Am J Psychiatry 1993; 150:859-866
Copyright © 1993 by American Psychiatric Association
A psychodynamic model of panic disorder
MK Shear, AM Cooper, GL Klerman, FN Busch and T Shapiro
Western Psychiatric Institute and Clinic, New York Hospital-Cornell University Medical College, Pittsburgh, PA 15213.
Current psychiatric research on panic disorder and its treatment are
heavily influenced by neurobiological and cognitive-behavioral models
rather than psychodynamic propositions, and psychodynamic treatment is
generally considered to be of little benefit in amelioration of symptoms.
However, because neither of the current models fully explains the clinical
psychopathology, etiology, or pathogenesis of panic disorder, there is a
need for further model building. The authors suggest that a psychodynamic
approach may add to the understanding of patients with panic disorder. They
base their psychodynamic formulation on pilot interviews with nine patients
with panic disorder, published reports of psychological characteristics of
patients with panic disorder, and data from infant and animal research on
temperament. Interview results included the following: 1) all of the
patients described themselves as fearful, nervous, or shy as children, 2)
they remembered their parents as angry, frightening, critical, or
controlling, 3) they frequently indicated discomfort with aggression, 4)
most described chronic feelings of low self-esteem, 5) their spouses were
characterized as passive, kind, and nonaggressive, and 6) stressors
associated with frustration and resentment preceded the onset of panic. The
authors propose a model in which inborn neurophysiological irritability
predisposes to early fearfulness. Exposure to parental behaviors that
augment fearfulness results in disturbances in object relations and
persistence of conflicts between dependence and independence, which
predispose to fears of feeling trapped, suffocated, and unable to escape
and/or feeling alone and unable to get help. Catastrophic fears of
helplessness in the face of suffocation or abandonment are easily
accessible.(ABSTRACT TRUNCATED AT 250 WORDS)
