Chinese, Mandarin

Spanish

English

Hindi

Arabic

Portuguese

Bengali

Russian

Japanese

Punjabi

German

Javanese

Malay

Telugu

Vietnamese

Korean

French

Marathi

Tamil

Urdu

Turkish

Italian

Chinese, Yue / Cantonese

Thai

Gujarati

Chinese, Jin

Chinese, Min Nan

Persian, Dari

Persian, Western

Polish

Pashto

Kannada

Chinese, Xiang

Malayalam

Sundanese

Hausa

Odia

Burmese

Chinese, Hakka

Ukrainian

Bihari, Bhojpuri

Tagalog

Yoruba

Bihari, Maithili

Uzbek

Sindhi

Amharic

Fula

Romanian

Oromo

Igbo

Azerbaijani

Chinese, Gan

Dutch

Kurdish, Central

Kurdish, Northern

Kurdish, Southern

Malagasy

Lahnda, Saraiki

Nepali

Sinhalese

Chittagonian

Zhuang

Khmer

Turkmen

Assamese

Madurese

Somali

Marwari

Bihari, Magahi

Haryanvi

Hungarian

Chhattisgarhi

Greek, Modern

Chewa

Dakhini

Akan, Twi

Akan, Fante

Kazakh

Chinese, Min Bei

Sylheti

Zulu

Czech

Kinyarwanda

Marwari, Dhundhari

Haitian Creole

Chinese, Min Dong

Ilocano

Quechua

Kirundi

Swedish

Hmong

Shona

Uyghur

Hiligaynon

Mossi

Xhosa

Belarusian

Balochi

Psychology

<OpenstaxParagraph>
	Imagine that you are at the mall one day with your friends and—suddenly and inexplicably—you begin sweating and trembling, your heart starts pounding, you have trouble breathing, and you start to feel dizzy and nauseous. This episode lasts for 10 minutes and is terrifying because you start to think that you are going to die. When you visit your doctor the following morning and describe what happened, she tells you that you have experienced a panic attack (<a href="#Figure_15_04_Panic">Figure 15.9</a>). If you experience another one of these episodes two weeks later and worry for a month or more that similar episodes will occur in the future, it is likely that you have developed panic disorder. 
</OpenstaxParagraph>
<OpenstaxFigure id="Figure_15_04_Panic" src="https://openstax.org/apps/archive/20240226.174525/resources/6ea8c0ddb1056ace0ea23e7d08b31d3b25f863c6" alt="A diagram shows an outline of a person’s upper body. Within this outline, some of the major organs appear. The brain is labeled, “Feeling dizzy, unsteady, lightheaded.” The heart is labeled, “Chest pain, palpitations and/or accelerated heart rate.” The lungs are labeled, “Shortness of breath.” The stomach is labeled, “Nausea or abdominal distress.”" mediaType="image/jpeg" width="649" height="485" />
<OpenstaxFigureText width="649">
	<strong>Figure 15.9</strong> Some of the physical manifestations of a panic attack are shown. People may also experience sweating, trembling, feelings of faintness, or a fear of losing control, among other symptoms.
</OpenstaxFigureText>
<OpenstaxParagraph>
	People with <OpenstaxTerm>panic disorder</OpenstaxTerm> experience recurrent (more than one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (e.g., avoidance of exercise or unfamiliar situations) (APA, 2013). As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. A <OpenstaxTerm>panic attack</OpenstaxTerm> is defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying (APA, 2013). Sometimes panic attacks are expected, occurring in response to specific environmental triggers (such as being in a tunnel); other times, these episodes are unexpected and emerge randomly (such as when relaxing). According to the DSM-5, the person must experience unexpected panic attacks to qualify for a diagnosis of panic disorder. 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Experiencing a panic attack is often terrifying. Rather than recognizing the symptoms of a panic attack merely as signs of intense anxiety, individuals with panic disorder often misinterpret them as a sign that something is intensely wrong internally (thinking, for example, that the pounding heart represents an impending heart attack). Panic attacks can occasionally precipitate trips to the emergency room because several symptoms of panic attacks are, in fact, similar to those associated with heart problems (e.g., palpitations, racing pulse, and a pounding sensation in the chest) (Root, 2000). Unsurprisingly, those with panic disorder fear future attacks and may become preoccupied with modifying their behavior in an effort to avoid future panic attacks. For this reason, panic disorder is often characterized as fear of fear (Goldstein &amp; Chambless, 1978). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Panic attacks themselves are not mental disorders. Indeed, around 23% of Americans experience isolated panic attacks in their lives without meeting the criteria for panic disorder (Kessler et al., 2006), indicating that panic attacks are fairly common. Panic disorder is, of course, much less common, afflicting 4.7% of Americans during their lifetime (Kessler et al., 2005). Many people with panic disorder develop agoraphobia, which is marked by fear and avoidance of situations in which escape might be difficult or help might not be available if one were to develop symptoms of a panic attack. People with panic disorder often experience a comorbid disorder, such as other anxiety disorders or major depressive disorder (APA, 2013). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Researchers are not entirely sure what causes panic disorder. Children are at a higher risk of developing panic disorder if their parents have the disorder (Biederman et al., 2001), and family and twins studies indicate that the heritability of panic disorder is around 43% (Hettema, Neale, &amp; Kendler, 2001). The exact genes and gene functions involved in this disorder, however, are not well-understood (APA, 2013). Neurobiological theories of panic disorder suggest that a region of the brain called the <OpenstaxTerm>locus coeruleus</OpenstaxTerm> may play a role in this disorder. Located in the brainstem, the locus coeruleus is the brain’s major source of norepinephrine, a neurotransmitter that triggers the body’s fight-or-flight response. Activation of the locus coeruleus is associated with anxiety and fear, and research with nonhuman primates has shown that stimulating the locus coeruleus either electrically or through drugs produces panic-like symptoms (Charney et al., 1990). Such findings have led to the theory that panic disorder may be caused by abnormal norepinephrine activity in the locus coeruleus (Bremner, Krystal, Southwick, &amp; Charney, 1996). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Conditioning theories of panic disorder propose that panic attacks are <OpenstaxTerm>classical conditioning</OpenstaxTerm> responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened (Bouton, Mineka, &amp; Barlow, 2001). For example, consider a child who has asthma. An acute asthma attack produces sensations, such as shortness of breath, coughing, and chest tightness, that typically elicit fear and anxiety. Later, when the child experiences subtle symptoms that resemble the frightening symptoms of earlier asthma attacks (such as shortness of breath after climbing stairs), they may become anxious, fearful, and then experience a panic attack. In this situation, the subtle symptoms would represent a conditioned stimulus, and the panic attack would be a conditioned response. The finding that panic disorder is nearly three times as frequent among people with asthma as it is among people without asthma (Weiser, 2007) supports the possibility that panic disorder has the potential to develop through classical conditioning. 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Cognitive factors may play an integral part in panic disorder. Generally, cognitive theories (Clark, 1996) argue that those with panic disorder are prone to interpret ordinary bodily sensations catastrophically, and these fearful interpretations set the stage for panic attacks. For example, a person might detect bodily changes that are routinely triggered by innocuous events such as getting up from a seated position (dizziness), exercising (increased heart rate, shortness of breath), or drinking a large cup of coffee (increased heart rate, trembling). The individual interprets these subtle bodily changes catastrophically (“Maybe I’m having a heart attack!”). Such interpretations create fear and anxiety, which trigger additional physical symptoms; subsequently, the person experiences a panic attack. Support of this contention rests with findings that people with more severe catastrophic thoughts about sensations have more frequent and severe panic attacks, and among those with panic disorder, reducing catastrophic cognitions about their sensations is as effective as medication in reducing panic attacks (Good &amp; Hinton, 2009). 
</OpenstaxParagraph>

15.4.4 Panic Disorder

1 Introduction to Psychology

1.1 What Is Psychology?

1.1.1 Why Study Psychology?

1.2 History of Psychology

1.2.1 Wundt and Structuralism

1.2.2 Functionalism

1.2.3 Freud and Psychoanalytic Theory

1.2.4 Wertheimer, Koffka, Köhler, and Gestalt Psychology

1.2.5 Pavlov, Watson, Skinner, and Behaviorism

1.2.6 Maslow, Rogers, and Humanism

1.2.7 The Cognitive Revolution

1.2.8 Multicultural And Cross-Cultural Psychology

1.2.9 Women in Psychology

1.3 Contemporary Psychology

1.3.1 Biopsychology and Evolutionary Psychology

1.3.2 Sensation and Perception

1.3.3 Cognitive Psychology

1.3.4 Developmental Psychology

1.3.5 Personality Psychology

1.3.6 Social Psychology

1.3.7 Industrial-Organizational Psychology

1.3.8 Health Psychology

1.3.9 Sport and Exercise Psychology

1.3.10 Clinical Psychology

1.3.11 Forensic Psychology

1.4 Careers in Psychology

1.4.1 Other Careers in Academic Settings

1.4.2 Career Options Outside of Academic Settings

2 Psychological Research

2.1 Why Is Research Important?

2.1.1 Use of Research Information

2.1.2 NOTABLE RESEARCHERS

2.1.3 The Process of Scientific Research

2.2 Approaches to Research

2.2.1 Clinical or Case Studies

2.2.2 Naturalistic Observation

2.2.3 Surveys

2.2.4 Archival Research

2.2.5 Longitudinal and Cross-Sectional Research

2.3 Analyzing Findings

2.3.1 Correlational Research

2.3.2 Causality: Conducting Experiments and Using the Data

2.3.3 Reliability and Validity

2.4 Ethics

2.4.1 Research Involving Human Participants

2.4.2 Research Involving Animal Subjects

3 Biopsychology

3.1 Human Genetics

3.1.1 Genetic Variation

3.1.2 Gene-Environment Interactions

3.2 Cells of the Nervous System

3.2.1 Neuron Structure

3.2.2 Neuronal Communication

3.2.3 Neurotransmitters and Drugs

3.3 Parts of the Nervous System

3.3.1 Peripheral Nervous System

3.4 The Brain and Spinal Cord

3.4.1 The Spinal Cord

3.4.2 The Two Hemispheres

3.4.3 Forebrain Structures

3.4.4 Midbrain and Hindbrain Structures

3.4.5 Brain Imaging

3.5 The Endocrine System

3.5.1 Major Glands

4 States of Consciousness

4.1 What Is Consciousness?

4.1.1 Biological Rhythms

4.1.2 Problems With Circadian Rhythms

4.2 Sleep and Why We Sleep

4.2.1 What is Sleep?

4.2.2 Why Do We Sleep?

4.3 Stages of Sleep

4.3.1 NREM Stages of Sleep

4.3.2 REM Sleep

4.4 Sleep Problems and Disorders

4.4.1 Insomnia

4.4.2 Parasomnias

4.4.3 Sleep Apnea

4.4.4 Narcolepsy

4.5 Substance Use and Abuse

4.5.1 Substance Use Disorders

4.5.2 Drug Categories

4.6 Other States of Consciousness

4.6.1 Hypnosis

4.6.2 Meditation

5 Sensation and Perception

5.1 Sensation versus Perception

5.1.1 Sensation

5.1.2 Perception

5.2 Waves and Wavelengths

5.2.1 Amplitude and Wavelength

5.2.2 Light Waves

5.2.3 Sound Waves

5.3 Vision

5.3.1 Anatomy of the Visual System

5.3.2 Color and Depth Perception

5.4 Hearing

5.4.1 Anatomy of the Auditory System

5.4.2 Pitch Perception

Question	Answer
area of the brainstem that contains norepinephrine, a neurotransmitter that triggers the body’s fight-or-flight response; has been implicated in panic disorder	locus coeruleus
period of extreme fear or discomfort that develops abruptly; symptoms of panic attacks are both physiological and psychological	panic attack
anxiety disorder characterized by unexpected panic attacks, along with at least one month of worry about panic attacks or self-defeating behavior related to the attacks	panic disorder