Abnormal Psychology

Anxiety Disorders 263

a particular external stimulus (such as seeing a snake), they are more frequently

cued by situations that are associated with internal sensations similar to panic.

For example, grocery shopping in the winter—with the heat and stuffi ness that

comes from being under layers of clothing while inside of a store—may remind

a person of sensations associated with a previous panic attack, which can lead

to anxiety about having another panic attack. In other cases, panic attacks are

uncued—they are spontaneous—they feel as though they come out of the blue, and

are not associated with a particular object or situation. Panic attacks can occur at

any time, even while sleeping (referred to as nocturnal panic attacks, which Camp-

bell experienced). Infrequent panic attacks are not unusual; they affect 30% of

adults at some point in their lives.

Recurrent panic attacks may interfere with daily life (for example, if they occur

on a bus or at work) and cause the individual to leave the situation to return home

or seek medical help. The symptoms of a panic attack are so unpleasant that people

who suffer from this disorder may try to prevent another attack by avoiding envi-

ronments and activities that increase their heart rates (hot places, crowded rooms,

elevators, exercise, sex, mass transportation, or sporting events). They might even

avoid leaving home (Bouton, Mineka, & Barlow, 2001).

What Is Panic Disorder?

Campbell describes panic disorder: “... the fear of having another panic attack,

because the last thing in the world you want to face is one more of those horrible,

frightening experiences. And the last thing you want to accept is the idea of living

the rest of your life with panic. This condition caused me to shut myself up in the

my house, where I would sit in the dark, frustrated, crying, afraid to go out. At one

point, I even considered suicide” (Campbell & Ruane, 1999, p. ii).

To mental health clinicians, panic disorder is marked by frequent, unexpected

panic attacks, along with fear of further attacks and possible restrictions of behav-

ior in order to prevent such attacks (see Table 7.4). Note, however, that having

panic attacks doesn’t necessarily indicate a panic disorder. Panic attacks are distin-

guished from panic disorder by the frequency and unpredictability of the attacks

and the individual’s reaction to the attacks. Campbell’s life changed as a result of his

efforts to prevent additional attacks: “I remember all the places I’ve had an attack,

and I make a concerted effort to avoid those places” (Campbell & Ruane, 1999,

p. 201). Table 7.5 lists additional facts about panic disorder, and Case 7.2 provides

a glimpse of a woman who suffers from panic attacks.

Panic disorder

The anxiety disorder characterized by

frequent, unexpected panic attacks, along

with fear of further attacks and possible

restrictions of behavior in order to prevent

such attacks.

Table 7.3 • DSM-IV-TR Criteria for a Panic Attack

A discrete period of intense fear or discomfort, in which at least four of the following symptoms

develop abruptly and reach a peak within 10 minutes:

• palpitations, pounding heart, or acceler-
  ated heart rate


• sweating


• trembling or shaking


• sensations of shortness of breath or
  smothering


• feeling of choking


• chest pain or discomfort


• nausea or abdominal distress
  
  
  • feeling dizzy, unsteady, lightheaded, or faint
  
  
  • derealization (feelings of unreality) or
    depersonalization (being detached from
    oneself )
  
  
  • fear of losing control or going crazy
  
  
  • fear of dying
  
  
  • paresthesias (numbness or tingling
    sensations)
  
  
  • chills or hot fl ushes
  
  
  
  

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,

Fourth Edition, (Copyright 2000) American Psychiatric Association.