Is panic disorder a disorder of physical fitness? A heuristic proposal

Abstract

Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD.

Experimental Drugs for Panic Disorder: An Updated Systematic Review

“…In conclusion, the ability of OX1R antagonists to decrease hypersensitivity to CO 2 /NaLac (a biomarker of human panic 7 , 16 ) in animal models encouraged future development of these compounds as potential novel treatment for PAs in patients with PD. Although very limited, preliminary clinical findings supported this possibility, suggesting that compounds such as JNJ-61393115 deserve further clinical investigation.…”

“… 65–67 These compounds may have potential additional therapeutic effects in PD, acting on conditioned responses and panic-related phobias. 7 , 16 …”

“… 13–15 We recently proposed that subtle imbalances in bodily homeostatic global functioning reduce global physical adaptability to internal changes and may lead to PAs. 16 …”

Network analysis applied to DASS-21: Emergence of a new dimension

“…Rapee [107] had identified hyperventilation and subtle onset of PD at an older age than people presenting with GAD. Panic is characterized by a set of sympathetic autonomic responses that culminate in anticipatory seizures, subjective discomfort and fear of losing control and/or dying [108][109][110][111][112][113][114], whereas GAD can be defined as a clinical condition held from distortions concerning ambiguous situations that are characterized by uncertain consequences [115]. These two clinical conditions exhibit distinct comorbidities.…”

Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry

“…In particular, anticipatory anxiety is known to be an important predictor of quality-of-life changes [47]. Therefore, lowering anticipatory anxiety through a variety of treatments can be an important factor in allowing patients with PD to participate in physical activity [48].…”