The phenomenon of nonclinical panic: Parameters of panic, fear, and avoidance

doi:10.1016/0887-6185(90)90021-Z

Journal of Anxiety Disorders

Volume 4, Issue 1, 1990, Pages 15-29

https://doi.org/10.1016/0887-6185(90)90021-Z Get rights and content

Abstract

Despite an emerging body of research that reveals many similarities between nonclinical and clinical panickers, little research has examined theoretically relevant parameters of panic, fear, and avoidance among nonclinical panickers. Accordingly, the present investigation administered the Panic Attack Questionnaire to 188 college students who also completed an extensive battery to assess anxiety sensitivity, fear-of-fear cognitions, self-focused and body-focused attentional dispositions, coping strategies, trait anxiety, and depression. Conservative DSM-III-R panic criteria produced 26.6% past-year panickers and 13.8% past-month panickers. Substantial panic phenomenology similarities were evident between these nonclinical panickers and other studies' samples of clinical and nonclinical panickers. Relative to nonpanickers, panickers reported higher levels of anxiety sensitivity, fear-of-fear cognitions, trait anxiety, depression, and emotion-oriented coping, as well as body-focused (but not generally self-focused) attention. Results are considered in the contexts of a continuity perspective on panic and its biopsyhosocial mediation.

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Thus, we sought to examine only those individuals who clearly endorsed or clearly denied these particular beliefs. The second screen was a set of questions regarding panic attacks, modified from questions used in other studies of subclinical panic attacks (e.g., Brown & Cash, 1990). HRG participants (Ps) responded “yes” to the following two questions: “In the past 12 months, have you experienced a spell or attack when, for no apparent reason (unexpectedly), your heart suddenly began to race, you felt faint, or you couldn't catch your breath?”
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A comparative evaluation of panicogenic processes and quality of life in a sample of non-clinical panickers and age and sex matched non-panicking controls
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These studies have been consistent in demonstrating that non-clinical panickers show levels of psychopathology, impairment, and distress that tend to fall mid-way between levels observed in persons suffering from panic disorder and non-clinical samples with no history of panic attacks (Norton et al., 1992). For instance, in terms of state and trait anxiety, depression, suicidality, and other indices of negative affect, non-clinical panickers show elevated levels compared to non-panickers, but levels that are lower than those observed among clinical panicking samples (e.g., Brown & Cash, 1990; Norton et al., 1985, 1986; Woodruff, Stanley, Lister, & Tabacchi, 1997). Nonetheless, results from studies of non-clinical panickers that have evaluated theoretically-relevant processes that are implicated both in the initial development of panic attacks and panic disorder (e.g., anxiety sensitivity, self-focused attention to bodily symptoms, agoraphobic avoidance, suffocation fear) have been somewhat mixed.
Contemporary models of panic attacks suggest that panic problems exist on a continuum and highlight the need to understand what differentiates persons who have never had a panic attack versus persons who have had panic attacks but have not yet developed panic disorder (i.e., non-clinical panickers). Accordingly, the present study evaluated several theoretically-relevant factors that were expected to distinguish a sample of (conservatively defined) non-clinical panickers (n = 72) from an age and sex-matched comparison sample of non-panicking controls (n = 72). As expected, panickers were characterized by higher levels of anxiety sensitivity, perceived uncontrollability, and state and trait anxiety relative to their non-panic counterparts. Moreover, higher levels of trait anxiety emerged as a predictor of poorer quality of life among panickers. Results are considered within the context of biopsychosocial continuum models of panic attacks and panic disorder and future directions for research are suggested.
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Here, studies have found that panic attacks are associated with an increased risk of panic disorder as well as other anxiety disorders (Reed & Wittchen, 1998), major depressive disorder (Bittner et al., 2004; Kessler et al., 1998), substance use disorders (Baillie & Rapee, 2005; Cox, Norton, Swinson, & Endler, 1990), as well as psychotic disorders (Goodwin, Fergusson, & Horwood, 2004). Other work has indicated that individuals with non-clinical panic attacks (i.e., panic attacks but not panic disorder) report greater levels of anxiety and depressive symptoms compared with individuals without a history of such attacks, but lower levels than individuals with clinical conditions like panic disorder (Brown & Cash, 1990; Norton, Pidlubny, & Norton, 1999; Telch, Lucas, & Nelson, 1989; Telch, Shermis, & Lucas, 1989). These findings are consistent with data that show greater levels of anxious responding to somatic perturbation among individuals with non-clinical panic attacks compared to those without panic attacks (Zvolensky & Eifert, 2000).
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The original version has been revised to incorporate the changes of the DSM-III-R (APA, 1987) and was easily modified to account for DSM-IV (APA, 1994) changes. The PAQ has been shown to have adequate test–retest reliability for all items except those evaluating onset to peak severity and reports of unexpected panic (Margraf & Ehlers, 1988) and to have high concordance with DSM-III-R (APA, 1987) criteria for PD (Brown & Cash, 1990). ADIS for DSM-IV (ADIS-IV:Brown et al., 1994): The ADIS-IV was used as the main clinical assessment tool to determine participants’ diagnosis.
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^∗: The authors express their appreciation to Edwin A. Deagle, III, for his assistance in data collection.

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