Background
Panic is characterized as a disorder of interoceptive physiologic hyperarousal, secondary
to persistent anticipation of panic attacks. The novel aim of this research was to
investigate whether severity of agoraphobia within panic disorder covaries with the
intensity of physiological reactions to imagery of panic attacks and other aversive
scenarios.
Methods
A community sample of principal panic disorder (n = 112; 41 without agoraphobia, 71 with agoraphobia) and control (n = 76) participants imagined threatening and neutral events while acoustic startle
probes were presented and the eye-blink response (orbicularis oculi) recorded. Changes
in heart rate, skin conductance level, and facial expressivity were also measured.
Results
Overall, panic disorder patients exceeded control participants in startle reflex and
heart rate during imagery of standard panic attack scenarios, concordant with more
extreme ratings of aversion and emotional arousal. Accounting for the presence of
agoraphobia revealed that both panic disorder with and without situational apprehension
showed the pronounced heart rate increases during standard panic attack imagery observed
for the sample as a whole. In contrast, startle potentiation to aversive imagery was
more robust in those without versus with agoraphobia. Reflex diminution was most dramatic
in those with the most pervasive agoraphobia, coincident with the most extreme levels
of comorbid broad negative affectivity, disorder chronicity, and functional impairment.
Conclusions
Principal panic disorder may represent initial, heightened interoceptive fearfulness
and concomitant defensive hyperactivity, which through progressive generalization
of anticipatory anxiety ultimately transitions to a disorder of pervasive agoraphobic
apprehension and avoidance, broad dysphoria, and compromised mobilization for defensive
action.
Key Words
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Article info
Publication history
Published online: May 10, 2011
Accepted:
March 4,
2011
Received in revised form:
February 16,
2011
Received:
December 22,
2010
Identification
Copyright
© 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
