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Panic Disorder |
Overcoming Anxiety (Home) > Panic Disorder > Recurrent Panic Attacks Recurrent Panic AttacksWhereas at least two unexpected panic attacks are required for the diagnosis, most individuals have considerably more. Although at least one uncued (unexpected) panic is necessary for the diagnosis, patients with PD frequently also have situationally predisposed panic attacks; situationally bound attacks can also occur, but they are less common. The frequency of the panic attacks varies widely: some individuals have moderately frequent attacks (e.g., once a week) that occur regularly for months at a time; others report short bursts of more frequent attack (e.g., daily for a week) separated by weeks or months without any attacks or with less frequent attacks (e.g.., one attack per month) over many years. Both full-blown and limited-symptom attacks are usually observed during the course of PD. It is quite common to observe that the frequency of full-blown attacks tends to decrease during the course of the illness, whereas the limited-symptom attacks may persist for longer periods. The common pattern during the years in fact is a decrease in the frequency of major attacks with a persistence of the sub-threshold panics. In this case it may be difficult to distinguish PD from generalized anxiety disorder (GAD): PD patients were more likely to complain of palpitation, breathlessness, chest pain, numbness, choking sensations and especially fear of dying; GAD patients tend to complain of feeling tense, insomnia, headaches, weakness, restlessness and muscle aches. The mechanisms, by which panic attacks become recurrent in some subjects, while in others these attacks are not repeated, still appear to be very speculative. In this field, the cognitive theories have been the object of recent developments, which call on notions both of hyperarousal and ‘‘locus of control perception’’. The subject’s interpretation of the indications relative to the state of peripheral and central stimulation occurring with panic attacks can play a major part in the maintenance of symptomatology. In this respect, the so-called ‘‘external’’ subjects, who have a tendency to perceive situations as if they were under the control of external forces, are more likely to experience recurrent attacks than the so-called ‘‘internal’’ subjects, who tend to perceive the situation under their own self-control. Thus, the catastrophic and inescapable interpretation of hyperarousal, whatever its cause, maintains and reinforces the patients’ symptomatology of anxiety. The efficacy of cognitive therapies which aim to re-establish a more ‘‘internalized’’ control point in these patients and to combat the mistaken interpretation which they give to their symptoms demonstrates the probable importance of these factors in the pathogenesis of recurrent panic attacks .
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