Descriptive Psychopathology: The Signs and Symptoms of ...

217 Chapter 8: Disturbances in emotional experienceTable 8.6. Panic attackEmotion: Apprehension, fear, terrorFlight/fight features: Dilated pupils, exophthalmus, piloerection, increased muscle tone,tachycardia, sweating, vascular shunting away from the periphery and gut to large musclegroupsNonadaptive features: Tremors, inner shakiness, dry mouth, blurred vision, chest pain ordiscomfort, palpitations, vascular throbbing, air hunger, feeling of choking, dyspnea,hyperventilation, dizziness and syncope, paresthesia, flushing or chills, weakness, suddenincreased bowel motility with abdominal distress or incontinence, nauseaCognition: Thoughts of impending doom, fear of dying, losing control, going crazy; inability toconcentrate; depersonalization and derealizationelicited anxiety. Persons with abnormal anxiety, however, are sensitive to bloodpH change and agents that accomplish this (e.g. sodium lactate, carbon dioxide)induce panic attacks in patients with anxiety disorder but not in comparisonpersons. 76Panic attackAlthough panic disorder has been established as a separate entity within theanxiety disorder category in the DSM and ICD, panic attacks occur in otheranxiety disorders as well as in general medical illness (e.g. hyperthyroidism),neurologic conditions (e.g. seizure disorder), and mood disorder (particularlyduring an episode of melancholia). Recurrent panic attacks without an apparentreason constitute panic disorder.Panic attacks emerge suddenly without an obvious trigger. The attack developsover several minutes, peaks quickly and lasts for minutes to hours. It is characterizedby feelings of intense fear and apprehension, the sufferer commonlybelieving death is imminent. Arousal is heightened with tachycardia, palpitations,shortness of breath, air hunger, sweating, and trembling. Table 8.6 displays thefeatures of a classic panic attack.Panic attacks are incapacitating, often leading to an emergency room visit, extensivebut unproductive evaluation, and hospitalization. Following an attack thesufferer feels exhausted. Jitteriness typically lingers for several hours to several days.Specific phobiaA phobia is an unrealistic or exaggerated fear of a specific object (e.g. an animal),place (e.g. a public space), situation (e.g. being in a thunder storm), or activity(e.g. public speaking). Fearing the sight of blood or receiving an injection areother specific phobias. About 12% of the general population has a life-time risk