OBJECTIVE: The purpose of this article is to offer a comprehensive,
data-based explanation of the relationship between hyperventilation and
panic disorder linking CO2 hypersensitivity, cognitive/behavioral factors,
and the respiratory effects of antipanic pharmacologic and psychological
treatments. METHOD: The authors conducted a computerized search of MEDLINE
for relevant articles. RESULTS: Some panic patients have a chronic, subtle
respiratory disturbance. Acute hyperventilation is neither necessary nor
sufficient for panic to occur. Respiratory abnormalities in panic patients
may adaptively aim at coping with a hypersensitive CO2 chemoreceptor
system. Pharmacologic panicogens also stimulate the respiratory system,
causing hyperventilation. Triggering this hypersensitive respiratory
control mechanism may incite panic. Antipanic medications may reset the
receptor threshold. Misattribution and catastrophic interpretation of
somatic symptoms or the sense of loss of control may contribute to panic
symptoms. Behavioral interventions such as desensitization or breathing
retraining may block the full-blown attack. Cognitive strategies through
cognitive control of respiration may supplement and accentuate these
interventions. CONCLUSIONS: Panic disorder may be due to an inherently
unstable autonomic nervous system, coupled with cognitive distress.Abstract Teaser