The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

Abstract

This article examines the ability of the "Panic Attack-PTSD Model" to predict how panic attacks are generated and how panic attacks worsen posttraumatic stress disorder (PTSD). The article does so by determining the validity of the Panic Attack-PTSD Model in respect to one type of panic attacks among traumatized Cambodian refugees: orthostatic panic (OP) attacks, that is, panic attacks generated by moving from lying or sitting to standing. Among Cambodian refugees attending a psychiatric clinic, we conducted two studies to explore the validity of the Panic Attack-PTSD Model as applied to OP patients, meaning patients with at least one episode of OP in the previous month. In Study 1, the "Panic Attack-PTSD Model" accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis-associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious-depressive distress (SCL subscales), and OP severity significantly mediated the effect of anxious-depressive distress on CAPS severity. In Study 2, as predicted by the Panic Attack-PTSD Model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a CBT study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.

Specificity of Peritraumatic Fear in Predicting Anxious Reactivity to a Biological Challenge among Traumatic Event-Exposed Adolescents

“…Relatively little work has explored predictions stemming from the hypothesis that peritraumatic fear-based interoceptive conditioning is likely to increase vulnerability to panic spectrum problems (Falsetti et al 1995;Foa et al 1989;Hinton et al 2008;Jones and Barlow 1990). Adult research has demonstrated that PTSD is related to anxious reactivity to bodily arousal Jensen et al 1997Jensen et al , 1998Rainey et al 1987;Southwick et al 1993Southwick et al , 1997a; however, this work does not directly speak to links between peritraumatic fear and anxiety elicited by bodily arousal.…”

“…In other words, previously neutral cues may become capable of eliciting both panic attacks and symptoms of posttraumatic stress disorder (PTSD) via activation of a traumatic event-related associative network (Falsetti et al 1995;Foa and Kozak 1986;Foa et al 1989;Hinton et al 2008;Jones and Barlow 1990). The fear-conditioned cues may be directly related to the traumatic event, such as reminders of the traumatic experience.…”

“…The fear-conditioned cues may be directly related to the traumatic event, such as reminders of the traumatic experience. However, posttraumatic panic may also result from conditioned fear of bodily arousal arising as a result of the pairing of intense peritraumatic fear with heightened physiological arousal (Hinton et al 2008;Jones and Barlow 1990). Here, posttraumatic exposure to internal physiological cues (e.g., breathlessness, heart racing) that were conditioned during a traumatic event to elicit fear may be sufficient to trigger panic even in the absence of direct reminders of the traumatic event.…”

Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V

“…In contrast, other findings suggest that whereas individuals with PAs only (without PD) and individuals with PD both have higher rates of suicidal ideation than controls, only individuals with PD have higher rates of suicide attempts after adjusting for comorbid psychiatric disorders and early trauma. [69] TREATMENT The presence or increased severity of PAs appears to negatively impact treatment response in a number of disorders, including unipolar depression, [70] bipolar disorder, [71,72] PTSD, [73] and psychotic disorders.…”

Idioms of Distress Among Trauma Survivors: Subtypes and Clinical Utility

“…The targeted idiom of distress may vary depending on the treatment aim: if the aim is to treat symptoms of GAD, panic or PTSD, the treatment should target those co-occurring cultural syndromes that generate fear about these types of symptoms and, in particular should address syndrome-associated catastrophic cognitions about somatic and mental symptoms. Illustrating this approach, in a CBT treatment of Cambodian refugees that targeted both PTSD and orthostatic panic-associated with a cultural syndrome, khyaˆl overload-improvement in PTSD was significantly mediated by improvement in orthostatic panic severity (Hinton et al 2008b). In syndromes in which worry plays a key role, treatment should specifically focus on the worry topics that are signaled by the cultural syndromes, since these represent ''experience-near'' entry points for the intervention with clear face validity for the patient.…”