The phenomenological study of 90 patients with panic disorder, Part II.

This paper examines the nosological and aetiological relationships of panic disorder to the anxiety states and depression. The phenomenology is detailed from an unbiased sample of 90 cases selected, on the basis of meeting positive criteria for panic disorder, from 3 series of consecutive cases. Panic attacks were found to be only quantitatively distinct from non-panic anxiety. Truly spontaneous attacks, not preceded by anxiety-provoking cognitions, were uncommon. No unique association with agoraphobia was seen, other anxiety states and depression being common. Social phobia and generalized anxiety often preceded the development of panic disorder, as did some cases of agoraphobia. Depression was usually non-specific and secondary when only DSM-III MDE criteria were used. Significant neurotic traits were found, particularly anxiety, dependency and poor sexual adjustment. Panic disorder has multiple causal factors only one of which is a genetic tendency for panic attacks. While important therapeutically, panic attacks should not be given the primary place in diagnosis.