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Section 4
Within-Person Effects with Panic Disorder

Question 4 | Test | Table of Contents

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In the last section, we discussed three aspects to keep in mind when diagnosing clients, which were diagnostic differentiation; common panic disorder personality types; and panic disorder controlled by substance abuse.

Over the course of your experience with clients suffering from panic disorder, have you found that some conditions seem to run in conjunction with panic disorder?  

In this section, we will examine four of these conditions and how they are connected with panic disorder. The four conditions we will examine are inner ear disorders; menstruation and pregnancy; mitral valve prolapse; and enzyme impairment.

Four Conditions in Conjunction with Panic Disorder

♦ Condition # 1 - Inner Ear Disorders
The first condition that seems to have a link to panic disorders is an inner ear disorder  Whenever a swelling occurs in the middle ear putting pressure on the fluid mechanism that maintains balance, a client can have the sensation of being off-balance, dizzy, or close to falling over. In clients prone to panic disorder, this state of insecurity can be frightening and may induce an attack. 

If situations such as rocking boats, elevators, cars, or any other vehicle associated with motion seem to trigger panic attacks in your clients, you might consider an inner ear disorder as the culprit. Brent had been coming to me for panic disorder treatment. Because he frequently experienced attacks in the car, Brent had developed agoraphobia and refused to go out. 

Brent stated, "I don’t know what’s wrong with me.  I’m fine when I get in the car. I sit down. I start driving. After about 10 or 20 minutes, it just hits me and I can’t control it." I asked Brent to describe his symptoms. He said, "Well, first I get sick. Real sick. Like the car is going to fly out from under me. Then I start getting scared, ‘cause I don’t know what to do. It even happens in situations where I’m not even driving, like the subway or bus." 

I suspected that Brent was suffering from an inner ear ailment. I recommended that he go to an ear-nose-and-throat specialist, otherwise known as an otolaryngologist. The doctor discovered that Brent had been suffering from an acute inner ear infection. After medication and a change of diet, his panic attacks gradually lessened.

♦ Condition # 2 - Menstruation and Pregnancy
A second condition that seems to correlate with panic attacks is when a woman is going through premenstrual syndrome. Irritation on the nervous system caused by water retention causes a premenstrual female client to be more susceptible to attacks. The decrease in blood sugar levels also contributes to the potential for panic attacks. 

On the other side of the spectrum, pregnancy seems to have the opposite effect on panic attacks. Several clients of other physicians stated that the intensity and frequency of their attacks greatly decreased while pregnant. This decline in symptoms was not in any way related to medication, psychotherapy or stabilization of life situations and was attributed solely to the pregnancy. After the birth, the attacks returned, and in their previous intensity. 

I have found it useful to warn my female clients to expect these fluctuations in their attacks.  In this way, they will not tend to attribute the sporadic nature of the attacks to anything chemically or emotional wrong with themselves.

♦ Condition # 3 - Mitral Valve Prolapse
In addition to inner ear disorders and menstruation, there are also correlations between mitral valve prolapse or MVP and panic disorders. MVP, as you are aware, is an anatomical imperfection relating to the mitral valve, which separates the heart’s upper and lower chambers on the left side of the heart. A client with MVP is one whose mitral valve is slightly damaged so that a small amount of blood may seep back through to the upper chamber. 

This condition is generally considered to be benign, not resulting in heart attacks or cardiac arrest. However, during stressful periods, enough blood cannot reach the brain, causing feelings of dizziness or lightheadedness. To compensate, the body speeds up the heart rate, which might alarm the client into thinking they are having a heart attack. This, obviously, results in a panic attack. One of my clients, Evan, had been diagnosed with this disorder when he was younger and it soon became a frequent cause of panic attacks. I suggested that Evan strengthen his heart through exercise. 

By continually working this muscle, it could soon pump more blood through the valves in one beat, which meant there was less a need to speed up during stress. Evan decided to run every day for 20 to 30 minutes. The next time Evan came under stress, his heart did not have to speed up its rate, thus Evan avoided a panic attack.

♦ Condition # 4 - Enzyme Impairment
In addition to inner ear disorders, menstruation, and mitral valve prolapse, a fourth condition that seems to often correlate with panic attacks is enzyme impairment. When enzymes do not work properly, lactic acid tends to accumulate and can trigger panic attacks in susceptible clients. 

Martha, a client of mine who frequently suffered from panic attacks, also suffered from an enzyme impairment. Martha had never eaten correctly, and her diet consisted of sweets, fast and fried foods, frozen dinners, and other unhealthy choices. The vitamin imbalance in her system overwhelmed her enzymes and they could not process the food properly. I asked Martha to completely change her eating habits. 

Instead of processed foods and sweets, I suggested she stick to all natural foods like fruits and vegetables. Also, I suggested she take one multi-vitamin in the morning to counteract any deficiencies she might have.

In this section, we discussed four conditions that seem to run in conjunction with panic disorder, which were inner ear disorders; menstruation and pregnancy; mitral valve prolapse; and enzyme impairment.

In the next section, we will examine depression co-occurring with anxiety disorder. We will look at primary depression; primary anxiety disorder; and the combination of primary depression and anxiety disorder.

- Chen, Y., Lin, H., & Lee, H. (June 2009). Pregnancy outcomes among women with panic disorder — Do panic attacks during pregnancy matter? Journal of Affective Disorders, 120(1-3), 258-262. doi:10.1016/j.jad.2009.04.025
Reviewed 2023

Peer-Reviewed Journal Article References:
Barber, J. P., Milrod, B., Gallop, R., Solomonov, N., Rudden, M. G., McCarthy, K. S., & Chambless, D. L. (2020). Processes of therapeutic change: Results from the Cornell-Penn Study of Psychotherapies for Panic Disorder. Journal of Counseling Psychology, 67(2), 222–231.

Hoffart, A. (2016). Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects. Journal of Consulting and Clinical Psychology, 84(9), 839–844.

Loo, L.-M., Prince, J. B., & Correia, H. M. (2020). Exploring mindfulness attentional skills acquisition, psychological and physiological functioning and well-being: Using mindful breathing or mindful listening in a nonclinical sample.Psychomusicology: Music, Mind, and Brain. Advance online publication. 

Lotfalian, S., Spears, C. A., & Juliano, L. M. (2020). The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior. Psychology of Addictive Behaviors, 34(2), 351–359.

Zilcha-Mano, S., McCarthy, K. S., Dinger, U., Chambless, D. L., Milrod, B. L., Kunik, L., & Barber, J. P. (2015). Are there subtypes of panic disorder? An interpersonal perspective. Journal of Consulting and Clinical Psychology, 83(5), 938–950. 

QUESTION 4
What are four conditions that seem to run in conjunction with panic disorder? To select and enter your answer go to Test.

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