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Carbon dioxide hypersensitivity, hyperventilation, and panic disorder

L A Papp1, D F Klein, J M Gorman

  • 1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY.

The American Journal of Psychiatry
|August 1, 1993
PubMed
Summary
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This study explains how hyperventilation and panic disorder are linked through CO2 hypersensitivity and cognitive factors. Treatments like medication and cognitive strategies can help manage panic attacks by addressing respiratory and psychological aspects.

Area of Science:

  • Psychiatry
  • Respiratory Medicine
  • Neuroscience

Background:

  • Panic disorder is a complex condition with potential links to respiratory disturbances.
  • Carbon dioxide (CO2) hypersensitivity is implicated in the pathophysiology of panic attacks.
  • Cognitive and behavioral factors play a significant role in the manifestation and maintenance of panic disorder.

Purpose of the Study:

  • To provide a data-based explanation of the relationship between hyperventilation and panic disorder.
  • To explore the roles of CO2 hypersensitivity, cognitive/behavioral factors, and respiratory system.
  • To examine the effects of antipanic pharmacologic and psychological treatments on respiratory control.

Main Methods:

  • A comprehensive computerized literature search of MEDLINE was conducted.

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  • Relevant articles were identified and analyzed to synthesize findings.
  • The study integrates data on respiratory physiology, neurobiology, and psychological mechanisms.

    • Main Results:

    • Some panic patients exhibit chronic, subtle respiratory disturbances, potentially as a coping mechanism for CO2 hypersensitivity.
    • Acute hyperventilation is not a prerequisite for panic, but pharmacologic agents can trigger it by stimulating respiratory control.
    • Antipanic medications may modulate CO2 receptor sensitivity, while cognitive and behavioral therapies (e.g., desensitization, breathing retraining, cognitive control) can mitigate panic symptoms.

    Conclusions:

    • Panic disorder may arise from an interplay between an unstable autonomic nervous system and cognitive distress.
    • Respiratory abnormalities and CO2 hypersensitivity are key factors in panic disorder.
    • Integrated treatment approaches targeting both physiological and cognitive aspects are crucial for managing panic disorder.