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Panic Disorder |
Overcoming Anxiety (Home) > Panic Disorder > Situation of Onset Situation of OnsetWith regard to the context in which the first panic attack occur, Lelliott et al. reported that 92% of their agoraphobic patients with panic experienced their first panic attack in phobogenic situations rather than at home. These sites are usually a loosely knit agoraphobic cluster of cues concerning public places, such as streets, stores, public transportation, auditoriums and crowds, and less central oncerning elevators, tunnels, bridges, open spaces, and heights. These findings are consistent with those reported by Faravelli et al.: they found that such an onset was significantly less common among patients with panic disorder who did not develop agoraphobia later. The association between public onset and agoraphobia merits special interest. An interpretation could suggest that a sort of subclinical agoraphobia might pre-date clinical panic, thus supporting the previously mentioned view that some predisposition pre-dates the acute onset of PD. Lelliott et al. suggest a role for an ethological factor (an evolutionary vulnerability to extraterritoriality), in addition to the biological and learning components of the disorder. Another simpler interpretation could be taken into account. The different psychological meaning of the context in which panic occurs might explain the evolution of the disorder. Experiencing the drama of an unexpected panic attack in a setting in which, objectively, help is not available has a different psychological impact from experiencing the same symptoms in protected settings (e.g., at home). It is possible that undergoing such a stressful experience as having an attack in contexts in which one is helpless will affect the later course of the disorder. In this case the basic core of PD would be the pathological evolution of panic, rather than panic itself. Lelliott et al. also found that, at least in Britain, the first panic attack occurred more often in late spring-summer and during warm weather than in winter and cold weather. The heat may lessen the stimulation needed to reach an intolerable degree of sweating and other autonomic discomfort that is felt to be anxiety or panic when in public places. On the other hand, good weather may simple increase the probability of being away from home.
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