Approaches to Panic Attacks

A recent review article on panic disorder in this journal brought together Freudian psychoanalysis, studies of classical conditioning, neurobiological research, developmental research showing the effects of early trauma, and PTSD research. A common denominator of current approaches to panic disorder is that no real danger exists, and the patient's anxiety is inappropriate. This paper reports clinical data on three patients, describing an effective treatment that offers a different perspective on panic disorder. While each person's background was unique, all the patients had a life circumstance that might be expected to cause them to be very afraid, but they had dissociated from the seriousness of the fear-causing situation. I was able to make this clear to the patients, suggesting that they might begin to tackle their anxiety disorder by addressing the fear-causing situation. The patients were unhappy to be paying attention to something so disturbing in their lives, producing continuous elevated anxiety. Yet in every case the panic attacks stopped, suggesting that dissociation plays a major role in panic attacks, at least for some patients. These clinical findings are reviewed in the context of several current general theories of panic attacks and the best ways to treat them.

Keywords: panic attack, danger, anxiety, life circumstances, dissociation

“To see what is in front of one's nose needs a constant struggle.”

George Orwell

Panic disorder is a major psychiatric problem. Patients with panic disorder generally have a poor quality of life, limit their activities, and have high rates of suicide. They frequently present in physicians' offices or emergency rooms and are given unnecessary medical tests (Katon, 1996; Schuman, Kramer, & Mitchell, 1985).

Panic disorder is also of great theoretical interest. Researchers have debated the involvement of psy-chodynamic factors, mistuning of brain fear systems, and cognitive misinterpretation of environmental and bodily perceptions