Current research on panic disorder: a review

¶ … Panic Disorder

Current research on panic disorder, as well as its treatment is telling of the state of the disorder in the population, as well as inroads being made in its treatment and diagnosis. According to Beamish, Granello & Belcastro, the understanding of the symptomology of panic disorder and its necessary features for diagnosis have not changed. As the essential features of the disorder is the recurrence of panic attacks, with a persistent fear of over one month of recurrence and the fact that many panic responses are not brought on by logical panic scenarios, but are what most would consider unfounded and unrelated to actual occurrences. (Whalen & Mckinney, 2007, p. 12) What has changed in recent research is an understanding of the importance of early intervention and the scope of available treatment through counseling intervention, mainly cognitive therapy to retrain the brain into accepting certain stimuli as normal and therefore not worthy of panic response, and pharmacology options including anti-depressant medications (Selective Serotonin Reuptake Inhibitors, Tricyclic Antidepressants, Monoamine Oxidase (MAO) Inhibitors, Benzodiazepines). The lasting impression of this work on treatment research is that developing systems that more quickly recognize, diagnose and intervene in cases of panic disorder will likely assist patients in that early intervention tends to reduce the incidence of progression of the disorder to full blown agoraphobia and cyclical repetitive attack regimens. Lastly the work clearly notes that some combination of counseling intervention and pharmacological results seems to be most effective in treatment. (Beamish, Granello & Belcastro, 2002, p. 224)

Concerning the etiology of panic disorder there is a recurrent theme in the recent literature denoting that it may be multicausal or singularly caused and that a complete understanding of the occurrence of the disorder is not available.

There are several theories regarding the causes of panic disorder, none of which appear to fully explain why it occurs (Jacobs & Nadel, 1999). Some think there is a purely biological explanation, while others posit that panic disorder is a learned behavioral response to stressful situations (Barlow, Brown, & Craske, 1994; Jacobs & Nadel). A third perspective suggests that initial panic attacks are based on the body's natural fear reaction occurring at an inappropriate time. Following this initial attack a small percentage of individuals develop anxiety based on fear of further attacks (Barlow et al.). (Whalen & Mckinney, 2007, p.12)

Regardless of a complete understanding of the disease it is known that gender is the only serious and persistent factor for prevalence as many more women than men are diagnosed with the disorder and this prevalence increases with age. (Whalen & Mckinney, 2007, p.12) Currently it is noted that 3.5% of the U.S. population suffers from the disorder, although as many as 14% of the U.S. population experience panic attacks, though not all warrant a diagnosis of panic disorder (Whalen & Mckinney, 2007, p.12)

Panic disorders in children is also a new filed of study, that has recently gained a great deal of attention, as recent research has pointed to the idea that children with anxiety disorders, panic disorder included share certain characteristics, "children with anxiety disorders have dysfunctional cognitions about ambiguous situations." (Bogels & Zigterman, 2000, p. 205)

Anxious and oppositional children were found to interpret ambiguous situations as more threatening than normal children, oppositional children even more so than anxious children. Anxious children, however, more often chose avoidant solutions, whereas oppositional children more often chose aggressive solutions. (Bogels & Zigterman, 2000, p. 205)

The research indicates that children with panic disorder are responding inappropriately to ambiguous stimuli, i.e. stimuli that is not a part of their idea of normal or is unknown to them.

One study sighted through research findings that, "sexual dysfunctions are frequent and neglected complications of social phobia and panic disorder." (Figueira, Possidente, Marques & Hayes, 2001, p. 369) Still another study, on panic disorder attempted to demonstrate through research that alcohol abuse is a high risk and frequent behavior exhibited by those who suffer from panic disorder, and needs to be looked at to help avoid further problems for those who suffer from the disorder. (Book & Randall, 2002, p. 130) Both of these lines of research are ripe for additional investigation, as they seem to clearly complicate and possibly exacerbate the social affect of the disorder to a large degree and are secondary problems shared by many who experience the disorder.

Other related disorders also give more clear insight into panic disorder, as post traumatic stress disorder has increased in severity as well as incidence, given the prolonged state of national crisis, war and other issues involving over stimulation in the fast paced society we share. One review work, demonstrates the conflicts and controversy that surrounds PTSD, often a precursor to panic disorder as the disorder leaves the individual with a cognitive reaction to normal events in an exaggerated panicked, fashion and in many ways correlates to panic disorder. The article states that victims in the past have been treated ineffectually due to preconceived notions about the traumatic event, if they are conscious of the memory or event and if they experienced such trauma as a result of war, as the politics of war and the dynamic of the military have skewed opinions and therefore policy on treatment, as has advocates and opponents of recovered memory subjects. The argument has also surrounded the event of lasting biological/psychological effects of trauma, as some believe it occurs while others dismiss it as unlikely. (Mcnally, 2003, p. 229) Studies in PTSD in children have dismissed some of the claims by opponents, as there are clear indications in research of biological lasting effects of trauma, but still others argue that such effects are limited by age, as the formative brain development is not like that of adults. (Cook-Cottone, 2004, p. 127) Another study discusses the utilization of technology to study such potential biological change, during reliving/resolution processes as a way to help science better understand the chemistry of PTSD, a precursor to panic disorder, with known etiology. (Gibson, 2000, p. 354) on this note PTSD may be a separate and distinct disorder but its symptomalogy indicates that further study in this area could be a significant help in better understanding panic disorder in general.