Panic disorder is a wide spectrum and other than panic attacks and agoraphobia, it also includes claustrophobia, fear of losing control, claustrophobia, rescue object, loss sensitivity, medical reassurance and reassurance from family members. There is not much empirical support to attribute the role of other factors to constitute the spectrum of panic disorder. Another extension to the spectrum of panic disorders is non-clinical panic attacks. This clinical entity is important because like panic disorder, it is also associated with a generalised anxiety disorder (Tulla et al, 2009). Shared relationship of emotion regulation difficulties makes generalised anxiety and panic disorder fall into the same spectrum of clinical symptoms (Tulla et al, 2009).
Panic disorder has a bimodal distribution. The highest incidence occurs in late adolescence followed by another peak in the third decade of life (Daniels, 2006). Panic attacks can be either fearful or non-fearful. In the latter group, the attacks occur without the element of subjective fear. Chen et al (2009) conducted a large study to examine the prevalence of the non-fearful panic disorder. According to this study, non-fearful panic attacks constitute about 30% of panic disorder.
The age of onset and frequency of symptoms are similar to fearful panic disorder. But the symptomatology varies, in the sense, symptoms associated with fear like shortness of breath, depersonalisation, smothering, trembling and anxiety are classically absent or occur in a reduced form. Also, this form of panic disorder is less associated with agoraphobia or other comorbid mental illnesses. In this study, recall bias and response bias are suspected to have affected the prevalence rates of non-fearful panic disorder. The causes of Panic disorder are not well established.
Some attribute hereditary and parenting aspects to the development of the disorder. It is not known whether specific parenting behaviours increases the vulnerability of the condition in the offspring.
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