A central cognitive feature of panic disorder is the catastrophic interpretation of subtle, harmless bodily changes that result from innocuous events. For instance, an individual might perceive dizziness from standing up quickly or an increased heart rate from exercise as signs of an impending heart attack. This misinterpretation is the trigger that creates the fear and anxiety leading to a panic attack.

Catastrophic Interpretation of Bodily Sensations in Panic Disorder

Cognitive theories propose that panic disorder is driven by a tendency to misinterpret ordinary bodily sensations in a catastrophic way. According to this model, these fearful interpretations of harmless physical changes initiate a vicious cycle of escalating fear and anxiety, which triggers more physical symptoms and ultimately culminates in a panic attack.

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This disorder is hallmarked by the experience of multiple, unexpected panic attacks. These attacks are often associated with intense fear that occurs quickly. Generally, this diagnosis is applied if you have had four or more panic attacks, and fear their reocurrence. Having one panic attack, is not a panic disorder. Worry over panic attacks and avoidance of situations, places, etc. that are associated with panic attacks can lead to further problems. 

Recurrent panic attacks may show temporal lobe abnormalities. Those who suffer from panic disorder typically have lower temporal lobe volumes. These attacks can occur unexpectedly or by a trigger. 



Panic Disorder

SG;, H. S. C. H. (n.d.). "third-wave" cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry. World psychiatry : official journal of the World Psychiatric Association (WPA). Retrieved November 17, 2021, from https://pubmed.ncbi.nlm.nih.gov/34505370/?fc=None&amp;ff=20211014202414&amp;v=2.15.0. 

"Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Panic Disorder. Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/panic-disorder. 

Panic Disorder Johns Hopkins 

Mayo Foundation for Medical Education and Research. (2018, May 4). Panic attacks and panic disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021#:~:text=A%20panic%20attack%20is%20a,heart%20attack%20or%20even%20dying. 

Panic attacks and disorder, Mayo Clinic

- Factors increasing anxiety
- Protective factors against anxiety

Areas impact between COVID and Anxiety/Panic Disorders

-  Sweating, trembling, shortness of breath or a feeling of choking
-  A pounding heart or rapid heart rate, and feelings of dread.
- Abdominal cramping, nausea, chest pain, headache, dizziness, numbness, tingling sensation. 
- Feeling of unreality or detachment. 
- Fear of loss of control or death.
-  Such attacks often happen suddenly, without warning
-  People who experience panic attacks often become fearful about when the next episode will occur, which can cause them to change or restrict their normal activities.

Signs of a Panic Attack

Though anxiety attacks and panic attacks are usually considered to be the same, the causes of these attacks differ. An anxiety attack is typically a result of a perceived threat or known cause. Anxiety attacks follow a  period of excessive worry, and apparent symptoms of anxiety, while panic attacks can happen out of the blue. 

Anxiety Attacks

Reference for Anxiety Sensitivity Theory

Anxiety sensitivity theory is the notion that panic disorder is partially caused by the inclination to interpret mental and physical signs of anxiety and stress as a catastrophic occurrence.  

Anxiety Sensitivity Theory 

Reference for The Prevalence of Panic Attacks

Every year, around 11% of the American population report experiencing at least one panic attack. Almost 2% to 3% of individuals in the United States suffer from panic disorder.

The Prevalence of Panic Attacks

Reference for Treatments for Panic Disorder

Treatment options for panic disorder are:
* Psychotherapy. 
* Medications.
* A combination of psychotherapy and medications.

Treatment options for panic disorder depend on the patient’s history, preference, and the severity of the disorder.

Treatments for Panic Disorder

A panic attack is an episode of intense anxiety that is marked by physical symptoms such as a racing heart, sweating, and choking sensations. These symptoms can be so severe that they can invoke the fear of dying, losing control, or going crazy.

Panic Attack

The locus coeruleus is a region located in the brainstem that serves as the brain's primary source of norepinephrine. This neurotransmitter is responsible for activating the body's fight-or-flight response. Research indicates a strong link between this area and anxiety, as its activation is associated with feelings of fear and anxiety. Studies involving nonhuman primates have demonstrated that direct stimulation of the locus coeruleus can induce panic-like symptoms, suggesting its potential role in panic disorder.

Locus Coeruleus

Which of these people are most likely to have a panic disorder?

To be diagnosed with panic disorder, an individual must experience recurrent and unexpected panic attacks. This must be followed by at least one month of persistent concern about having more attacks, worry about the consequences of the attacks (e.g., losing control), or significant, self-defeating changes in behavior aimed at avoiding future attacks.

Diagnostic Criteria for Panic Disorder

A diagnosis of panic disorder is only appropriate if the panic attacks are not a direct physiological result of substance use, a medical condition, or another mental disorder. These potential causes must be ruled out before confirming a panic disorder diagnosis.

Exclusion Criteria for Panic Disorder

A panic attack is formally defined as an abrupt surge of intense fear or discomfort that reaches its peak within ten minutes. The experience is characterized by symptoms such as an accelerated heart rate, sweating, trembling, sensations of choking, hot flashes or chills, dizziness, and intense fears of dying or losing control.

Definition of a Panic Attack

Panic disorder is often characterized as a 'fear of fear' because the experience of a panic attack is so terrifying that individuals develop an intense fear of having another one. This secondary fear leads them to become preoccupied with avoiding future attacks, often by modifying their behavior and avoiding situations they associate with panic.

Panic Disorder as 'Fear of Fear'

Panic attacks, in isolation, are not classified as a mental disorder. They are relatively common occurrences. In contrast, panic disorder is a diagnosable mental health condition characterized by recurrent, unexpected attacks and persistent fear about them, and it is significantly less common in the population.

Distinction Between Panic Attacks and Panic Disorder

Panic disorder affects a smaller portion of the population compared to isolated panic attacks. Throughout their lifetime, an estimated 4.7% of Americans meet the diagnostic criteria for the disorder.

Lifetime Prevalence of Panic Disorder

A common complication of panic disorder is the development of agoraphobia. This secondary condition is characterized by the fear and subsequent avoidance of situations or places where escape could be difficult or help might be unavailable in the event of a panic attack.

Link Between Panic Disorder and Agoraphobia

Individuals diagnosed with panic disorder often have at least one other co-occurring mental health condition. Among the most common comorbid diagnoses are other anxiety disorders and major depressive disorder.

Comorbidity in Panic Disorder

The development of panic disorder has a significant genetic component, with family and twin studies estimating its heritability at approximately 43%. This genetic predisposition is evidenced by the fact that children whose parents have panic disorder are at an increased risk of developing the condition themselves. However, the specific genes and their functions that contribute to this risk are not yet fully understood.

Genetic Factors in Panic Disorder

One prominent neurobiological theory posits that panic disorder may stem from abnormal activity of the neurotransmitter norepinephrine within the locus coeruleus. This theory is based on findings that the locus coeruleus, a major source of norepinephrine, is involved in the body's fight-or-flight response and that its stimulation can produce panic-like symptoms.

Neurobiological Theory of Panic Disorder

This theory posits that panic attacks can be learned responses acquired through classical conditioning. It suggests that subtle bodily sensations, which resemble those experienced during an initial frightening event, can become conditioned stimuli that subsequently trigger a panic attack as a conditioned response.

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