Panic Disorder, Palpitations, and the Awareness of Cardiac Activity
Abstract
One hundred forty-five consecutive patients referred for ambulatory electrocardiographic monitoring for the evaluation of palpitations were studied just before monitoring. They were compared with 75 asymptomatic, nonpatient volunteers. The research battery included a structured diagnostic interview, self-report questionnaires, and perceptual tasks measuring awareness of cardiac activity. After monitoring, symptom reports were compared with concurrent electrocardiographic recordings to determine their accuracy. Forty palpitation patients (27.6%) had DSM-III-R lifetime panic disorder, and 27 (18.6%) had current (1-month) panic disorder. Panic patients were significantly more likely to describe their palpitations as "racing" or "pounding" and to have been awakened from sleep by them. They did not have more cardiac arrhythmias during 24-hour, electrocardiographic monitoring, and their symptom reports were significantly less likely to be due to demonstrable cardiac irregularities. They were not more accurately aware of resting heartbeat than nonpanic palpitation patients. They did score higher on self-report measures of somatization, hypochondriasis, and bodily amplification.
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Psychosomatic disorders most frequently associated with palpitations include anxiety, panic attacks, depression, and somatization, which can either induce sinus tachycardia or modify the patient's subjective perception of a heartbeat that is otherwise normal or presents minimal irregularities.
“Psychosomatic disorders that are most frequently associated with palpitations include anxiety, panic attacks, depression, and somatization, which can either induce sinus tachycardia or modify the patient's subjective perception of a heartbeat that is otherwise normal or presents minimal irregularities.20 -23”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [22]
According to case records, the prevalence of anxiety syndrome and panic attacks in patients with palpitations ranges from 15% to 31%.
“According to the case records, the prevalence of anxiety syndrome and panic attacks in patients with palpitations ranges from 15% to 31%.20 -22”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [22]
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“Therefore, it would be interesting to combine these approaches with the assessment of heart beat perception, as has been done for panic disorder (Barsky et al., 1994; Ehlers et al., 1995).”
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BackgroundGray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0007 · Cited by 1 · see citing works
Panic Disorder and Agoraphobia
Brown, L. A., & Craske, M. G. (2017) · Wiley eBooks · doi:10.1002/9781118877142.ch4 · Cited by 1 · see citing works
Douleurs thoraciques fonctionnelles
Allaz, A., Desmeules, J. A., & Piguet, V. (1995) · Douleur et Analgésie · doi:10.1007/bf03005365
Özkorumak, E., Gazioğlu, S., Tiryaki, A., Velioğlu, S., & Kizilay, P. (2014) · Journal of the Turkish Epilepsi Society · doi:10.5505/epilepsi.2014.95967
“also reported that the somatic amplification is a central predisposing factor in somatization and hypochondriazis;[16,17] our results suggest a discrepancy between the presence of somatization and the severity of somatic amplification in patients with epilepsy.”
ResultGray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0004
Gray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0003
Gray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0013
Symptoms and syndromes of anxiety
Gray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0011
Anxiety and the Effects on Cardiovascular Disease
Tully, P. J., & Baune, B. T. (2016) · Springer eBooks · doi:10.1007/978-3-319-32480-7_5
- Authors
- BARSKY, A. J., CLEARY, P. D., SARNIE, M. K., & RUSKIN, J. N.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 1994-02
- Volume
- 182
- Issue
- 2
- Pages
- 63-71
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2045041052
- Cited by
- 135
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 26 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 3
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl043216-08)
- National Heart, Lung, and Blood Institute (HL 43216)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- panic disorder, palpitations, heartbeat perception, cardiac arrhythmias, symptom validity, somatization, health anxiety, Holter monitoring
- MeSH terms
- Adult, Arrhythmias, Cardiac, Awareness, Echocardiography, Exercise Test, Female, Heart, Heart Rate, Humans, Hypochondriasis, Male, Middle Aged, Personality Inventory, Sensation, Somatoform Disorders, Electrocardiography, Ambulatory, Panic Disorder
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