The Biochemistry of Panic - Essay Example

? The Biochemistry of Panic: An Analysis Are Panic Attacks Biological or Mental? Introduction There are two major theories of the cause of panic attacks: biological and psychological. Many support the view that biological and psychological aspects are to be held responsible, but assumptions differ on the degree of influence of each factor. There is still no adequate and comprehensive and complete explanation of panic attack. However, this essay aims to answer the question, are panic attacks biological or mental? Nevertheless, this essay aims to demonstrate that panic attacks are caused more by psychological factors than biological ones. Analyzing the Nature of Panic Attacks The observation that panic attacks are normally accompanied by difficulties in breathing triggered what eventually became the most compelling rival of the biological theory. Similar to numerous physicians, Professor David Clark observed the regularity with which individuals experiencing panic attack suffer from hard breathing. Their breathing has a tendency to be very shallow and/or very fast. The consequences of excessive breathing, or hyperventilation, normally involve chest pains and/or stiffness, hypersensitivity of the extremities, nausea, fast heartbeat, lightheadedness, and hallucinations (Rachman & de Silva, 2009). Among panic disorder patients, panic attacks can be caused by excessive breathing. The findings of Dr. Clark made him think that the panic attacks arise when the individual thinks that the outcome of too much breathing, like chest pains, hallucinations, and dizziness, imply that something bad is going to come about. For instance, “My chest is tight and I feel dizzy and faint, which means I am having a heart attack. I am about to die” (Rachman & de Silva, 2009, 35). Several clinicians extended their efforts outside the investigation of excessive breathing to include an array of undesirable and/or inexplicable bodily feelings and responses and afterward provided a new analysis of panic attacks. Individuals become very fearful or scared when they think that they are in danger, and respond as a consequence. Their crisis responses include extreme physical sensations, like disastrous thoughts, breathing difficulties, and fast heartbeat (McNally, 1994). Nevertheless, if there is no actual threat, the crisis responses are stressful and impairing. Dr. Clark suggested that panic attacks are brought about by a severe misreading of different physical sensations or feelings. The most usual misreading that incite panic attacks are a fear of fatal diseases, a fear of rejection or public embarrassment, a fear of being mad, a fear of things that are beyond one’s control, a fear of totally losing control, a fear of losing oxygen, a fear of a possible nervous breakdown or seizure (Schmidt, Norr, & Korte, 2013). Individuals who are vulnerable to at least one of these fears, either due to their personal experiences, and who are very responsive to their bodily senses, are at greater risk of panic attacks. Any episode or condition that triggers undesirable physical sensations, like weakness brought about by too much breathing, is vulnerable to misunderstanding. An individual, who is very scared of a premature death by an unexpected stroke, perhaps due to a family history of high blood pressure, may misread severe headache while jogging as a sign of an imminent attack, and panic. Yet, if that same individual recognizes the sensation as a natural reaction to jogging, then s/he will not suffer from any panic attack. In most instances such disastrous thoughts emanate from the individual’s personal experiences or from disasters that they have seen, or been informed about, or from life-threatening sicknesses, or death (Nutt, Ballenger, & Lepine, 1999). For instance, a patient may be scared of developing cancer because of family history. Another patient may fear that his sporadic delusions are an indication that s/he would develop schizophrenia and be hospitalized for a long time. These examples show how adverse thoughts arising from various sources can create disastrous thoughts, and they can be provoked when the individual suffers from undesirable physical sensations and/or goes in a situation that seems dangerous or frightening. Hardships or calamities that have taken place to family, relatives, friends, and other loved ones are a usual and dominant source of adverse thoughts; they trigger the at-risk individual’s stockpile of negative memories. Disturbing, persistent images of traumatic memories are quite intense, emotionally powerful and rigid. Several images arise from experiences in childhood or adolescence, and issues of suffocation, neglect, are typical (Marchand et al., 2013). These frightening, adverse memories and persistent, disturbing images of disastrous episodes can be unusually insistent and trouble the individual for a long time. In summary, belief of inexplicable/undesirable physical sensations and/or disastrous thoughts can bring about a panic attack. If the individual makes a disastrous misreading of the adverse thoughts and/or sensations, a panic attack is expected to occur. If the individual makes a harmless, nonthreatening interpretation of the thoughts and/or sensations, a panic attack will not occur (Nutt et al., 1999). Two major groups of clinicians oppose the biological theory: cognitive-behavioral psychologists and European therapists. They argue that a panic attack is a particular occurrence, which can be observed in numerous other disorders—psychosis, borderline conditions, anorexia nervosa, substance abuse, depression, and others. In addition, individual panic attacks are common in normal people. This perspective hence argues that panic as such is not pathological or particular (Marchand et al., 2013). Panic develops into pathology when its episode is accompanied by particular premorbid susceptibility variables; according to these clinicians “Preconstitutive aspects of panic must exist either as a peculiar cognitive pattern or as a vulnerability to environmental events” (Nutt et al., 1999, 37). The argument of these clinicians claims that an irrational or overanxious behavior precedes the occurrence of panic attacks and that certain temperamental or volatile aspects are needed in order for panic attacks to happen (Schmidt et al., 2013). There are evidences that substantiate this argument. Beck (1985) introduced a perspective that highlights the role of variables that predispose and precipitate. Trauma, weak coping mechanisms, specific bodily conditions, or heredity, for instance, could work as aspects that predispose several individuals to the impact of precipitating variables, such as substance abuse, physical disorder, or direct stressors like death of a loved one. As stated by Beck (1985), the signs of anxiety arise after the initial thought of dying. Having suffered several panic attacks, the individual actualizes certain reflex thoughts, or mental shortcuts that demand minor processing and create inaccurate assumptions which place emphasis on imminent threat, insanity, injury, or death. Barlow’s (1988) theory of learned alarm reaction is derived from the proposed link between physiological flight or fight response and panic attack. It claims that panic attack is basically a flight or fight response without the actual threat. Hence the alarm of an individual, that is very helpful in situations of actual threat, becomes incorrect and hence dysfunctional. Due to the intensity of the experience, merging immediately takes place between the bodily sensations and the alarm during an episode of panic. After this habituation, every time there is an impetus similar to the bodily sensations related to the occurrence, a false alarm response and then a panic attack are elicited (Barlow, 1988). These psychological theories offer reliable and valid assumptions of the causes of panic attacks, and definitely describe the life of individuals who experience it. All together, these assumptions are derived from clinical observations of patients with panic disorder (Rachman & de Silva, 2009). However, their reliability does not disprove the assumption that these patients have a neurobiological defect as well that is cause or outcome of their experiences. Nevertheless, the role of early environmental aspects was verified by empirical findings. As usually comes about with biological findings, though, all of these evidences may open themselves to various explanations. For example, the atypical reaction to life experiences may be because of defect in the cerebral neuroendocrine systems that must handle stressful conditions (Nutt et al., 1999). In addition, Dr. Donald Klein of the New York Psychiatric Institute discovered that patients who suffered from acute, sudden panic attacks were not able to respond to treatments that improved most other forms of anxiety disorder, but unexpectedly did react positively to a single medication—imipramine-- which is administered mostly to lessen depressive symptoms (Rachman & de Silva, 2009). He then reached the conclusion that individuals who suffered from panic attacks were different from individuals who suffer from other types of anxiety disorder. Dr. Klein therefore argued that panic attacks are mostly biological in nature; that is, individuals with panic disorder have a “super-sensitive alarm system that is repeatedly and unexpectedly triggered by pathological discharges in the nervous system, causing spontaneous panics” (Rachman & de Silva, 2009, 33). Such discharges are believed to be connected to separation or suffocation anxiety. The sudden panic attacks happen at unexpected times and can take place in unusual places. The experience of sudden panic attacks leads to anxiety about subsequent episodes, heightened fear or anxiety, and finally agoraphobia (Marchand et al., 2013). Both the biological theory and psychological theory embody extreme interpretations of the issue, and numerous scholars recognize the need for a midway perspective. In an integrated framework, wherein psychological and biological factors should essentially be interrelated, the autonomic nervous system (ANS) may have a fundamental part in the pathogenesis of panic disorder. This connection may be concluded based on a number of issues (Nutt et al., 1999, 38): (a) Most of the somatic symptoms of the panic attack are mediated by the ANS; (b) Increased values of autonomic functions are common observations in patients with PD even outside the panic attacks; (c) Several papers have reported dys- (over-) functioning of the noradrenergic system in PD at both the central and peripheral levels; (d) Some theoretical models, of which the learning theory is probably the best known, propose the hyperactivity of the ANS, interacting with conditioning, is at the basis of neuroses. Too much focus on biological features of panic attacks, although useful in moderating some adverse assumptions, is not free from weaknesses. The unfounded idea that a biological component of human behavior weakens moral will can be particularly degrading to individuals with panic disorders or other mental disorders (McNally, 1994). These biological assumptions may be used as a tool for discrimination. Hence a balanced view of panic disorder and other forms of mental illness should be made. Conclusions There are several ideas that arise from this analysis. First, there seems to be a genetic relationship because panic disorder does have a tendency to be hereditary. Second, there seems to be some general environmental causes of panic attacks. However, not every individual who experiences such environmental stimuli are vulnerable. Not every person who grew up in an undesirable environment, or has weak attachment or stressful experiences, suffers from panic attacks. Third, researchers have found out specific brain anomalies and metabolic difficulties in individuals suffering from panic attacks. However, attempting to identify whether anxiety or fear brings about these anomalies or whether such anomalies bring about anxiety is a very difficult task. Thus far, the precise causes of panic attacks are still unidentified. Therefore, it would be more logical to think that panic attacks happen due to a combination of environmental and biological factors. Hence future studies should explain and determine a connection between these different sources of panic attacks. References Barlow, D. (1988). Psychological Treatment of Panic. New York: Guilford Press. Beck, A.T. (1985). Theoretical perspectives on clinical anxiety. In A.H. Tuma & J. Maser (eds.) Anxiety and the anxiety disorders (pp. 183-196). Hillsdale, NJ: Erlbaum. Marchand, L. et al. (2013). Efficacy of Two Cognitive-Behavioral Treatment Modalities for Panic Disorder with Nocturnal Panic Attacks. Behavior Modification, 37(5), 680-704. McNally, R. (1994). Panic Disorder: A Critical Analysis. New York: Guilford Press. Nutt, D., Ballenger, J., & Lepine, J. (1999). Panic Disorders: Clinical Diagnosis, Management and Mechanisms. London: SUNY Press. Rachman, S. & de Silva, P. (2009). Panic Disorder: The Facts. Oxford: Oxford University Press. Schmidt, N., Norr, A., & Korte, K. (2013). Panic Disorder and Agoraphobia: Considerations for DSM-V. Research on Social Work Practice, 24(1), 57-66. Read More