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Panic Disorder: Genetic and Biological Factors

Panic disorder with or without agoraphobia has a lifetime prevalence of between 1.5% and 3.8%.  The female to male ratio is 2:1.  The usual onset of the first panic attack seems to usually be in the early 20’s.  It's a relative rarity for children under the age of 16 to have a panic attack and also rare for individuals over 45 to have their first panic attack. 

Panic disorder: Genetic and biological factors 

Experts believe there may be a moderate genetic connection associated with panic disorder and agoraphobia.  Some of the biological signs have been identified as compensated respiratory alkalosis which is related to the hyperventilation syndrome, which sometimes accompanies panic disorder.  Also, some individuals with panic disorder have increased responses to lactate infusion and to CO2 inhalation, although these symptoms are not usually significant enough to diagnose panic disorder.  Panic disorders also have been found to have some effect on the dysregulation of the serotonergic and noradrenergic systems.  Panic disorders are frequently inhibited by certain medications such as imipramine and fluvoxamine. 


Some experts have suggested an evolutionary model for panic disorder and agoraphobia, which suggests that there may be some adaptive quality associated with it, and sensitivity toward certain conditions and stimuli (such as being trapped in close spaces, open fields, being at great heights or being left alone).  For example, from an evolutionary standpoint, crossing an open field may make one more prone to attack by predators.  The normal responses to these threats include flight or freezing which are similar to the sympathetic and parasympathetic responses in panic disorder.  However, since individuals may also seem to be unable to escape in modern everyday life (e.g. being a supermarket line or on a subway), the anxiety may continue to rise resulting in a panic attack. 

Coexisting conditions associated with panic disorder: 

There are many other psychological conditions which frequently coexist with panic disorder such as major depression, dysthymic disorder, generalized anxiety disorder, obsessive-compulsive disorder, social phobia, specific phobia, hypochondriasis, and substance abuse or dependence.  Also, withdrawal from alcohol or other substances may result in panic attacks.  It has also been noted that individuals with panic disorder who are having other psychological difficulties such as marital problems, may not report the problems as they are afraid of losing their “safety persons”.  Couple conflict however, is not that uncommon among these patients because of the strain of agoraphobia on the patience of an individual's spouse or partner.  While one study found that the risk for suicide was higher among individuals with panic disorder than with major depression, continued analysis of this information found that the higher incidence for panic disorder was probably more related to individuals with coexistent borderline personality disorder and or comorbid substance abuse problems.  Panic disorder per se is not a strong predictor of a high risk for suicide.

Information adapted from Treatment Plans and Interventions for Depression and Anxiety Disorders by Robert L. Leahy and Stephen J. Holland

Webpage and additional information By Paul Susic MA Licensed Psychologist Ph.D Candidate 

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