The Characteristics of Panic Attack Symptoms in Panic Disorder Patients

Abstract

It has been 16 years since panic disorder was first classified as a psychiatric disease entity. However, the nature and characteristics of panic attacks and panic disorder are not fully understood yet. The Diagnostic and Statistical Manual, Fourth Edition(DSM-IV) carries conflicting statements regarding the definitions and diagnostic criteria of the panic attacks and panic disorder. Moreover, the DSM-IV only checks the presence or absence of each symptom, while failing to clarify which of each panic symptom are the earlier or more important symptoms. This study was designed to investigate the nature and characteristics of the panic attack symptoms. Forty outpatients diagnosed with DSM-IV panic disorder criteria were the subjects. All the subjects completed Panic Attack Questionnaire, Anxiety Sensitivity Index, State- Trait Anxiety Inventory, and Becks Anxiety Inventory. Results were as follows : 1) Majority(90%) of the subjects experienced somatic symptoms as the first symptom of their panic attack, and there was a significant correlation (0.741，P〈0.01) between the somatic symptoms and the cognitive symptoms of panic attack. 2) Both cognitive symptoms(0.695, P〈0.01) and somatic symptoms(0.599, P〈0.01) showed significant correlation with agoraphobic avoidance. However, in partial correlation using somatic and cognitive symptoms as control variables for each other, only cognitive symptoms showed significant correlation with agoraphobic avoidance(0.467, P = 0.003). 3) Cognitive symptoms showed significant correlation with the anxiety sensitivity(0.563, P 〈0.01)，state anxiety(0.324, P〈0.05)，trait anxiety(0.484, P〈0.01)，and Becks anxiety(0.456, P<0.01). Somatic symptoms also showed significant correlation with the anxiety sensitivity(0.528, P〈0. 01)，trait anxiety(0.411, P〈0.01)，Becks anxiety(0.348, P<0.05)，but not with the state anxiety(0.171). 4) In partial correlation using somatic and cognitive symptoms as control variables for each other, cognitive symptoms showed statistically significant correlation with anxiety sensitivity and anxiety levels, while the somatic symptoms did not show such correlations. These results suggest that panic attack is a complex phenomenon in which the somatic symptoms are “triggers”，and the cognitive symptoms are secondary reactions to the somatic symptoms. Psychological anxiety and anxiety sensitivity increase in proportion to the cognitive symptoms of the panic attack, which are important in the clinical process of panic disorder. The severity of cognitive symptoms also determines the development of agoraphobic avoidance. The authors propose to revise the diagnostic criteria of panic attack by the somatic symptoms only, and include cognitive symptoms, such as the desire to escapc from the scene of panic attack, as necessary diagnostic criteria for panic disorder.