Commentary on “Integrating the Psychoanalytic and Neurobiological Views of Panic Disorder”

Alexander, Feigelson, & Gorman entertain a fear-conditioning model of panic disorders that seeks to integrate first-person experiential views and third-person neuroscientific approaches in a seamless synthesis. It is not yet clear to me what specific testable hypotheses arise from their perspective. May I request the authors to advance a few? For my part I shall simply supplement their coverage with a more comprehensive summary of current neuroscientific possibilities for understanding panic attacks.

Perhaps a clearer distinction between panic attacks and panic disorders will be critical for how well Gorman, Kent, Sullivan, and Coplan's (2000) amygdala-based fear system model of panic will hold up to empirical scrutiny. At this point, a critical issue is to clarify how the precipitous affective surges of panic emerge from brain dynamics, along with an explicit recognition that the affective sources of acute panic attacks may be quite different from the anticipatory “signal anxiety” that eventually culminates in the chronic panic syndrome. However, without the initial panic attacks (including sudden autonomic discomforts,