Impact of stressful life events on the course of panic disorder in adults

Abstract

Background Panic Disorder with/without Agoraphobia (PD/PDA) is a prevalent anxiety disorder, associated with impairment in quality of life and functionality, as well as increased healthcare utilization. Extant research shows a relationship between stressful life events (SLEs) and the onset of panic attacks in adults who ultimately develop PD/PDA. However, limited attention has been paid to how SLEs might affect the severity of panic symptoms in individuals with PD/PDA. In this study, we examined the relationship between SLEs and panic symptom severity in adults with PD/PDA. Methods Four hundred-eighteen adults with PD/PDA from the Harvard/Brown Anxiety Research Program (HARP), a long-term prospective longitudinal observational multicenter study of adults with a current or past history of anxiety disorders were included in this study. We examined occurrence of SLEs and their impact on panic symptom severity 12-weeks pre- and post-SLE. Results A time-slope effect showed that participants had worsened panic symptoms over the course of the 12-weeks after family/friends/household and work SLEs. That is, their symptoms worsened progressively after the event, rather than immediately thereafter (i.e., significant symptom change within the same week of the event). Limitations The sample may not be representative of the general population. Conclusions These findings provide new insights into how SLEs affect panic symptoms in adults with PD/PDA in that household-related SLEs, such as serious family arguments, and work-related SLEs, such as being fired, put some adults at risk for worsened panic symptoms within 12-weeks of the event.

Perievent Panic Attacks and Panic Disorder After Mass Trauma: A 12‐Month Longitudinal Study

“…Other variables that were significantly associated with PPAs in our sample were life stressors before the attacks and negative emotionality, coinciding with the findings of other studies (Coryell, Dindo, Fyer, & Pine, 2006;Moitra et al, 2011). On the other hand, low social support and life stressors in the year prior to the attacks seemed to be associated with PD at Waves 2 and 3, which is also consistent with findings in another study (Batinic, Trajkovic, Duisin, & Nikolic-Balkoski, 2009).…”

The Anxiety Spectrum and the Reflex Physiology of Defense: From Circumscribed Fear to Broad Distress

“…Mental illness is typically accompanied by lifespan sociocontextual adversity, the magnitude and frequency of which often covary with anxiety/depression severity. [125][126][127][128] As such, the current data tentatively implicate the debilitating effects of cumulative, chronic stress on the integrity of the underlying fear/defense system. Animal data corroborate that variations in stressor intensity, duration, and recurrence can result in dampened defensive responses.…”

“…Importantly, the symptoms defined by diagnosis are not the only burden. Mental illness is typically accompanied by lifespan sociocontextual adversity, the magnitude and frequency of which often covary with anxiety/depression severity . As such, the current data tentatively implicate the debilitating effects of cumulative, chronic stress on the integrity of the underlying fear/defense system.…”

Distinct Responses to Predictable and Unpredictable Threat in Anxiety Pathologies: Effect of Panic Attack

“…Research shows that stressful life events increase the risk of PAs (38, 39) and that, when exposed to a threat context, children of parents with panic disorder exhibit lower anxiety thresholds, as assessed by startle magnitude, compared to children of healthy parents (40). It is therefore possible that, in individuals who are hypersensitive to unpredictable threat, accumulation of mild unpredictable adverse events lowers the threshold for strong arousal reaction (e.g., more readily engages cardio-vascular responses), which increases their sensation of interoceptive symptoms and ultimately leads to PAs.…”