outcomes mentioned in the current study, it is important to note that high-end state functioning does not always correspond with the virtually complete eradication of terror. After six months, the exposure group outperformed the controls on every anxiety and panic measure. This research was not a pure preventative study because 40% of the sample group had symptoms of panic disorder. In a different study, college students with at least one recent panic attack and moderate anxiety sensitivity were given the option of being placed on a waiting list or participating in a 5-hour cognitive-behavioral program. Comparatively to the workshop group, 18% of people experienced the onset of panic disorder 6 months later, against 13.6% of controls. It will be necessary to conduct more studies on techniques for spotting and identifying those at risk for panic disorder (such as children of those who have the disease or kids who have behavioral inhibitions).