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A psychodynamic model of panic disorder
M K Shear1, A M Cooper, G L Klerman
1Western Psychiatric Institute and Clinic, New York Hospital-Cornell University Medical College, Pittsburgh, PA 15213.
The American Journal of Psychiatry
|June 1, 1993
Summary
This study proposes a psychodynamic model for panic disorder, suggesting early fearfulness and parental interactions contribute to adult symptomology. This approach offers new insights beyond neurobiological and cognitive-behavioral frameworks.
Area of Science:
- Psychiatry
- Psychology
- Neuroscience
Background:
- Current panic disorder research prioritizes neurobiological and cognitive-behavioral models.
- Existing models inadequately explain panic disorder's psychopathology, etiology, and pathogenesis.
- Psychodynamic treatment is often overlooked for panic disorder symptom amelioration.
Purpose of the Study:
- To propose a psychodynamic model for understanding panic disorder.
- To integrate findings from patient interviews, psychological literature, and developmental research.
- To offer a complementary perspective to existing neurobiological and cognitive-behavioral approaches.
Main Methods:
- Pilot interviews with nine patients diagnosed with panic disorder.
- Review of published reports on psychological characteristics of panic disorder patients.
- Inclusion of data from infant and animal research on temperament.
Main Results:
- Patients reported childhood fearfulness, shy temperaments, and critical/controlling parents.
- Themes of low self-esteem, discomfort with aggression, and passive partners emerged.
- Stressors involving frustration and resentment preceded panic onset.
Conclusions:
- A psychodynamic model suggests inborn neurophysiological irritability interacts with early experiences.
- Parental influences and disturbed object relations contribute to core fears (e.g., suffocation, abandonment).
- This psychodynamic formulation enhances understanding of panic disorder's complexity.