Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-18T01:05:32.845Z Has data issue: false hasContentIssue false

A Prospective Study of Panic and Anxiety in Agoraphobia with Panic Disorder

Published online by Cambridge University Press:  02 January 2018

Metin Başoǧlu*
Affiliation:
Institute of Psychiatry, 99 Denmark Hill, London SE5
Isaac M. Marks
Affiliation:
Institute of Psychiatry, 99 Denmark Hill, London SE5
Seda Şengün
Affiliation:
Institute of Psychiatry, 99 Denmark Hill, London SE5
*
Correspondence

Abstract

The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM–III–R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and ‘going crazy’/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorder (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Anderson, D. J., Yoes, R. Jr & Crowe, R. R. (1984) A comparison of panic disorder and generalized anxiety disorder. American Journal of Psychiatry, 141, 572575.Google Scholar
Aronson, T. A. (1987) Is panic disorder a distinct diagnostic entity? A critical review of the borders of a syndrome. Journal of Nervous and Mental Disease, 175, 584594.CrossRefGoogle ScholarPubMed
Barlow, D. H. (1988) Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford Press.Google Scholar
Barlow, D. H., Cohen, A. S., Waddell, M., et al (1984) Panic and generalized anxiety disorders: nature and treatment. Behavior Therapy, 15, 431449.Google Scholar
Barlow, D. H., Vermilyea, J., Blanchard, E. B., et al (1985) The phenomenon of panic. Journal of Abnormal Psychology, 94, 320328.Google Scholar
Bass, C., Lelliott, P. & Marks, I. M. (1989) Fear talk versus voluntary hyperventilation in agoraphobics and normals: a controlled study. Psychological Medicine, 19, 669676.Google Scholar
Beck, A. T. & Emery, G. (1985) Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.Google Scholar
Borden, J. W. & Turner, S. M. (1989) Is panic a unique emotional experience? Behavior Research and Therapy, 27, 263268.Google Scholar
Chambless, D. L., Caputo, G. C., Bright, P., et al (1984) Assessment of fear in agoraphobia: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 10901097.Google Scholar
Clark, D. M. (1986) A cognitive approach to panic. Behavior Research and Therapy, 24, 461470.Google Scholar
Clark, D. M., Salkovskis, P. M., Gelder, M., et al (1988) Tests of a cognitive theory of panic. In Panic and Phobias II (eds Hand, D. J. & Wittchen, H.). Berlin: Springer-Verlag.Google Scholar
Ehlers, A., Margraf, J., Roth, W. T., et al (1986) Lactate infusions and panic attacks: do patients and controls respond differently? Psychiatry Research, 17, 295308.Google Scholar
Ehlers, A., Margraf, J., Roth, W. T., (1988) Selective information processing, interoception, and panic attacks. In Panics and Phobias II (eds Hand, D. J. & Wittchen, H.). Berlin: Springer-Verlag.Google Scholar
Foa, E. B. (1988) What cognitions differentiate panic disorder from other anxiety disorders. In Panics and Phobias II (eds Hand, D. J. & Wittchen, H.). Berlin: Springer-Verlag.Google Scholar
Freedman, R. R., Ianni, P., Ettedgui, E., et al (1985) Ambulatory monitoring of panic disorder. Archives of General Psychiatry, 42, 244250.Google Scholar
Hamilton, M. (1959) The assessment of anxiety state by ratings. British Journal of Medical Psychology, 32, 5055.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.Google Scholar
Hand, D. J. (1983) Common errors in data analysis: the apparent error rate of classification rules. Psychological Medicine, 13, 201203.Google Scholar
Hibbert, G. A. (1984) Ideational components of anxiety: their origin and content. British Journal of Psychiatry, 144, 618624.Google Scholar
Hoehn-Saric, R. (1981) Characteristics of chronic anxiety patients. In Anxiety: New Research and Changing Concepts (eds Klein, D. F. & Rabkin, J. G.). New York: Raven Press.Google Scholar
Klein, D. F. & Klein, H. M. (1989) The definition and psycho-pharmacology of spontaneous panic and phobia. In Psychopharmacology of Anxiety (ed. Tyrer, P.). Oxford: Oxford University Press.Google Scholar
Lelliott, P., Marks, I. M. & McNamee, G. (1989) The onset of panic disorder with agoraphobia. Archives of General Psychiatry, 46, 10001004.Google Scholar
Ley, R. (1985) Blood, breath, and fears: a hyperventilation theory of panic attacks and agoraphobia. Clinical Psychological Review, 5, 271285.CrossRefGoogle Scholar
Liebowitz, M. R., Fyer, A. J., Gorman, J. M., et al (1984) Lactate provocation of panic. Archives of General Psychiatry, 41, 764770.CrossRefGoogle Scholar
Margraf, J., Ehlers, A. & Roth, W. T. (1986) Biological models of panic disorder and agoraphobia: a review. Behavior Research and Therapy, 24, 553567.Google Scholar
Margraf, J., Taylor, C. B., Ehlers, A., et al (1987) Panic attacks in the natural environment. Journal of Nervous and Mental Disease, 175, 558565.Google Scholar
Marks, I. M. (1969) Fears and Phobias. London: Academic Press.Google Scholar
Marks, I. M. (1987) Fears, Phobias and Rituals. New York: Oxford University Press.Google Scholar
Marks, I. M. & Mathews, A. M. (1979) Brief standard self-rating for phobic patients. Behavior Therapy, 17, 263267.CrossRefGoogle ScholarPubMed
Marks, M. P., Başo$gnlu, M., Alkubaisy, T., et al (1991) Are anxiety symptoms and catastrophic cognitions directly related? Journal of Anxiety Disorders, 5, 247254.Google Scholar
McNally, R. J. & Lorenz, M. (1987) Anxiety sensitivity in agoraphobics. Journal of Behavior Therapy and Experimental Psychiatry, 18, 311.CrossRefGoogle ScholarPubMed
Norton, G. R., Dorward, J. & Cox, B. J. (1986) Factors associated with panic attacks in nonclinical subjects. Behavior Therapy, 17, 239252.Google Scholar
Rachman, S. & Levitt, K. (1985) Panics and their consequences. Behavior Research and Therapy, 23, 585600.Google Scholar
Rachman, S., & Lopatka, C. (1987) Panic: the links between cognitions and bodily symptoms – I. Behavior Research and Therapy, 23, 585600.Google Scholar
Rapee, R. M. (1985) A distinction between panic disorder and generalized anxiety disorder: clinical presentation. Australian and New Zealand Journal of Psychiatry, 19, 227232.CrossRefGoogle ScholarPubMed
Roy-Byrne, P., Uhde, T. W., Sack, D. A., et al (1986) Plasma HVA and anxiety in patients with panic disorder. Biological Psychiatry, 21, 849853.Google Scholar
Shader, R. I. & Greenblatt, D. J. (1984) An interactive model for panic disorder. Journal of Clinical Psychopharmacology, 4, 177.Google Scholar
Spitzer, R. L. & Williams, J. B. W. (1983) Structured Clinical Interview for DSM–III–Upjohn Version (SCID–UP). New York: New York State Psychiatric Institute, Biometrics Division.Google Scholar
Street, L. L., Craske, M. G. & Barlow, D. H. (1989) Sensations, cognitions and the perception of cue associated with expected and unexpected panic attacks. Behavior Research and Therapy, 27, 189198.Google Scholar
Taylor, C. B., Sheikh, J., Agras, W. S., et al (1986) Self-report of panic attacks: agreement with heart rate changes. American Journal of Psychiatry, 143, 478482.Google Scholar
Tyrer, P. (1986) Classification of anxiety disorders: a critique of DSM–III. Journal of Affective Disorders, 11, 99104.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.