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panic disorder symptoms and characteristics

Panic attacks occur in a number of anxiety disorders and may be a response to various external situations or triggers, as in specific phobias. Where the occurrence becomes the central cause for concern, panic disorder is said to develop. Unlike other anxiety disorders, where the situations that trigger panic attacks can be easily identified, panic disorder is characterized by episodes of intense anxiety that occur ‘out of the blue’ – including at night while asleep – making it difficult for an individual to predict their occurrence. A consequence of this is that people become hypervigilant to bodily changes in their level of physiological arousal that results in an increased perception to changes in bodily arousal. This body vigilance was observed to be elevated in panic disorder patients compared to social phobia patients and non-anxious controls by Schmidt et al., who also noted that body vigilance is related to a history of spontaneous panic attacks. Similarly, Ehlers  suggested that heightened symptom perception in panic disorder patients may be explained by three factors;

1 greater physiological reactivity;

2 enhanced ability to perceive physiological sensations;

3 increased attention.

Panic disorder may be associated with avoidance of places or situations in which panic attacks may occur, in which case the term panic with agoraphobia is used. The lifetime prevalence of panic disorder with or without agoraphobia is between 1.5 per cent and 3.5 per cent of the populations studied. Panic disorder with agoraphobia occurs in twice as many women as men, with panic disorder without agoraphobia showing a female to male gender ratio of 3:1. Panic disorder is also associated with impaired quality of life and an increased risk of suicidal ideation and attempts when compared with other psychiatric disorders. An important feature of panic disorder is the cognitive interpretation that people make of their symptoms. Clark’s cognitive model of panic disorder proposed that panic attacks result from a catastrophic misinterpretation of bodily sensations (i.e. that sensations are perceived as more dangerous than they really are). Examples of such misinterpretations include palpitations being interpreted as a sign of an impending heart attack, breathlessness indicating impending suffocation and dizziness as a sign that someone is about to faint. A further feature of panic disorder with and without agoraphobia is the presence of safety behaviours. Three main types of safety behaviours have been suggested by Salkovskis et al. as: •avoidance, •escape, •subtle avoidance behaviours.

All three types of safety behaviours are seen to maintain the presence of panic attacks and panic disorder as they prevent the client from learning that the feared catastrophe does not happen. Salkovskis et al. identified a number of safety behaviours that people engaged in that were associated with the type of catastrophe they feared. For example, where people feared having a heart attack, common responses were to sit down, keep still and ask for help. Similarly, where people feared losing control, common responses were making deliberate attempts to control behaviour, slowing down and looking for an escape route. The identification of safety behaviours forms an important part of treatment.

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