Towards a ‘map’ of panic: structure of the bodily symptoms

Abstract

Despite the large amount of research on panic attacks according to DSM criteria, there are some inconsistencies between this and reports from clinical settings. Some naturalistic and non‐standard studies are needed. The authors of the present study submitted a list of 24 bodily symptoms to 65 panic patients who had sought medical help. The results of principal‐component analysis revealed five factors, four of which represent the forms described in clinical and epidemiological contexts: cephalo‐vertiginous, cervico‐respiratory, thoraco‐cardiac and abdomino‐digestive. Each of these factors is differentially related to some specific fearful anticipations, which may organize the symptoms in a body‐related topographical way.

Dimensional structure of bodily panic attack symptoms and their specific connections to panic cognitions, anxiety sensitivity and claustrophobic fears

“…Although chest pain also appeared to be associated with the respiratory factor in our models, the best fit was obtained when subsuming this symptom together with palpitations under a separate cardiac factor. Such a distinct cardiac factor is consistent with Pio-Abreu et al (1998).…”

“…Thus, future attempts to uncover the structure of PAS should disaggregate the combined symptoms into single symptoms and also include more items to represent hitherto neglected symptom domains (Ottaviani & Beck, 1987). For example, Pio-Abreu et al (1998) have both disaggregated the DSM-IV PAS and included abdominal PAS in addition to the bodily DSM-IV PAS and reported a separate abdominal factor in addition to a respiratory and a cardio factor.…”

“…We will present a dimensional analysis for a sample of German patients with PD with agoraphobia. We followed the strategy of Pio-Abreu et al (1998), confining this analysis to the ten bodily DSM-IV PAS. Cognitive models consider bodily PAS and catastrophic cognitions as functionally different components of panic attacks and postulate that the perception of bodily PAS activates catastrophic cognitions, which in turn provokes or amplifies further panic symptoms (e.g.…”

Psychophysiological responses to inspiratory resistive loads

“…For example, bodily sensations can trigger anxiety responses in healthy individuals (Walker and Furer, 2008) and panic disorder (PD) patients are typically afraid of sensations of faster breathing or elevated heart rate (Schmidt et al, 1997). The difficulty to experimentally induce and control sensations originating in, for example, the cardiovascular, gastro-intestinal or respiratory system (Pio-Abreu et al, 1998) has probably limited experimental research on interoceptive fear. In that respect, an interesting stimulus is breathing through an inspiratory resistive load (IRL).…”

Modification of the Body Sensations Interpretation Questionnaire (BSIQ-M): validity and reliability

“…There are clinical reports (e.g., Frances et al, 1993), and factor analytic studies (e.g., PioAbreu, Ramalheira, & Valente, 1998) that indicate that some panic sufferers complain of panic symptoms not listed in the DSM-IV such as blurred vision, headache, tinnitus and urinary frequency. Although there may be some basis on which to include items based on these symptoms, there is no evidence to suggest that they are as commonly experienced as those listed in the DSM-IV (APA, 1994).…”