Abnormal Psychology

262 CHAPTER 7

Panic Disorder (With and Without Agoraphobia)

Earl Campbell’s uncomfortable episodes of anxiety didn’t stop:

The second night we were in the [new] house, I had my third episode. It felt just like the

second one had. I was lying in bed watching television, and Reuna was sound asleep

next to me. I was trying to relax and not think about my problem, but my problem was

all I could think about. All of a sudden, my heart went crazy—pounding, pounding

harder and harder. I thought it was going to leap right out of my chest. I sat up, strug-

gling to regain my composure. It got worse. I couldn’t breathe again.

(Campbell & Ruane, 1999, p. 92)

Campbell again thought he was having heart attack and that his life was ending. Camp-

bell was having a panic attack. A panic attack is a specifi c period of intense dread, fear,

or a sense of imminent doom, accompanied by physical symptoms of a pounding heart,

shortness of breath, shakiness, and sweating.

The Panic Attack—A Key Ingredient of Panic Disorder

Some of the physical symptoms of a panic attack may resemble those associated with a

heart attack—heart palpitations, shortness of breath, chest pain, and a feeling of chok-

ing or being smothered (see Table 7.3), which is why Earl Campbell mistook his panic

attacks for heart attacks. In fact, emergency room staff have learned to look for evi-

dence of panic attack when a patient arrives who purportedly has had a heart attack,

as was the case with Campbell, who was brought to the hospital by ambulance after

his second panic attack. During a panic attack, the symptoms generally begin quickly,

peak after a few minutes, and disappear within an hour. As noted by Campbell, the

symptoms of a panic attack can be frightening and extremely aversive.

In some cases, panic attacks are cued—they are associated with particular ob-

jects, situations, or sensations. Although panic attacks are occasionally cued by

Key Concepts and Facts About Generalized Anxiety Disorder

• Generalized anxiety disorder is marked by persistent uncontrol-
  lable worry about a number of events or activities that are not
  solely the focus of another Axis I disorder. Most people with
  GAD also have comorbid depression.


• Neurological factors associated with GAD include:
  
  
  • more gray and white matter in the areas of the brain related
    to hearing and language comprehension—the superior tem-
    poral gyrus—particularly in the right hemisphere. Moreover,
    unlike most other anxiety disorders, GAD is associated with
    decreased arousal because the parasympathetic nervous
    system is extremely responsive.
  
  
  • unusually strong activation in the right front lobe when
    viewing angry faces, which may be related to the operation
    of coping mechanisms;
  
  
  • abnormal activity of serotonin, dopamine, and other neuro-
    transmitters, which in turn infl uences motivation, response
    to reward, and attention;
  
  
  • a genetic predisposition to become anxious and/or depressed.
    This predisposition, however, is not specifi c to GAD.
  
  
  
  


• Psychological factors that contribute to GAD include being
  hypervigilant for possible threats, a sense that the worrying is

out of control, and the reinforcing experience that worrying

prevents panic.

• Social factors that contribute to GAD include stressful life
  events, which can trigger the disorder.


• Treatments for GAD include:
  
  
  • medication (which targets neurological factors), such as
    buspirone or an SNRI or SSRI when depression is present
    as a comorbid disorder; and
  
  
  • CBT (which targets psychological factors), which may in-
    clude breathing retraining, muscle relaxation training,
    worry exposure, cognitive restructuring, self-monitoring,
    problem solving, psychoeducation, and/or meditation.
    CBT may be employed in a group format.
  
  
  
  

Making a Diagnosis

• Reread Case 7.1 about A. H., and determine whether or not her
  symptoms meet the criteria for generalized anxiety disorder.
  Specifically, list which criteria apply and which do not. If you
  would like more information to determine her diagnosis, what
  information—specifi cally—would you want, and in what ways
  would the information infl uence your decision?

Panic attack
A specifi c period of intense dread, fear, or
a sense of imminent doom, accompanied
by physical symptoms of a pounding heart,
shortness of breath, shakiness, and sweating.