Panic Disorder

Panic disorder is a widespread, disabling condition among patients in primary healthcare. Close to 5% of the population are affected by panic disorders at some time in life. A notable increase from 5. 3% to 12. 7% in panic attacks has been seen in recent decades. (Yi-Hua, Chaur-Jong, Hsin-Chien & Herng-Ching, 2010). Diagnosis is based on repeated panic attacks that consist of the rapid onset of severe fear or distress along with a number of somatic and cognitive symptoms (Yi-Hua, et al. , 2010).

According to the DSM-IV definition, the person must have experienced recurrent unexpected attacks and have been consistently concerned of having another attack or worried about the consequences of having an attack (Carson, Butcher & Mineka, 2000). There are a number of speculative theoretical models which try to clarify the origin or cause of panic disorders. One is the psychodynamic approach, according to Freud pathologic anxiety happens when intolerable libidinal feelings, inclinations, recollections, and desires leak into consciousness.

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These formerly repressed elements release psychic energy that appears in the form of panic attacks. Fantasies or dreams of separation and autonomy are frequent areas of conflict for people with panic disorders. Clinical studies imply that individuals with panic disorder have trouble enduring and controlling thoughts and feelings of anger. Even though panic attacks frequently happen in situations of diverging hostility, a number of patients allow their attacks to have stimulating implications related to fantasies that are sadomasochistic and sexual in nature (Busch, Milrod, & Singer, 1999).

The recommended treatment that coincides with the psychodynamic approach is the development of a biweekly 24-session, Panic-Focused Psychodynamic Psychotherapy (PFPP). This intervention concentrates on central conflicts of anger, hesitation, autonomy, and fear of abandonment, rejection and loss as frequently seen in panic disorders. Throughout the session the therapist works to expose meanings of panic symptoms which the individual is unaware of and to comprehend and modify central conflicts (Stirman, Toder & Crits-Cristoph, 2010).

Enhancement of quality of life was significant and constant across all areas with the PFPP approach and symptomatic achievements were maintained for over six months (Milrod, Busch, Leon, Aronson, Roiphe, Rudden, Singer, Shapiro, Goldman, Richter & Shear, 2001). Subjects in panic-focused psychodynamic psychotherapy have had a considerable decrease in panic symptoms.

In addition, those getting PFPP were notably more inclined to respond to termination, another outcome, which is the adjustment in psychosocial performance also reflect these results (Milrod, Leon, Busch, Rudden, Schwalberg, Clarkin, Aronson, Singer, Turchin, Klass, Graf, Teres & Shear, 2007). Another approach is the cognitive behavioral model. This speculates that anxiety is a learned response from parental influence or through the process of classical conditioning.

With parental influence, patients with panic disorder are thought to have had a significantly elevated degree of separation anxiety during childhood. However it has been found that subjects diagnosed with separation anxiety disorder during childhood have not displayed a higher risk for acquiring panic disorder in young adulthood as compared to those who have had other initial anxiety diagnoses (Aschenbrand, Kendall, Webb, Safford & Flannery-Schroeder, 2003).

Moreover, experience of childhood physical and sexual maltreatment was connected to increased risks of panic attack or disorder even if adjustment to the assessed factors has been achieved. It is important to note that exposure to violence between parents during childhood is not related to a heightened possibility of panic disorder after adjustment is made (Goodwin, Fergusson, & Horwood, 2005). This suggests that therapists need to be conscious of patients with histories of physical and sexual abuse because they are at a higher risk to acquire panic disorders during adulthood.

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