Panic Disorder
- Panic Attack
- Panic Disorder
- Recurrent Panic Attacks
- Anticipatory Anxiety
- Agoraphobia
- Hypochondriasis
- Demoralisation
- Epidemiology
- Age of Onset
- Situation of Onset
- Stressful Life Events
- Early Life Events
- Maternal Over-Protection
- Separation Anxiety
- Short and Long-term Outcomes
- Comorbidity
- Panic Disorder: Pathogenesis
- Biological Findings
- Provocative Agents
- Neurotransmitter Systems
- Neuroanatomical Models
- Brain Imaging
- Psychological Models
- Psychodynamic Models
- Behavioural Models
- Cognitive Models
- Areas of Controversy and Debate
- The Evolutionary Perspective
- Panic Disorder: Treatment
- Pharmacotherapy
- Benzodiazepines
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors
- Selective Serotonin Re-uptake Inhibitors
- Other Drugs
- Psychotherapy
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What is Evolutionary Perspective
The two positions briefly outlined represent two extremes, built up by following two strong ideological theories of the disorder:
- Biological PD is due to a brain dysfunction
- Psychological PD is caused by the sequence of the previous social interactions. A third body of evidence, based on an evolutionary perspective is usually ignored.
This theory states that:
- Anxiety (or at least an anxiety-like phenomenon) is present in all the animal species, it is adaptive and useful both for the preparation of a fight or flight action and for the communication of danger in social animals.
- Almost all the physical phenomena by which this process of activation are mediated by the autonomic nervous system (ANS), and namely by a sympathetic stimulation.
- The somatic symptoms of panic are expression of an ortho-sympathetic stimulation.
- ANS dysreactivity has been consistently reported in PD and increased values of autonomic functions are common observations in patients with PD even outside the panic attacks.
- The cognition of danger is not necessarily acquired: a typical example is that of new-born chicks that are scared by the shadow of a hawk even though they have never experienced a predator. There is sensible support for the view that phobias could be considered to be the persistence of innate adaptive fears.
- Agoraphobia definitely has a certain adaptive value: it contrasts the exploratory instinct and protects the offspring of any species from naturally occurring dangers. In the animal kingdom, agoraphobic-like behaviours are frequent: mice always cross a room following the walls and never cross it in a straight line or diagonally. Many animals predispose safe ways of returning to their holes, and when such ways are interrupted, they show panic-like behaviours. Even among humans, the agoraphobic phenomenon is useful at least during the first years of life. It closely resembles innate behavioural patterns, which are present also in humans and which must be necessarily transmitted through precognitive biological pathways. On this basis, agoraphobia is more easily understandable in the evolutionary perspective rather than using purely psychological (symbolic) interpretations. Agoraphobia would represent the persistence (or the lack of suppression) of an instinct which is normal in earlier phases of development. When the transmission of agoraphobia is stronger, the disease would appear. An enhanced message would induce an increased vegetative response, provoking panic. In this perspective, the distinction between panic and agoraphobia would be more quantitative than qualitative.
The evolutionary approach could help to reduce the gap between purely biological and purely psychological positions.