Invited essay
Panic disorder: A product of classical conditioning

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Abstract

Contrary to the common view that all panic attacks have a single etiology, it is shown that a distinction must be made between initial attacks, for which there are many causes, and recurrent attacks (panic disorder) which have a common basis. Most initial panic attacks are attributable to the physiological effects of hyperventilation resulting from severe and prolonged anxiety. It has been claimed that the attacks are due to such symptoms as dyspnea, tachycardia and dizziness being misattributed to deadly illness or incipient insanity. We reject this view on several grounds, and in particular because of a pilot study that showed that such attributions follow the onset of panic. Apart from some biological cases, the common initial panic is an unconditioned response to a bizarre stimulus complex produced by excessive hyperventilation, and panic disorder is the result of contiguous stimuli, especially endogenous stimuli, being conditioned to the elicited anxiety. Treatment accords with principles of conditioning.

References (55)

  • D.V. Sheehan

    Current concepts in psychiatry: Panic attacks and phobias

    N. Engl. J. Med.

    (1982)
  • D.V. Sheehan et al.

    The classification of phobic disorders

    Int. J. Med.

    (1983)
  • J. Wolpe

    Experimental neurosis as learned behavior

    Br. J. Psychol.

    (1952)
  • J. Wolpe et al.

    Differentiation between classically conditioned and cognitively based neurotic fears: two pilot studies

    J. Behav. Ther. exp. Psychiat.

    (1985)
  • C.M. Zitrin et al.

    Treatment of phobias: I. Comparison of imipramine hydrochloride and placebo

    Arch. gen. Psychiat.

    (1983)
  • American Psychiatric Association

    Diagnostic Statistical Manual of Mental Disorders

    (1987)
  • D.L. Chambless et al.

    Clinical treatment of agoraphobia

  • M. Craske et al.

    Night panic

  • R. Crowe et al.

    Panic Disorder and Mitral Valve Prolapse

  • S.R. Dager et al.

    Panic disorder precipitated by exposure to organic solvents in the work place

    Am. J. Psychiat.

    (1987)
  • R.M. Doctor

    Major results of a large scale pretreatment survey of agoraphobics

  • R. Finlay-Jones et al.

    Types of stressful life event and the onset of anxiety and depressive disorders

    Psychol. Med.

    (1981)
  • E. Fonberg

    On the manifestation of conditioned defensive reactions in stress

    Bull. Soc. Sci. Lett. Lodz. Class III. Sci. Math. Nat.

    (1956)
  • H. Garakani et al.

    Treatment of panic disorder with imipramine alone

    Am. J. Psychiat.

    (1984)
  • J.M. Gorman et al.

    Mitral valve prolapse and panic disorders: Effect of Imipramine

  • E. Griez et al.

    A single case study: treatment of phobophobia by exposure to CO2 induced anxiety symptoms

    J. Nerv. men. Dis.

    (1983)
  • T.R. Harrison

    Harrison's Principles of Internal Medicine

    (1987)
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