Causes of Panic Disorder | Treating Panic Disorder 

What is Panic Disorder Caused by & How is the Disorder Treated

To make a diagnosis, clinicians will look to confirm that panic attacks are followed by at least one month of continual worry about having another attack as well as its implications or consequences, and that the attacks have led to significant behavior changes (e.g., agoraphobia).

WHAT CAUSES PANIC DISORDER?

Several lines of research support the idea that both neurobiological and psychological factors have important roles in the causes and features of panic disorder. 

The familial connection. Panic disorder tends to run in families. About half of those with panic disorder have at least one relative who also suffers from it. And first-degree relatives of people with panic disorder are five times more likely to have the condition than first-degree relatives of controls.

It is not clear, however, how much this pattern of inheritance has to do with environment (e.g., children tend to model behavior they see at home) and how much is actually genetic. Equally unclear is whether what's inherited is a personality trait or a specific biological vulnerability. Researchers are looking at several genes that might contribute to what causes panic disorder.

Laboratory studies. In an effort to understand the biology of panic disorder, researchers have provoked panic attacks in people by giving them intravenous infusions of sodium lactate (the same compound muscles release during strenuous exercise), high concentrations of inhaled carbon dioxide, and compounds that affect brain chemicals.

Several anxiety drugs block laboratory-provoked panic attacks, suggesting a basis in biology. Still, researchers do not fully understand the role psychological factors play in the expression of biological functions. Laboratory-induced panic attacks also have been short-circuited by psychological treatments.

The brain. Neuroscientists are studying neurotransmitters, the brain's chemical messengers, to discover which are implicated in panic disorder and how certain meds affect them. These neurotransmitters include gamma-aminobutyric acid (GABA), serotonin, corticotropin-releasing factor, and norepinephrine.

Research suggests that some causes of panic disorder people have faulty brain receptors that block the availability of the body's own anxiety-reducing neurochemicals. Some research suggests panic disorder may involve an abnormality in the limbic system, or the emotional brain. Researchers are investigating the amygdala, an area of the brain involved with fear.

Psychological factors. Studies suggest people with panic disorder have an exaggerated, possibly genetically based, neurobiological response to stressful life events. Their body's natural alarm system (its "fight or flight" response) tends to go off as if the body is in grave danger even when it isn't.

An initial panic attack may become associated with the distressing feelings that accompanied it, leading to chronic panic disorder, or continual fear of having future panic attacks. Most people with panic disorder are found to have experienced problems with anxiety or panic even as children.

Treating Panic Disorder

A recent study in the Journal of the American Medical Association (May 17, 2000) confirmed the value of treating panic disorder both pharmacologically and psychosocially. The study randomly assigned 312 patients to the antidepressant imipramine alone, cognitive-behavioral therapy alone, placebo, cognitive-behavioral therapy with imipramine, and cognitive-behavioral therapy with placebo. Imipramine was chosen because its usefulness in treating panic disorder is well established, but other medications also are effective.

Overall, imipramine and cognitive-behavioral therapy were each superior to placebo, and at different phases of treatment - acute, maintenance, and follow-up -either one, or both together, worked well to limit symptoms of panic disorder. Interestingly, those who received cognitive-behavioral therapy (alone or with placebo) were better able to maintain their improvement once treatment was discontinued than those who had gotten cognitive-behavioral therapy with imipramine.

Through cognitive-behavioral therapy, patients learn how to manage anxiety (e.g., by proper breathing) and resolve anxiety-provoking thoughts. Many people with panic disorder are inclined to catastrophize, e.g., they assume heart palpitations are the start of a heart attack or panic attack and go on to further symptoms and anxiety.

During cognitive-behavioral therapy, patients recall their pattern of thoughts during panic attacks. Once recognizable sequences emerge, therapists help patients replace their catastrophic assumptions with more rational alternatives.