Introduction

Panic disorder is new to the DSM, but it has been written about for quite some time. One of the earliest reports of the disorder was back in the 17th century, when Robert Burton, an English clergyman, described it in his book, The Anatomy of Melancholy (1621) as "[a] fear [that] causeth in man, as to be red, pale, tremble, sweat… It amazeth men that are to speak or show themselves in public". During the 1800s, panic disorder was first described in medical documentation, when a Civil War physician named Jacob De Costa described symptoms similar to those of panic disorder in soldiers after the fighting had finished. Sigmund Freud is widely considered to be the first major psychiatrist to study the disorder in depth. He coined the term anxiety neurosis, and this was the term that was used to describe the disorder for over half a century. It appeared in the DSM-I and DSM-II this way. The leading researcher in the field during the 20th century was Donald F. Klein, who, in the middle of the century, first demonstrated the use of anti-depressants to avoid recurring panic attacks. Then, in 1980, the DSM-III came out. It listed panic disorder as a separate disorder for the first time.

An Attempt to Define Panic

Many different people have defined panic disorder in many different ways over the years. Sigmund Freud wrote the first clinical definition:

"… an anxiety attack… may consist of the feeling of anxiety, alone, without any associated idea… or else some kind of paresthesia… may be combined with the feeling of anxiety, or, finally, the feeling of anxiety may have linked it to a disturbance of… bodily functions- such as respiration, heart action, vasomotor innervation or glandular activity."

A panic, or anxiety, attack, as described by the American Psychological Association, is defined as a "…sudden surge of overwhelming fear that comes without warning…". The symptoms listed by the APA include a racing heartbeat, difficulty breathing, paralyzing terror, hot flashes, and a fear of impending death or insanity. The first 2 editions of the DSM defined only one kind of anxiety disorder, as mentioned earlier. By the time of the DSM-III publication in 1980, it was broken up into 2 different diseases: panic disorder and general anxiety disorder (GAD). The major difference between the two is that panic disorder sufferers experience anxiety only during the panic attacks, while GAD sufferers experience anxiety all day, every day.

Non-Psychological Symptoms and Side Effects

Panic disorder is unlike other mental disorders in that it causes physical harm and side effects as well as psychological harm. Because of the cardiovascular symptoms of the disorder, such as heart palpitations and irregular heartbeat, panic disorder sufferers are 30-40% more likely to suffer from mitral valve prolapse, a serious heart condition, than members of the general population. Panic patients also tend to go in for expensive surgeries, mainly coronary and abdominal in nature, more often than non-panic sufferers do.

They make up 20-30% of patients who go in for coronary arteriography surgery, even though they tend to not need it. They also have a higher risk for migraines and severe headaches. According to a recent study, nearly 28% of all individuals between 24 and 29 years of age who visited a physician for headache had a history of panic disorder. The cause for these migraines is usually not discovered by the medical doctor, because his training is in a different area. Generally, because of these superfluous visits to the doctor, people who suffer from panic disorder visit the doctor or hospital much more frequently than people without it do. This not only ties up the doctor from dealing with patients who need medical help (as opposed to psychological help), but it also makes the panic sufferer’s medical bill much higher than the average person’s.

The Causes of Panic Disorder

The cause of panic disorder had been theorized in different ways over the years. The causes seem to vary from person to person, but the two major reasons are biology and heredity.

Biological Reasons for Panic Disorder

Psychologists with a biological approach to their field have their own explanation for what causes panic disorder. According to these biological psychologists, people who suffer from panic disorder suffer from a lack of the neurotransmitter serotonin in their brains. Serotonin is the neurotransmitter that regulates sleep, mood, and appetite. Everyone has serotonergic fibers that travel through the amygdala and the hippocampus. These are the regions of the brain that interpret sensory stimuli, like fear. People with panic disorder usually have damaged serotonergic fibers in their brains, causing a flaw in the way their brains interpret the sensation of fear. They suddenly experience fear, even when there is no fear to experience.

Hereditary Factors

Various research by many psychologists has yielded evidence that flaws in both dominant and recessive genes are significant causes of panic disorder in the children of parents with panic disorder. Many different kinds of studies have been done to confirm this. Some of these include family studies, in which the genes of different members of a family are compared; twin studies, in which twin babies are studied for their genes; and linkage studies, in which DNA links from parents are compared to DNA from their children. All results seem to point to a genetic cause for the disorder.

There is not one main cause. Both of these factors play a significant role in the cause of panic disorder.

Treatment

Because there is not just one cause for panic disorder, treatment for the disorder varies from person to person. No research has been done as of yet to determine which method of treatment is best.

There are 2 major methods of treatment that have been proven to work better than any other method: the use of antidepressants, specifically tricyclic antidepressants (TCAs) to increase the level of serotonin in the brain; and the use of serotonin selective reuptake inhibitors (SSRIs) for the same purpose. Different methods work for different people and no research has been done as of yet to determine a link between the cause of the disorder and the medication.

Conclusion

The knowledge we have on the subject of panic disorder has increased fairly rapidly since its admittance into the DSM in 1980. Despite all of the progress made in the field, we still have a long way to go before a full understanding is reached. The quality of treatment of panic disorder has room for improvement. As of 1996, only 18% of panic disorder patients recovered from their disorder, and of that 18%, there was a 60% relapse rate.

An increase in the caliber of treatment is the next step in the long battle to fight panic disorder.