An Integrated Model of Panic Disorder

Clinicians are shifting away from dualistic conceptions of mind and brain toward a view of psychiatric illnesses as involving interactions between biology, mind, and environment. Our understanding of panic disorder benefits from such an integrative analysis. We review genetic, neurochemical, and neuroimaging data on panic disorder, along with a series of biological and psychological models. We propose that separation and suffocation alarm systems cut across various models, and we suggest how biological, psychological, and environmental interactions can lead to panic onset and persistence. Separation and suffocation alarm systems may become sensitized due to environmental events, an inborn vulnerability, or both. These oversensitized systems create a vulnerability to environmental experiences of loss and intrusion and to frightening psychological experiences of separation and suffocation. In individuals with this vulnerability, angry feelings and fantasies, often unconscious, further intensify fears of los...