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Redecker TM, Jeung-Maarse H, Brandt C. Panic disorder in epilepsy. Epilepsy Behav Rep 2024; 25:100646. [PMID: 38299123 PMCID: PMC10828572 DOI: 10.1016/j.ebr.2024.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
A 51-year-old woman showed structural epilepsy following an atypical, nontraumatic intracranial hemorrhage in the right frontal area. Despite successful seizure control with lamotrigine, she developed severe morning anxiety and panic attacks, leading to agoraphobia, social withdrawal, and psychogenic nonepileptic seizures. Neuropsychiatric and psychological assessments confirmed an anxiety disorder with no significant symptoms of depression. The patient received various psychopharmacological treatments with limited success. This case report illustrates that managing panic disorder in patients with structural epilepsy requires a comprehensive treatment approach that includes pharmacotherapy and psychotherapy. Differential diagnosis and accurate treatment are crucial because of the symptom overlap between panic attacks and peri-ictal fear. Screenings instruments such as the Panic and Agoraphobia Scale (PAS) can aid in assessing anxiety-related symptoms. First-line pharmacotherapy with selective serotonin reuptake inhibitors, especially sertraline, or venlafaxine can effectively reduce panic attacks and can be recommended in patients with epilepsy. Psychotherapy, particularly cognitive-behavioral therapy, is the treatment of choice. Referral to a psychiatrist is indicated when symptoms are severe or refractory to treatment.
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Affiliation(s)
- Tobias M. Redecker
- Bielefeld University, Medical School and University Medical Center OWL, Mara Hospital, Department of Epileptology, Maraweg 21, 33617 Bielefeld, Germany
| | - Haang Jeung-Maarse
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Psychiatry and Psychotherapy, Remterweg 69-71, 33617 Bielefeld, Germany
| | - Christian Brandt
- Bielefeld University, Medical School and University Medical Center OWL, Mara Hospital, Department of Epileptology, Maraweg 21, 33617 Bielefeld, Germany
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Nonclinical Panic Attacks in Adolescents: Prevalence, Symptomatology, and Associated Features. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s0813483900004940] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this study, we examined the prevalence and nature of nonclinical panic attacks in 649 Australian youth and explored the relations between such attacks and measures of social support, stress, anxiety, depression, and fear. Full-blown attacks (attacks involving four or more symptoms with rapid onset) were reported by 104 of the youth (16%). Attacks were reported more frequently by girls than boys; however, age was unrelated to panic-attack status. Heightened levels of anxiety and fear, as well as stress in the family and lack of family support, were related to attack status. Path-analytic procedures supported a working model consisting of stress, social support, and emotional distress as related to panic status. Limitations of the self-report data on panic attacks and the other measures used in this study are acknowledged.
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Nair MKC, Russell PSS, Mammen P, Abhiram Chandran R, Krishnan R, Nazeema S, Chembagam N, Peter D. ADad 3: the epidemiology of Anxiety Disorders among adolescents in a rural community population in India. Indian J Pediatr 2013; 80 Suppl 2:S144-8. [PMID: 24043513 DOI: 10.1007/s12098-013-1097-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/20/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite being the most common mental health concern, there is paucity of literature on the epidemiology of anxiety disorders among the adolescent population in India. This study aimed to estimate the period prevalence of Anxiety Disorders (AD) among 11 to 19 y old adolescents in India. METHODS A representative sample of adolescents (N = 500) from a rural community in Southern India was assessed for the period prevalence of all and specific Anxiety Disorders using Screen for Child Anxiety Related Emotional Disorders (SCARED), and confirmed in a subsequent interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). RESULTS The prevalence for all AD using the international, Indian SCARED cut-offs and DSM-IV-TR criteria was 8.6 % (boys = 2%; girls = 6.6%), 25.8% (boys = 6.6%; girls = 19.2%) and 14.4 % (boys = 4.8%; girls = 9.6%) respectively. There were significant gender differences in the prevalence for all Anxiety Disorders (χ (2) = 3.61, df = 1; P < 0.05), Separation Anxiety Disorder (χ (2) = 22.27, df = 1; P < 0.001) and Social Anxiety Disorder (χ(2) = 4.29, df = 1; P < 0.03). Significant age difference in the prevalence of Panic Disorder (χ(2) = 10.32; df = 1; P = 0.00) and Generalized Anxiety Disorder (χ(2) = 5.87; df = 1; P = 0.05) was noted. CONCLUSIONS The prevalence of Anxiety Disorders in South Indian adolescents was higher than found in the western literature. Prevalence of specific AD was age and gender specific. Adolescent and mental health policies must integrate anxiety disorder of public health significance.
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Affiliation(s)
- M K C Nair
- Child Development Centre, Thiruvananthapuram Medical College, Thiruvananthapuram, 695 011, Kerala, South India,
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Russell PSS, Nair MKC, Mammen P, Chembagam N, Vineetha KS, Shankar SR, Nazeema S, George B. ADad 5: the co-morbidity in Anxiety Disorders among adolescents in a rural community population in India. Indian J Pediatr 2013; 80 Suppl 2:S155-9. [PMID: 24062269 DOI: 10.1007/s12098-013-1207-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 08/02/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anxiety Disorders (AD) have been known to have high prevalence of intra-AD and extra-AD co-morbidities. This study documents the prevalence and profile of intra and extra-AD co-morbidities, the effect of the presence and number of co-morbidities on the severity of anxiety symptoms and the influence of age as well as gender on the co-morbidity. METHODS In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) to collect the required data. Descriptive statistics, independent t tests, one-way ANOVA and Chi-square tests were done to evaluate the prevalence and profile of co-morbidity presentation, compare the effect of co-morbidity on severity of anxiety symptoms as well as analyse the influence of age groups and gender on intra-AD co-morbidities. RESULTS Among those with AD, 14.2% had a DSM-IV-TR intra-AD co-morbidity and 70% had SCARED based intra-AD co-morbidity. Adolescents with Separation Anxiety Disorder and Generalised Anxiety Disorder had the highest SCARED and DSM-IV-TR prevalence of intra-AD co-morbidity respectively. Also, 23.7% had overlapping extra-AD co-morbidity. Presence and number of intra-AD co-morbidity was significantly associated with severity of total anxiety score and subscale scores (all with P = 0.001). Age and gender of adolescents were not related to the co-morbidity. CONCLUSIONS Intra and extra-AD co-morbidities are quite prevalent among adolescents with Anxiety Disorders in India. As such, co-morbidities increase the severity of anxiety symptoms, they should be identified and appropriate management should be established.
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Queen AH, Ehrenreich-May J, Hershorin ER. Preliminary validation of a screening tool for adolescent panic disorder in pediatric primary care clinics. Child Psychiatry Hum Dev 2012; 43:171-83. [PMID: 21938484 DOI: 10.1007/s10578-011-0256-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examines the validity of a brief screening tool for adolescent panic disorder (PD) in a primary care setting. A total of 165 participants (ages 12-17 years) seen in two pediatric primary care clinics completed the Autonomic Nervous System Questionnaire (ANS; Stein et al. in Psychosomatic Med 61:359-364, 40). A subset of those screening positive (n = 22) and negative (n = 23) for panic symptoms on the ANS completed follow-up phone interviews assessing fit with DSM-IV criteria for panic disorder, self-reported anxiety and depression symptom severity, anxiety-related correlates, and functional impairment. A two-question version of the ANS demonstrated excellent sensitivity (Se = 1.00), but lower specificity (Sp = 0.47) for PD diagnostic status. Three-question and five-question versions modestly improved specificity (Sp = 0.57 and 0.65, respectively). In addition, screen-positive participants reported higher panic symptoms, anxiety sensitivity, and functional impairment, relative to screen-negative participants. Preliminary results suggest the ANS may be a valid screening tool for PD among adolescents, while simultaneously being brief and easy to score. Replication with larger samples is recommended as one related future research endeavor.
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Affiliation(s)
- Alexander H Queen
- Department of Psychology, University of Miami, Flipse Building, Room 346, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA.
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Doyle KW, Wolchik SA, Dawson-McClure SR, Sandler IN. Positive Events as a Stress Buffer for Children and Adolescents in Families in Transition. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2010; 32:536-45. [PMID: 14710462 DOI: 10.1207/s15374424jccp3204_6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examined whether positive events mitigated the relation between negative events and maladjustment in samples of children and adolescents experiencing family transitions. The study examined this relation in two samples, used multiple reporters of maladjustment, and employed "tailor-made" checklists to measure events. The first sample included 86 stepfamilies with adolescents 10 to 17 years of age. The second sample included 171 divorced families with children 8 to 15 years of age. Evidence that positive events are protective for children and adolescents experiencing high levels of negative events was found across the 2 samples and across mother and child report of adjustment. These findings have implications for theory and intervention development.
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Schenck CE, Braver SL, Wolchik SA, Saenz D, Cookston JT, Fabricius WV. Relations between Mattering to Step- and Non-Residential Fathers and Adolescent Mental Health. ACTA ACUST UNITED AC 2009; 7:70-90. [PMID: 20019889 DOI: 10.3149/fth.0701.70] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined the relations between perceptions of 133 early adolescents in stepfamilies concerning how much they mattered to their stepfathers and nonresidential biological fathers and adolescents' mental health problems. Mattering to nonresidential biological fathers significantly negatively predicted mother-, teacher-, and youth-reported internalizing problems. Mattering to stepfathers significantly negatively predicted youth-reported internalizing and stepfather- and youth- reported externalizing problems. For teacher-reported externalizing problems, mattering to stepfathers and nonresidential biological fathers significantly interacted. Mattering to either father predicted low externalizing problems; perceptions of mattering to the second father did not predict a further reduction in problems. Results suggest that mattering is an important aspect of father-adolescent relationships, and highlight the importance of considering adolescents' relationships with both nonresidential fathers and stepfathers.
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King NJ, Ollendick TH, Mattis SG. Panic in children and adolescents: Normative and clinical studies. AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050069408257329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leen-Feldner EW, Reardon LE, McKee LG, Feldner MT, Babson KA, Zvolensky MJJ. The interactive role of anxiety sensitivity and pubertal status in predicting anxious responding to bodily sensations among adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2006; 34:799-812. [PMID: 17115272 DOI: 10.1007/s10802-006-9079-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022]
Abstract
The present study examined the interaction between pubertal status and anxiety sensitivity (AS) in predicting anxious and fearful responding to a three-minute voluntary hyperventilation challenge among 124 (57 females) adolescents between the ages of 12 and 17 years (Mage = 15.04; SD = 1.49). As predicted, after controlling for baseline anxiety, age, and gender, there was a significant interaction between pubertal status and AS in predicting anxious responding to bodily sensations to the hyperventilation challenge. Specifically, adolescents reporting more advanced pubertal status and higher levels of AS reported the greatest post-challenge self-reported anxiety focused on bodily sensations, whereas pubertal status had relatively less of an effect on low AS adolescents. A test of specificity also was conducted; as expected, the interaction between AS and pubertal status was unrelated to generalized negative affectivity, suggesting the predictor variables interact to confer specific risk for anxious responding to bodily sensations. Finally, exploratory analyses of psychophysiological reactivity to the challenge indicated AS, but not pubertal status, moderated the relation between challenge-related change in heart-rate and post-challenge anxiety such that high AS youth who had experienced a relatively greater heart-rate change reported the most anxious reactivity to the challenge. Results are discussed in relation to theory regarding vulnerability to anxious responding to bodily sensations among adolescents.
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Affiliation(s)
- Ellen W Leen-Feldner
- Department of Psychology, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.
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Wolchik SA, Tein JY, Sandler IN, Ayers TS. Stressors, quality of the child-caregiver relationship, and children's mental health problems after parental death: the mediating role of self-system beliefs. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2006; 34:221-38. [PMID: 16502140 DOI: 10.1007/s10802-005-9016-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 08/22/2005] [Accepted: 08/25/2005] [Indexed: 11/29/2022]
Abstract
Investigated whether three self-system beliefs, fear of abandonment, coping efficacy, and self-esteem, mediated the relations of stressors and caregiver-child relationship quality with concurrent and prospective internalizing and externalizing problems in a sample of children who had experienced parental death in the previous 2.5 years. The cross-sectional sample consisted of 340 children ages 7-16 and their surviving parent/current caregiver; the longitudinal analyses employed a subset of this sample that consisted of 100 children and their parents/caregivers who were assessed at three time points. A multirater, multimethod measure of caregiver-child relationship quality and a multirater measure of children's mental health problems were used. The cross-sectional model supported a mediational relation for fear of abandonment, coping efficacy, and self-esteem. The three-wave longitudinal model showed that fear of abandonment at Time 2 mediated the relation between stressors at Time 1 and internalizing and externalizing problems at Time 3. Implications of these findings for understanding the development of mental health problems in parentally bereaved children and designing interventions for this at-risk group are discussed.
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Affiliation(s)
- Sharlene A Wolchik
- Prevention Research Center, Arizona State University, Tempe, AZ 85287, USA.
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Leen-Feldner EW, Feldner MT, Bernstein A, McCormick JT, Zvolensky MJ. Anxiety Sensitivity and Anxious Responding to Bodily Sensations: A Test among Adolescents Using a Voluntary Hyperventilation Challenge. COGNITIVE THERAPY AND RESEARCH 2005. [DOI: 10.1007/s10608-005-3510-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin KK, Sandler IN, Ayers TS, Wolchik SA, Luecken LJ. Resilience in parentally bereaved children and adolescents seeking preventive services. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2005; 33:673-83. [PMID: 15498735 DOI: 10.1207/s15374424jccp3304_3] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examined environmental stress, family, and child variables that differentiate resilient children and adolescents from those with mental health problems following the death of a primary caregiver. The community-based sample included 179 bereaved children ages 8 to 16 years and their surviving caregivers who completed a test battery of measures before participating in a prevention program. Forty-four percent of bereaved children were classified as resilient and 56% as affected based on the absence of clinically significant mental health problems on at least 1 measure as reported by either the child, surviving caregiver, or teacher on standardized measures of mental health problems. Results of multivariate analyses indicated that bereaved resilient versus affected status was a function of both family and child variables. Higher levels of caregiver warmth and discipline and lower levels of caregiver mental health problems were family-level variables that significantly differentiated resilient children from affected children. Bereaved children's perceptions of less threat in response to negative events and greater personal efficacy in coping with stress were child-level variables that differentiated resilient from affected status. Family and child variables were entered into a discriminant function analysis that correctly classified 72% of the sample. The findings are consistent with a model of resilience in which multilevel variables account for children's positive adaptation following exposure to adversity.
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Affiliation(s)
- Kirk K Lin
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA
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Diler RS, Birmaher B, Brent DA, Axelson DA, Firinciogullari S, Chiapetta L, Bridge J. Phenomenology of panic disorder in youth. Depress Anxiety 2004; 20:39-43. [PMID: 15368595 DOI: 10.1002/da.20018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We compared the demographic and clinical characteristics of youth with panic disorder (PD) (n=42), non-panic anxiety (n=407), and non-anxiety psychiatric disorders (n=1,576). Subjects were recruited from a mood and anxiety disorders clinic and assessed with the KSADS-P. In this large clinical sample, approximately 2% of the patients had PD. Most of these patients were adolescent, female, and Caucasian. PD was associated frequently with comorbid bipolar disorder, MDD, and other anxiety conditions, in particular general anxiety and separation anxiety disorders. Palpitations, chest pain, faintness, and trembling/shaking were the most frequent PD symptoms. In comparison with the other groups, youths with PD were significantly slightly older, Caucasian, and have more comorbid bipolar disorder. Subjects with both panic and non-panic anxiety disorders were more likely to have comorbid major depression and conduct disorders than those with other non-anxiety disorders.
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Affiliation(s)
- Rasim Somer Diler
- Division of Child Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA.
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Ginsburg GS, Lambert SF, Drake KL. Attributions of Control, Anxiety Sensitivity, and Panic Symptoms Among Adolescents. COGNITIVE THERAPY AND RESEARCH 2004. [DOI: 10.1007/s10608-004-0664-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther 2004; 42:813-39. [PMID: 15149901 DOI: 10.1016/s0005-7967(03)00200-6] [Citation(s) in RCA: 487] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2003] [Revised: 06/30/2003] [Accepted: 07/02/2003] [Indexed: 11/29/2022]
Abstract
This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings.
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Affiliation(s)
- Maaike H Nauta
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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Abstract
OBJECTIVE To determine the association between panic attacks and mental disorders among youth in the community. METHOD Data were drawn from the Methods for the Epidemiology of Child and Adolescent Mental Disorders study (n = 1285), a community-based sample of youth aged 9-17. Multiple logistic regression analyses were used to determine the association between panic attacks and the range of mental disorders, diagnosed with the Diagnostic Interview Schedule for Children 2.3. RESULTS Panic attacks were prevalent among 3.3% of the sample. Panic attacks were associated with an increased likelihood of any anxiety disorders [OR = 4.6 (2.5, 8.5)] and any affective disorder [OR = 5.8 (2.8, 11.7)], as well as social phobia [OR = 2.3 (1.0, 5.4)], specific phobia [OR = 3.4 (1.1, 10.1)], agoraphobia [OR = 2.9 (1.1, 7.6)], generalized anxiety disorder [OR = 4.8 (1.9, 12.1)], separation anxiety disorder [OR = 3.1 (1.3, 7.7)], major depression [OR = 3.6 (1.6, 8.3)], dysthymia [OR = 6.7 (2.9, 15.5)], and hypomania [OR = 26.1 (5.5, 124.1)]. CONCLUSION These data are consistent with, and extend, previous clinical findings by showing that panic attacks are associated with increased likelihood of a range of affective and anxiety disorders, but not substance use disorders, among youth in the community. The use of longitudinal study designs in future investigations may be useful in increasing our understanding of the mechanisms underlying these associations.
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Affiliation(s)
- R D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Schneider S, Hensdiek M. Panikanfälle und Angstsensitivität im Jugendalter. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2003. [DOI: 10.1026/0084-5345.32.3.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Das Jugendalter ist mit einem substantiellen Anstieg in der Häufigkeit von Panikanfällen verbunden. Erscheinungsbild und klinische Merkmale von Panikanfällen in dieser Altersgruppe sind noch kaum erforscht. Fragestellung: Neben der Häufigkeit von Panikanfällen wurde v.a. untersucht, ob sich plötzliche Panikanfälle von situationsgebundenen Panikanfällen im Erscheinungsbild sowie in Massen zur Angstsensitivität unterscheiden. Methode: Es wurden 1268 Schüler (12-16 Jahre alt) anhand eines Fragebogens befragt. Ergebnisse: 55% der Jugendlichen hatten bereits einen Panikanfall erlebt. Jugendliche mit plötzlichen Panikanfällen berichteten im Unterschied zu Jugendlichen mit situationsgebundenen Panikanfällen signifikant häufiger kognitive Symptome, die die Bedrohung der körperlichen Unversehrtheit beinhalteten. Jugendliche mit plötzlichen Panikanfällen bzw. Panikstörung zeigten die höchsten Mittelwerte in Massen zur Angstsensitivität und Depressivität. Schlussfolgerungen: Die Befunde sprechen für eine zentrale Rolle kognitiver Symptome und stehen damit im Einklang mit psychologischen Modellvorstellungen zur Panikstörung wie sie für Erwachsene formuliert wurden.
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Schneider S, Unnewehr S, Florin I, Margraf J. Priming panic interpretations in children of patients with panic disorder. J Anxiety Disord 2003; 16:605-24. [PMID: 12405521 DOI: 10.1016/s0887-6185(02)00126-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cognitive and psycho-physiological models of panic disorder stress the role of interpretation bias in the maintenance of the disorder. Several studies have reported results consistent with this hypothesis, but it is still unclear whether this bias precedes panic disorder or is a consequence of it. In the present study, we compared the interpretations of ambiguous scenarios of children of individuals with panic disorder, children of individuals with animal phobia, and children of healthy controls. Children were presented with three types of scenarios each including one of the following descriptions: panic-relevant physical sensations, animal-relevant stimuli, and panic-irrelevant physical sensations (i.e., cold symptoms). To test, if children's interpretation bias is affected by priming, we compared their responses to the scenarios before and after watching a panic, a spider phobic, and a cold model. The results revealed that (a) children of panic disordered parents but not of parents with animal phobia and of healthy controls showed a significant increase in anxious interpretations after priming; and (b) this significant increase emerged only after priming through presentation of a panic-relevant model and not after priming through presentation of a phobia-relevant or cold-relevant model. Because the children of panic disordered parents did not have panics themselves, their increase in panic interpretations can be viewed as a vulnerability factor. Longitudinal studies should clarify the role of interpretation style in the etiology of panic disorder.
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Abstract
This study investigated the prevalence of nonclinical panic attacks and associated psychopathology in 576 older adolescents. Nonclinical panic attacks are defined as panic occurring in individuals not seeking treatment. In this study, recent panickers (those reporting at least one nonclinical panic attack in the past month) comprised 12.2% of the sample. Nonpanickers and past panickers comprised 71.4 and 16.5% of the sample, respectively. Recent panickers evidenced significantly higher levels of trait anxiety, state anxiety, and depression, with a trend toward higher levels of anxiety sensitivity and internal negative attributions. This group also reported lower life experiences ratings suggesting higher levels of negative life stress. Finally, 46 recent panickers were administered a structured diagnostic interview, and 31 received a clinical diagnosis. The most common diagnoses were generalized anxiety disorder, social phobia, and specific phobia. Comorbidity rates were high in this sample: 24 of the 31 who received a diagnosis were comorbid with at least one other disorder. Implications of these findings for assessment and treatment are discussed.
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Affiliation(s)
- Sara G Mattis
- Virginia Polytechnic Institute and State University, Blacksburg, USA.
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Ginsbur GS, Drake KL. Anxiety sensitivity and panic attack symptomatology among low-income African-American adolescents. J Anxiety Disord 2003; 16:83-96. [PMID: 12171215 DOI: 10.1016/s0887-6185(01)00092-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined the concurrent and prospective relation between anxiety sensitivity (AS) and panic attack symptomatology among a community sample of African-American adolescents (N = 107; mean age 15.6 years) from predominantly low-income, single-parent households. On two occasions, 6 months apart, youth completed self-report measures of AS, measured by the Childhood Anxiety Sensitivity Index (CAS I), and panic symptomatology, measured by the Panic Attack Questionnaire (PAQ) and/or the Panic subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED-P). Results indicated that adolescents with high levels of AS reported higher concurrent levels of panic symptomatology, compared to their less anxious peers. Earlier levels of AS were correlated with panic symptoms 6 months later but did not predict later panic symptoms once initial levels of panic were controlled. Panickers, compared to non-panickers, also reported significantly higher levels of AS at Time 2. Overall, these findings are consistent with research on AS and panic in adult and Caucasian populations and support the hypothesis that elevated levels of AS may be one of several risk factors implicated in the development of panic attack symptomatology.
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Affiliation(s)
- Golda S Ginsbur
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-3325, USA.
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Wolchik SA, Tein JY, Sandler IN, Doyle KW. Fear of abandonment as a mediator of the relations between divorce stressors and mother-child relationship quality and children's adjustment problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2002; 30:401-18. [PMID: 12108768 DOI: 10.1023/a:1015722109114] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examines whether fear of abandonment mediates the prospective relations between divorce stressors and mother-child relationship quality and adjustment problems of children of divorce. Participants were 216 children, ages 8-12, and their primary residential mothers. Children reported on divorce stressors and fear of abandonment; mothers and children reported on mother-child relationship quality and internalizing and externalizing problems. Structural equation models indicated that Time 1 fear of abandonment mediated the relation between Time 1 divorce stressors and Time 2 internalizing and externalizing problems. Time 1 fear of abandonment also mediated the relation between Time 1 mother-child relationship quality and Time 2 internalizing and externalizing problems. Implications of these results for understanding variability in children's postdivorce adjustment problems and interventions for divorced families are discussed.
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Affiliation(s)
- Sharlene A Wolchik
- Program for Prevention Research, Arizona State University, Tempe 85287-1104, USA.
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Doyle KW, Wolchik SA, Dawson-McClure S. Development of the stepfamily events profile. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2002; 16:128-143. [PMID: 12085727 DOI: 10.1037/0893-3200.16.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This project developed and examined the validity of a tailor-made life events checklist specific to the experiences of adolescents in stepfamilies (i.e., the Stepfamily Events Profile; STEP). The STEP was developed from information gathered in focus groups and interviews and includes positive and negative events that are meaningful to adolescents in stepfamilies. The STEP was given to 90 adolescents residing with their biological mother and stepfather. Negative events were significantly related to adolescent report of maladjustment, and positive events were significantly related to mother and adolescent report of internalizing problems, above and beyond the effects of several covariates. Also, the effects of negative and positive events were uniquely predictive of adolescent maladjustment. Events reflecting interactions within the adolescent's dyadic family relationships were most strongly predictive of adolescent maladjustment.
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Abstract
This study examined whether anxiety symptoms in preschoolers reflect subtypes of anxiety consistent with current diagnostic classification systems, or should be better regarded as representing a single dimension. Parents of a large community sample of preschoolers aged 2.5 to 6.5 years rated the frequency with which their children experienced a wide range of anxiety problems. Exploratory factor analysis indicated four or five factors and it was unclear whether separation anxiety and generalized anxiety represented discrete factors. Results of confirmatory factor analyses indicated a superior fit for a five-correlated-factor model, reflecting areas of social phobia, separation anxiety, generalized anxiety, obsessive-compulsive disorder and fears of physical injury, broadly consistent with DSM-IV diagnostic categories. A high level of covariation was found between factors, which could be explained by a single, higher order model, in which first order factors of anxiety subtypes loaded upon a factor of anxiety in general. No significant differences were found in prevalence of anxiety symptoms across genders. Symptoms of PTSD in this sample were rare.
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Affiliation(s)
- S H Spence
- School of Psychology, University of Queensland, Brisbane, Australia.
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Calamari JE, Hale LR, Heffelfinger SK, Janeck AS, Lau JJ, Weerts MA, Taglione PA, Schisler RL. Relations between anxiety sensitivity and panic symptoms in nonreferred children and adolescents. J Behav Ther Exp Psychiatry 2001; 32:117-36. [PMID: 11934125 DOI: 10.1016/s0005-7916(01)00026-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anxiety sensitivity (AS), the fear of anxiety-related sensations, has been posited to be a cognitive risk factor for the development of anxiety disorders but has been understudied in youth. The purpose of the present investigations was to evaluate relations between AS and panic symptoms in nonreferred children and adolescents. In Study 1, (N = 113, mean age, 13.98). scores on the Childhood Anxiety Sensitivity Index (CASI) predicted the experience of uncued panic attacks after controlling for general anxiety and depression, although the total variance accounted for was small. In Study 2 (N = 52; mean age, 9.48), the Panic/ Agoraphobia subscale of the Spence Children's Anxiety Scale was used as the criterion variable. CASI score again predicted panic symptoms after controlling for trait anxiety and depression. Identification of a risk factor for panic attacks and panic disorder in youth will have important implications for etiologic theory, intervention, and prevention.
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Affiliation(s)
- J E Calamari
- Department of Psychology, Finch University of Health Sciences, The Chicago Medical School, IL 60064, USA.
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Bouton ME, Mineka S, Barlow DH. A modern learning theory perspective on the etiology of panic disorder. Psychol Rev 2001; 108:4-32. [PMID: 11212632 DOI: 10.1037/0033-295x.108.1.4] [Citation(s) in RCA: 598] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views, particularly those that emphasize the role of catastrophic misinterpretation of somatic sensations, is discussed.
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Affiliation(s)
- M E Bouton
- Department of Psychology, University of Vermont, Burlington, Vermont 05405, USA.
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Hoffman EC, Mattis SG. A developmental adaptation of Panic Control Treatment for panic disorder in adolescence. COGNITIVE AND BEHAVIORAL PRACTICE 2000. [DOI: 10.1016/s1077-7229(00)80081-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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MacKinaw-Koons B, Vasey MW. Considering sex differences in anxiety and its disorders across the life span: A construct-validation approach. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0962-1849(05)80004-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wolchik SA, Wilcox KL, Tein JY, Sandler IN. Maternal acceptance and consistency of discipline as buffers of divorce stressors on children's psychological adjustment problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2000; 28:87-102. [PMID: 10772352 DOI: 10.1023/a:1005178203702] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examines whether two aspects of mothering--acceptance and consistency of discipline--buffer the effect of divorce stressors on adjustment problems in 678 children, ages 8 to 15, whose families had divorced within the past 2 years. Children reported on divorce stressors; both mothers and children reported on mothering and internalizing and externalizing problems. Multiple regressions indicate that for maternal report of mothering, acceptance interacted with divorce stressors in predicting both dimensions of adjustment problems, with the pattern of findings supporting a stress-buffering effect. For child report of mothering, acceptance, consistency of discipline, and divorce stressors interacted in predicting adjustment problems. The relation between divorce stressors and internalizing and externalizing problems is stronger for children who report low acceptance and low consistency of discipline than for children who report either low acceptance and high consistency of discipline or high acceptance and low consistency of discipline. Children reporting high acceptance and high consistency of discipline have the lowest levels of adjustment problems. Implications of these results for understanding variability in children's postdivorce adjustment and interventions for divorced families are discussed.
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Affiliation(s)
- S A Wolchik
- Department of Psychology, Arizona State University, Tempe 85287-1108, USA
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Abstract
OBJECTIVE To identify risk factors for onset of panic attacks in adolescents, a prospective cohort design was used to evaluate the following risk factors: negative affectivity, female sex, anxiety sensitivity, and childhood separation anxiety disorder. These risk factors were also evaluated for predicting onset of major depression to test their specificity. METHOD The sample consisted of 2,365 high school students assessed over a 4-year period. Assessments included self-report questionnaires and structured clinical interviews. Cox proportional hazards models were used to evaluate risk. RESULTS Consistent with previous studies, prior major depression predicted onset of panic attacks and a history of panic attacks predicted onset of major depression. After adjusting for the effects of prior major depression, negative affectivity and anxiety sensitivity, but not female sex or childhood separation anxiety disorder, predicted onset of 4-symptom panic attacks. However, female sex and negative affectivity but not anxiety sensitivity or childhood separation anxiety disorder predicted onset of major depression after adjustment for the effects of prior panic attacks. CONCLUSION Negative affectivity appears to be a nonspecific risk factor for panic attacks and major depression, whereas anxiety sensitivity appears to be a specific factor that increases the risk for 4-symptom panic attacks in adolescents.
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Affiliation(s)
- C Hayward
- Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305-5722, USA.
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Mattis SG, Ollendick TH. Children's cognitive responses to the somatic symptoms of panic. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1997; 25:47-57. [PMID: 9093899 DOI: 10.1023/a:1025707424347] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to test Nelles and Barlow's (1988) hypothesis that spontaneous panic attacks are rare or nonexistent prior to adolescence as children lack the ability to make the internal, catastrophic attributions (i.e., thoughts of losing control, going crazy, or dying) characteristic of panic according to the cognitive model (Clark, 1986). Conceptions of panic attacks, including the understanding of symptoms and causes, and cognitive interpretations of the somatic symptoms of panic were examined in children from Grades 3, 6, and 9. A significant main effect for grade was found for conceptions of panic attacks, with third graders receiving significantly lower scores than sixth and ninth graders. However, the majority of all children, regardless of age, tended to employ internal (e.g., "I'd think I was scared or nervous") rather than external (e.g., "I'd think I was feeling that way because of the temperature or the weather") explanations of panic attacks. No significant grade differences were found for the tendency to make internal versus external and catastrophic versus noncatastrophic attributions in response to the somatic symptoms of panic. When presented with panic imagery in a panic induction phase, children, regardless of age, made more internal and noncatastrophic attributions. Finally, internal attributional style in response to negative outcomes and anxiety sensitivity were found to be significant predictors of internal, catastrophic attributions. The challenge that these findings pose to Nelles and Barlow's hypothesis, and their relevance for understanding children's cognitive interpretations of panic symptomatology are discussed.
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Affiliation(s)
- S G Mattis
- Virginia Polytechnic Institute and State University, Department of Psychology, Blacksburg 24061, USA
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Hayward C, Killen JD, Kraemer HC, Blair-Greiner A, Strachowski D, Cunning D, Taylor CB. Assessment and phenomenology of nonclinical panic attacks in adolescent girls. J Anxiety Disord 1997; 11:17-32. [PMID: 9131879 DOI: 10.1016/s0887-6185(96)00032-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recent reviews of studies concerning panic attacks in adolescents have emphasized research limitations, noting problems of validity, reliability, and lack of normative data. To address some of these limitations we evaluated two methods of panic ascertainment (questionnaire versus interview), reliability of interview-determined panic, and clinical correlates of panic symptoms in a large sample (N = 1013) of early adolescent girls. The 5.4% of the sample who, when interviewed, reported ever experiencing a panic attack scored significantly higher on measures of depression, anxiety sensitivity, and alcohol use, but were not more avoidant than others. Using the interview as the standard, the questionnaire had a specificity of 81% and a sensitivity of 72%. Adolescents do experience panic attacks-whether identified by questionnaire or interview-although for many the attacks may not be salient. Longitudinal studies are required to determine those qualities of nonclinical panic (severity, context, interpretation/attribution), which render some episodes as clinically meaningful.
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Bouchard S, Pelletier MH, Gauthier JG, Côté G, Laberge B. The assessment of panic using self-report: a comprehensive survey of validated instruments. J Anxiety Disord 1997; 11:89-111. [PMID: 9131884 DOI: 10.1016/s0887-6185(96)00037-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A repertoire of reliable and valid self-report instruments to assess panic and panic disorder would help both researchers and clinicians. This review presents a description and an analysis of the available instruments. Following a comprehensive search of the literature, 14 instruments with published information on reliability and validity were reviewed. The following information is reported for each instrument: brief description of the instrument and its development, mean and standard deviation for clinical and nonclinical samples, and psychometric properties. Four types of instruments are presented: general assessment and information (n = 2), severity of panic disorder (n = 2), body sensations (n = 2) and cognitive dimensions of panic (n = 8). Overall, it would seem that panic measures have moderate to excellent psychometric qualities. However, the comparison between the instruments is difficult because the amount of empirical support available varies widely from one instrument to the other.
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Affiliation(s)
- S Bouchard
- Départment de Psychoéducation, Université du Québec à Hull.
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Abstract
Minimal attention has been focused on the concept of panic in the discipline of nursing. Hindering a greater understanding of panic is its lack of explication and development in nursing. To help remedy this situation, a concept analysis of panic was performed. The hybrid model of concept development was used, which consists of an initial theoretical phase, a fieldwork phase, and a final analytical phase. In the theoretical phase, after a cross-disciplinary literature search was done, existing definitions and measurement of the concept of panic were analyzed, and a working definition of panic was formulated. In the fieldwork phase, women experiencing postpartum panic disorder were interviewed to collect qualitative data for further analysis of panic. The final phase focused on comparing and contrasting the findings from the theoretical phase with the insights discovered from the fieldwork. Applicability of panic across nursing is addressed along with implications for nursing theory, practice, and research.
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Affiliation(s)
- C T Beck
- College of Nursing, University of Rhode Island, Kingston 02881-0814, USA
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Abstract
Based on our review of the available data, we conclude that panic attacks are common among adolescents, while both panic attacks and Panic Disorder appear to be present, but less frequent, in children. Furthermore, it is evident that both adolescents and children who report panic attacks describe the occurrence of cognitive symptoms, although with less frequency than physiological ones. Consistent with the cognitive model of panic, it seems that at least some youngsters are capable of experiencing the physiological symptoms of panic accompanied by the requisite catastrophic cognitions. However, a more complete understanding of the cognitive manifestation of panic attacks/disorder among children awaits further investigation. Future research should aim to explore the developmental progression in children's cognitive responses to specific panic symptomatology. Risk factors (e.g. anxiety sensitivity, depression) which may contribute to the likelihood of misinterpreting physiological sensations in a catastrophic manner throughout the course of development should also be assessed: Finally, we are in general agreement with Abelson and Alessi (1992) who argue that we must begin to ask ourselves how panic disorder may be manifested in children. That is, rather than assessing the frequency with which children experience symptoms of adult panic, we should explore what panic would look like in children. They propose that the study of panic in children would be facilitated by a reformulation of separation anxiety as a childhood expression of panic disorder. Although this reformulation makes intuitive sense and is appealing from a developmental perspective, we would insert a strong caveat. Although the research is yet to be conducted, it is probable that childhood separation anxiety is only one of many routes to panic disorder outcome. It is improbable that such direct and continuous pathways are present for the majority of children, adolescents and adults who experience panic disorder. More probably, the pathways are multiple, complex, and discontinuous (Robbins & Rutter, 1990). Much work remains to be done before we are able to ferret out the linkages between developmental processes and clinical outcomes for panic disorder in children and adolescents.
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Affiliation(s)
- T H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg 24061-0436
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