Is there a hypersensitive visual alarm system in panic disorder?
Abstract
Agoraphobia in panic disorder (PD) has been related to abnormal balance system function. Vision influences balance and behavioural adaptations; peripheral vision influences orienting and fast defensive reactions whereas central vision analyzes details of objects. We have hypothesized that the abnormal balance function in PD could be mainly related to peripheral vision as part of a defensive alarm system in the brain. In 25 patients with PD and agoraphobia and 31 healthy controls we assessed, by posturography, balance system reactivity to video-films projected in peripheral and central visual fields (randomized sequence). Length, velocity and surface of body sway were calculated. Patients increased their body sway during peripheral stimulation, whereas controls did not; the two groups showed a similar increase of body sway during central stimulation. Anxiety levels during peripheral stimulation significantly influenced the postural response in the group of patients. These preliminary results suggest that the higher visual sensitivity to peripheral stimulation in patients with PD and agoraphobia may be linked to a more active "visual alarm system" involving visual, vestibular and limbic areas that might influence the development of agoraphobia in situations where environmental stimuli are uncertain.
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Some experimental studies have found subclinical abnormalities in balance systems and postural instability particularly related to impaired visuovestibular interactions in panic disorder patients; this feature is thought to influence the development and course of agoraphobia.
“Some experimental studies have found subclinical abnormalities in these patients’ balance systems and postural instability particularly related to impaired visuovestibular interactions; this feature is thought to influence the development and course of agoraphobia [60–64].”
From Management of Treatment-Resistant Panic Disorder (2017) · cites this paper as [60]
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- Authors
- Caldirola, D., Teggi, R., Bondi, S., Lopes, F. L., Grassi, M., Bussi, M., & Perna, G.
- Affiliations
- Hermanas Hospitalarias del Sagrado Corazón de Jesús (IT)
- Vita-Salute San Raffaele University (IT)
- Maastricht University (NL)
- Corresponding author
- Caldirola, Daniela
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 187
- Issue
- 3
- Pages
- 387-391
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2116786205
- Cited by
- 35
- References
- 34
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 2 · 2012: 5
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- panic disorder, agoraphobia, peripheral vision, postural sway, balance system, posturography, anxiety, vestibular system, limbic system
- MeSH terms
- Adult, Agoraphobia, Analysis of Variance, Postural Balance, Female, Humans, Male, Middle Aged, Pain Measurement, Photic Stimulation, Psychiatric Status Rating Scales, Sensation Disorders, Visual Fields, Visual Perception, Panic Disorder, Young Adult
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