The many faces of pan: Psychological and physiological differences among three types of panic attacks

Ley, Ronald

doi:10.1016/0005-7967(92)90046-j

Cited by 93 publications

(83 citation statements)

References 20 publications

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“…There is considerable evidence that the respiratory symptoms of panic attacks cluster together, although evidence for external validators is limited to self-report data. The respiratory subtype was first classified by Ley [3] and expanded upon in Klein's [5] suffocation false-alarm theory of panic. Currently, the respiratory subtype is operationalized as endorsement of four of the following five symptom criteria during an individual's most recent severe panic attack: feeling of choking or smothering sensations; shortness of breath; chest pain or discomfort; numbness or tingling sensations; and fear of dying.…”

Section: Respiratory Subtypementioning

confidence: 99%

“…[1] If symptom clusters were to indicate distinct subtypes of panic attacks, and external validators (e.g., family history, co-morbidity, course, treatment response) were to suggest functional differences across the subtypes, clinical assessment and treatment procedures could be more effectively tailored to particular types of symptoms or patients. Although several authors have previously reviewed the literature on specific symptom clusters (e.g., [2,3] ), no comprehensive review has been conducted. Additionally, no research has examined alternative approaches for subtyping panic attacks, such as genetics, which have emerged for other psychiatric disorders.…”

Section: Introductionmentioning

confidence: 99%

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Subtypes of panic attacks: a critical review of the empirical literature

et al. 2009

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Although at present the data do not warrant the utility of subtyping, further research aimed at patent gaps in the literature, including clearer operationalization of symptom subtypes, greater use of biological challenge paradigms and physiological and other more objective measures of fear and anxiety, and exploration of subtyping based on biological factors such as genetics, may support the future designation of panic attack subtypes and their ultimate clinical utility.

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Section: Respiratory Subtypementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subtypes of panic attacks: a critical review of the empirical literature

et al. 2009

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“…Researchers have identified distinct subtypes of panic disorder (PD) on the basis of a predominant symptom constellation (Bass et al, 1987;Aronson and Logue, 1988;Ley, 1992). Such an approach may contribute to a better understanding of the etiology of panic since dysregulation in different psychobiological mechanisms may underlie phenotypically similar attacks.…”

Section: Introductionmentioning

confidence: 99%

Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Colasanti

Salamon

Schruers

et al. 2008

Neuropsychopharmacol

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A number of evidences have established that panic and respiration are closely related. Clinical studies indicated that respiratory sensations constitute a discrete cluster of panic symptoms and play a major role in the pathophysiology of panic. The aim of the present study was to explore the phenomenology of an experimental model of panic in healthy volunteers based on the hypothesis that: (1) we can isolate discrete clusters of panic symptoms, (2) respiratory symptoms represent a distinct cluster of panic symptoms, and (3) respiratory symptoms are the best predictor of the subjective feeling of panic, as defined in the DSM IV criteria.Sixty-four healthy volunteers received a double inhalation of four mixtures containing 0, 9, 17.5 and 35% CO 2, respectively, in a double-blind, cross-over, random design. An electronic visual analog scale and the Panic Symptom List (PSL) were used to assess subjective 'fear/discomfort' and panic symptoms, respectively. Statistical analyses consisted of Spearman's correlations, a principal component factor analysis of the 13 PSL symptoms, and linear regressions analyses.The factor analysis extracted three clusters of panic symptoms: respiratory, cognitive, and neurovegetative (r 2 ¼ 0.65). Respiratory symptoms were highly related to subjective feeling of fear/discomfort specifically in the CO 2 -enriched condition. Moreover, the respiratory component was the most important predictor of the subjective feeling of 'fear/discomfort' (b ¼ 0.54).The discrete clusters of symptoms observed in this study were similar to those elicited in panic attacks naturally occurring in patients affected by panic disorder. Consistent with the idea that respiration plays a crucial role in the pathophysiology of panic, we found that respiratory symptoms were the best predictors the subjective state defined in the DSM IV criteria for panic.

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“…According to Ley (1992) panic attacks according to DSM-III-R criteria (American Psychiatric Association, 1987) can be defined on the basis of physiological and psychological dimensions that fit three categories of severity: Type I (classic panic attack), Type II (anticipatory panic attack), and Type III (cognitive panic attack). The classic panic attack is characterized by uncontrollable dyspnea in conjunction with the fear of suffocation.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary function in panic disorder: evidence against the dyspnea-fear theory

Spinhoven

Onstein

Sterk

1995

Behaviour Research and Therapy

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Summary--The present study addresses the hypothesis consistent with the dyspnea-fear theory of panic, that in a subgroup of panic patients a non-pathological pulmonary obstructive component may induce dyspnea, dyspneic fear and, ultimately, panic. In 38 patients who met DSM-III-R criteria for panic disorder, pulmonary function was assessed and various measurements for panic symptoms and concomitant psychopathology were collected. In comparison to patients with a high Forced Expiratory Flow at 50% (FEF 50%), low FEF 50% patients demonstrated significantly lower levels of Forced Expiratory Volume (first second) and Peak Expiratory Flow and significantly lower FEVJFVC ratios. None of the differences on psychological measurements for symptom severity between low and high FEF 50% patients proved to be significant. Moreover, FEF 50% scores and FEV#FVC ratios were not correlated to any of the measures for panic or associated psychopathology. It is concluded that the existence of a distinct subgroup of panic patients with signs of actual airway obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.

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The many faces of pan: Psychological and physiological differences among three types of panic attacks

Cited by 93 publications

References 20 publications

Subtypes of panic attacks: a critical review of the empirical literature

Subtypes of panic attacks: a critical review of the empirical literature

Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Pulmonary function in panic disorder: evidence against the dyspnea-fear theory

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