Atypical panic attacks and lack of resolution of mourning

A number of psychologic and biologic contributors to panic disorder have been identified. Three cases of young adult women who experienced atypical panic attacks are described. The attacks are atypical because they had ideational or situational precipitants and because they were inevitably accompanied by intrusive visual images of a deceased loved one. In each case, there was also the persistence of irrational beliefs and/or unintegrated feelings about the deceased, corroborating that the intrusive images and panic attacks occurred in the context of unresolved mourning. Although the association between panic attacks and intrusive images apparently has not been reported previously, both phenomena have been associated with lack of resolution of mourning. The discussion considers similarities in these cases and in reports of Vietnam veterans suffering from posttraumatic stress disorder and panic attacks. Together, these similarities suggest that unresolved traumas of various kinds may at times contribute to the development of atypical panic attacks accompanied by intrusive visual images.