An integrative network approach to panic disorder: the complex association among vulnerability factors and symptoms.

Most theoretical models of panic disorder have emphasized the role of several vulnerability factors in the development of this disorder, such as: neuroticism, low perceived control, trait emotional intelligence, emotion regulation, and anxiety sensitivity. To examine the nature of the relationship between these factors and panic disorder symptoms, we performed a complex network analysis to determine the symptoms and mutually reinforcing patterns that define this disorder. Participants with self-reported panic disorder (n = 326) completed a series of online self-report questionnaires. Node centrality indices, estimation of bridge nodes, and community analysis, were calculated using partial correlation coefficients and glasso regularization. The results revealed that low levels of well-being and the frequency of panic attacks were the most central symptoms of the network, while fear of physical concerns of anxiety sensitivity was a strong predictor of other network symptoms. Moreover, depression and fear of physical concerns represented the bridge nodes that link the vulnerability factors to panic disorder symptoms network. These results suggest that low levels of well-being should be included in the clinical taxonomy and assessment of panic disorder, and can be considered as a therapeutic target in cognitive and behavioral therapy for this disorder. [ABSTRACT FROM AUTHOR]