Over time, a large number of theories related to Panic Attacks have been developed, allowing us to know more details about this process. However, there are currently certain gaps regarding the causal factors of this problem.
Psychological Causes of Panic Attacks
Panic Attacks, also known as „Panic Crisis,” are defined as a response of intense fear and/or discomfort that appears suddenly and isolated, with a very variable duration. Likewise, diagnostic manuals such as the DSM indicate that this response is usually accompanied by various manifestations of somatic nature, such as tachycardia, sweating, tremors, shortness of breath, chest tightness, nausea, dizziness, fainting, hot flashes, a sense of unreality and loss of control, fear of dying, etc. In addition, these manifestations cannot be explained by substance use or other conditions.
On the other hand, to specify the nature of the problem, it is necessary to consider the context in which this episode occurs. Taking into account the relationship with possible triggers, panic attacks can be classified as:
– Unexpected: The onset of the episode does not coincide with evident triggers.
– Situationally Determined: The attacks occur in the presence or anticipation of a specific stimulus or situation.
– Situationally Predisposed: The episodes are more common in specific situations, although they are not completely associated with them.
Panic attacks can originate in a multitude of situations, especially those capable of generating a state of high physiological arousal or in response to a specific stressful event. Once the first episode has occurred, the situation becomes associated with the sensations experienced during it. As a result, there is a tendency to avoid this situation. Thus, panic attacks have traditionally been linked to agoraphobia, characterized by an intense anxiety response in situations where it is difficult to escape or get help. These situations are experienced with profound discomfort and, in many cases, avoided. In some cases, due to chronicity of the problem, home confinement can occur, which has serious repercussions in different areas of a person’s life. Likewise, a high convergence has been observed with other problems such as generalized anxiety, mood disorders, phobias, excessive alcohol, drug and substance use, etc.
Despite having such precise definitions of this disorder, research has not been able to determine the exact course of the episode, as well as the factors that contribute to greater vulnerability. In this respect, one current explanation refers to an alarm system that is activated in situations where it is not necessary. Also, due to the correlation with certain physiological (hypotension, hyperventilation…) and biochemical (norepinephrine and serotonin) alterations, a congenital origin of this disorder has been suggested. However, there is still a significant gap in understanding the etiology or causes of these alterations that could partially explain the onset of panic attacks. For this reason, most interventions are focused on symptom suppression, which can result in a superficial treatment in many cases.
Factors Linked to Panic Attacks
Despite not knowing the specific causes of this problem, a list of factors of different nature that could account for panic attack episodes has been highlighted. The most significant are:
– Parental variables and childhood anxiety: One of the major difficulties extracted from family studies to determine the influence of family factors on the origin of a particular problem is the difficulty of discerning genetic from environmental influence. However, various longitudinal studies support that individuals raised in overprotective and rigid family environments have a higher prevalence of Panic Disorder. These studies also suggest that these parental patterns, along with different stressors experienced during childhood and adolescence, could increase the likelihood of developing an Avoidant or Dependent Personality Disorder, as well as influencing the onset and maintenance of Panic Disorder with or without Agoraphobia. Other factors that have been linked to this problem are family economic issues, experiences of abuse, separation anxiety in childhood, or early loss of parents.
– Behavioral inhibition: Defined by Kagan and colleagues as a temperamental trait that involves being cautious, quiet, and reserved in unfamiliar situations or contexts. It is also a stable tendency maintained throughout childhood and adolescence. Additionally, Segui and colleagues conducted a study with individuals diagnosed early with Panic Disorder and concluded that the early onset of this disorder comes from a common temperamental factor of behavioral inhibition.
– Anxiety sensitivity: This factor alludes to a greater predisposition to respond with fear to signs of anxiety. However, it is important to emphasize that the results of different studies have correlated this factor with the maintenance of Panic Disorder but not with its origin.
– Perception of anxiety control: Panic Disorder has been associated in several studies with difficulty controlling or managing emotional responses and life situations. For this reason, these individuals may make excessive efforts to prevent anxiety or distress states. It has also been suggested that these individuals may have a deficit in emotional processing, indicating a higher vulnerability to experiencing a first episode.
– Remote backgrounds: Recent research has provided data on the neurophysiological components that would explain why not all individuals experience the somatic manifestations that characterize Panic Attacks in traumatic or conflictive situations. Additionally, there is a wide variety of signs manifested among different people. Along these lines, current studies conclude that situations of abuse and neglect during childhood are correlated with disorganized patterns in stress and fear response, related to the hyperactivation of the hypothalamic-pituitary-adrenal axis (HPA). Furthermore, it has been observed that this pattern tends to remain stable, promoting the emission of hyperactivation responses. Consequently, it is hypothesized that these episodes may not be directly related to a current stressful event, which would explain the difficulty in identifying a manifest cause that could generate this episode. In this way, present stimuli or situations could act as triggers without the person being able to become aware of the underlying and real source of this problem.
Factors Linked to the Persistence of Panic Attacks
Once the first crisis has occurred, the distress experienced by the person does not depend solely on the unconscious conflicts that caused it, but the evocation of the situation, acting as an „alarm distress,” is capable of reactivating the bodily manifestations or the latent conflicts, favoring the appearance of a new episode. In this way, the panic crisis could be mediated by the activation of representations of different levels of symbolization, such as guilt feelings for some fantasy or conflicting desire, loss or abandonment of important figures, an unknown place, as well as the appearance of physiological signals such as chest discomfort. As a result, a new representation of „oneself in danger” is generated, implying a feeling of being under threat. Additionally, this can be influenced by the discourse of parents, as well as possible identification with the endangered self of the parents. However, this representation is mediated by another factor linked to this problem, control over anxiety. The presence of an attachment figure with the ability to soothe childhood anxiety (heteroregulation) is internalized as a capacity for „self-soothing,” through which the person is able to properly manage their levels of psychophysiological activation. Therefore, the absence of this capacity creates a state of vulnerability for the development of various problems, as well as dependence on other significant figures for regulating high levels of activation.
Overall, a large number of factors, both present and past, are linked to the origin and maintenance of panic attacks.
