Panic Disorder Socio-Cultural Aspects and Gender Specificity

In some native cultures, panic attacks are induced by intense fear due to traditional beliefs on witchcraft, super natural powers and magic (Wittchen and Essau, 1993). Likewise, women in some ethnic groups have limited participation in social activities (Wittchen and Essau, 1993). These cultural features were considered as major factors in the acquisition of panic disorder with or even without agoraphobia. In line with this, panic disorder with agoraphobia and panic disorder without agoraphobia are respectively diagnosed thrice and twice often in women than in men.

As the epidemiological statistics established the vulnerability of women to panic disorder than men, the National Comorbidity Survey or NCS confirmed the co-occurrence of this disorder with other psychiatric disorders. Further, the gender variation of panic disorder seemed to increase with the patients’ ages. In particular, the prevalence of panic disorder among individuals with ages of 15 to 24 years was 2. 5% and 1. 3% respectively for women and men (Eaton, Kessler, Wittchen, and Magee, 1994). Even though the prevalence rate drops, as both groups get older, the gender difference still progresses.

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For instance, the panic disorder prevalence rate among individuals of 35 to 44 years of age was noted as 2. 1% and 0. 6% for women and men respectively (Eaton, Kessler, Wittchen, and Magee, 1994). Moreover, women are often afflicted with much debilitating types of panic disorder. In the longitudinal study conducted by Yonkers, Zlotnick, Warshaw, Allsworth, Shea, and Keller (1998), they found that the relapse rate of panic disorder was twice in women than in men. In 2002, Sheikh, Leskin, and Klein found that heart pounding is the most common symptom, regardless of gender, reported by diagnostic groups.

In terms of breathing difficulty, more women have suffered from shortness of breath, difficulty in swallowing, choking, and felt smothered and tendency to faint. Meanwhile, Seeman (1997) postulated that the hormonal changes during premenstrual period of women can possibly explain their high vulnerability to panic disorder. She ascribed the anxiolytic effects of progesterone to its agonistic reaction with benzodiazepine and gamma-aminobutyric acid or GABA receptors. This notion was supported by the reports on the higher tendency of females with premenstrual dysphoric disorder to panic attacks.

This signified that benzodiazepine or GABA receptors’ dysregulation is the possible underlying factor for both reproductive cycle problems and panic response of women. Furthermore, Klein (1993) suggested that the hormonal fluctuation during the premenstrual period of women can also be inferred as the cause of the high occurrence of respiratory distress among women with panic disorder. As argued by the “suffocation false alarm theory,” a suffocation alarm system of the body tends to become unduly hypertensive.

Thus, the fluctuation in any physiological process in the body may lead to the misinterpretation of the brains of the physiologic process which in turn causes the perception of fear to the individual. For example, the physiological fluctuation of brain lactate and carbon dioxide level in blood can be interpreted by the system as asphyxiation threat. Consequently, this misinterpretation of the suffocation alarm system of the body generates the sense of breathing difficulty, dyspnea, and hyperventilation which eventually inflame panic response.

Nevertheless, normal women with premenstrual syndrome were observed having respiratory troubles similar to what have been observed among panic disorder patient. This empirical proof then further strengthened the relationship between women’s physiology and panic disorder. Meanwhile, different studies revealed that family involvement in the treatment of anxiety disorders, schizophrenia, substance abuse, depression, and mental illness improved patient’s conditions (WHO, 2001).

Moreover, treatment outcomes at home showed positive results than in medical institutions. But relapse rate incidence was noted higher at home (WHO, 2001). Thus, it is inferred that by providing the best emotional atmosphere at home would result to a better treatment outcomes. In fact, it was proven that family therapy in parallel with antipsychotic medications has more positive treatment outcomes (WHO, 2001). Nonetheless, the mutual support from the general public to avoid discrimination against mentally-disturbed individuals is highly encouraged.

For the attainment of mutual support, collaborative efforts from the government, private organizations, media, and concern citizens are needed in the disseminating proper information and educating the mind of the general public concerning mental health problems and panic disorders (WHO, 2001). For example, World Psychiatric Association, WPA, led a worldwide campaign through mass media in eradicating discrimination against schizophrenic patients (WHO, 2001).

In general, although patients may develop disability due to the late detection and treatment of panic disorder, the disorder has a good long-term prognosis (Arntz, 2002). Since major depression occurs among 40% of patients, the antidepressant drugs are utilized; however, the comorbid depression aggravates the panic disorder condition and elevates the risk for suicidal attempts (Pollack, 1997). Furthermore, among panic disorder cases, it was observed that around 7% of which have high suicidal behavior risks while more than 20% eventually lead to suicide (Pollack, 1997).

As well, alcoholism and other substance abuse co-occur with panic disorder cases primarily due to major depression among the patients. References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorder, 4th ed. Washington, DC: APA. Arntz, A. (2002). Cognitive Therapy Versus Interoceptive Exposure as Treatment of Panic Disorder without Agoraphobia. Behaviour Research and Therapy, 40, 325–341. Bakker, A. , van Balkom, A. J. , Stein, D. J. (2005). Evidence-based Pharmacotherapy of Panic Disorder.

International Journal of Neuropsychopharmacology, 8, 473. Coryell, W. , Pine, D. , Fyer, A. , Klein, D. (2006). Anxiety Responses to CO2 Inhalation in Subjects at High-risk for Panic Disorder. Journal of Affective Disorder, 92, 63–70. Eaton, W. W. , Kessler, R. C. , Wittchen, H. U. , and Magee, W. J. (1994). Panic and Panic Disorder in the United States. American Journal of Psychiatry, 151(3), 413-420. Hirschfeld, R. M. (1996). Panic Disorder: Diagnosis, Epidemiology, and Clinical Course. Journal of Clinical Psychiatry, 57, Supplementary 10, 3.

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