Peritraumatic and persistent panic attacks in acute stress disorder

This study examined the prevalence of peritraurnatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n = 30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety. There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (David, Giron, Mellman, 1995; Falsetti, Resnick, Dansky, Lydiard, & Kilpatrick, 1995; Silove, 1987). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (Falsetti & Resnick, 1997). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (Taylor, Koch, & McNally, 1992). Recent attention. has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (Falsetti, Resnick, Dansky, Lydiard & Kilpatrick, 1995). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (Bryant & Panasetis, 2001; Resnick, Falsetti, Kilpatrick, & Foy, 1994). Further, people with acute stress disorder (ASD) are more likely to report peritraurnatic panic attacks than non-ASD individuals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD (Bryant Harvey, 1998; Harvey Bryant, 1998).