Psychopathological Description of Hyperventilation-Induced Panic Attacks: A Comparison with Spontaneous Panic Attacks

Abstract

Our aim was to describe the clinical features of hyperventilation-induced panic attacks (HPA) in panic disorder patients – DSM-IV – and to compare them with their spontaneous panic attacks and with spontaneous panic attacks in panic disorder (PD) patients not sensible to the hyperventilation challenge test. We reexamined 88 previously studied PD patients when they were submitted to a hyperventilation challenge test. They were induced to hyperventilate (30 breaths/min) for 4 min and anxiety scales were applied before and after the test. A total of 51.1% (n = 45) PD patients had a panic attack after hyperventilating – HPA (χ² = 13.11, d.f. = 1, p = 0.017). The clinical symptoms of the most severe panic attack were recorded by the HPA patient and by the PD patients not sensible to this test (non-HPA; n = 43, 48.9%) in a diary during a 1-week period and then compared. The HPA group had more respiratory symptoms (χ² = 15.26, d.f. = 1, p < 0.001), fulfilling the criteria for the respiratory PD subtype (75.6%), the disorder started later (Mann-Whitney, p < 0.001), had a higher familial prevalence of PD (χ² = 19.45, d.f. = 1, p = 0.036), and had more previous depressive episodes (χ² = 18.74, d.f. = 1, p < 0.001). The HPA group had similar symptomatology in spontaneous attacks and HPA. The HPA group may be regarded as a subgroup of the respiratory panic disorder subtype with diagnostic and therapeutic implications.

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

“…(33) In a previous study, (7) our group described the clinical features pulmonary membranes and are important in the maintenance of upper airway patency in obstructive sleep apnea. (23,24) Sertraline, a selective serotonin reuptake inhibitor, reduces dyspnea in patients with COPD, (25) and paroxetine relieves respiratory symptoms in patients with obstructive sleep apnea.…”

“…Klein (5) proposed the existence of an evolved "false suffocation alarm" system that triggers spontaneous panic attacks when the brain erroneously signals a lack of useful air and activates maladaptive autonomic responses to suffocation. Sensitivity to CO 2 might play a role in this hypersensitive suffocation detector, (5) and various respiratory tests, such as carbon dioxide inhalation, (6) hyperventilation (7) and breathholding, (8) have been fruitful in generating hypotheses about panic disorder. (3,5) Panic disorder patients exhibit behavioral and physiological abnormal responses to respiratory challenge tests that are very similar to those experienced during spontaneous panic attacks.…”

Fear and Phobia: A Critical Review and the Rational-Choice Theory of Neurosis

“…Hyperventilation may be better understood as a consequence of panic (p. 805). Other researchers reported additional inconsistent findings (Gorman et al, 1994;Nardi et al, 2004;De Ruiter, Garssen, Rijken, & Kraaimat, 1992).…”

Which Diagnostic Approach Is More Valid? The DSM or the Rational-Choice Theory of Neurosis

“…This suggestion, however, has met serious criticism (e.g., see Clark, 1988;McNally, 1990;Rachman, 1990;Rofé, 2000Rofé, , 2015, such as the fact that hyperventilation, characterized by intense physiological sensations, does not invariably lead to a panic attack among panic disorder patients (e.g., see Gorman et al, 1994;Nardi et al, 2004;Sanderson & Beck, 1989). Similarly, only a minority of asthmatic patients develops panic disorder (Katon, Richardson, Lozano, & McCauley, 2004;Shavitt, Gentil, & Mandetta, 1992;Yellowlees & Kalucy, 1990), despite their frequent exposure to such intense bodily sensations.…”