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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 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]
In the citing paper
“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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ResultPsychological and Perceptual Factors Associated With Arrhythmias and Benign Palpitations
Ehlers, A., Mayou, R., Sprigings, D. C., & Birkhead, J. S. (2000) · Psychosomatic Medicine · doi:10.1097/00006842-200009000-00014 · Cited by 82
“This finding is in line with results of previous studies (4, 13), although the overall prevalence of panic disorder in the present sample was somewhat lower than in American studies.”
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Does this patient with palpitations have a cardiac arrhythmia?
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“A history of panic disorder should be explored.(12) The details of a family history of palpitations should be recorded, especially if family members have established diagnoses such as arrhythmogenic right ventricular cardiomyopathy(13) or atrial fibrillation.”
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“However, a straightforward relationship between interoception and anxiety is challenged by a number of studies that either do not show a relationship between anxiety and interoceptive accuracy (Anthony et al., 1995; Barsky et al., 1994), or reveal a reverse relationship, with reduced interoceptive accuracy related to…”
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Petersen, S., Staeyen, K. V., Vögele, C., von Leupoldt, A., & den Bergh, O. V. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00732 · Cited by 65
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“Based on the results from previous studies of the IAS in panic disorder (PD) patients [14–16], we hypothesized that the resulting factors would discriminate between PD and non-PD patients.”
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“By contrast, panic patients tended to report arrhythmic HR without actual arrhythmias (50), thus indicating that the perception may be a result of top-down processes (53).”
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“There is evidence that psychiatric disorder is common among such patients [2, 4] and that outcome is poor [2, 5–7].”
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A theory of the septo-hippocampal system
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“It has been suggested that patients with panic attacks were more likely to describe palpitations as "racing" or "bouncing” beats, and this pattern was not associated with significant arrhythmia on ECG or 24-h ambulatory monitor [18].”
BackgroundPutting Humpty Dumpty together again: the anxious personality and its inheritance
Gray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0012 · Cited by 2
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Memory and the septo-hippocampal system
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“Psychiatric disorders such as panic attacks, generalized anxiety disorder or stress induced have also been implicated in up to nearly one-third of all patients [13].”
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Panic Disorder and Agoraphobia
Brown, L. A., & Craske, M. G. (2017) · Wiley eBooks · doi:10.1002/9781118877142.ch4 · Cited by 1
Douleurs thoraciques fonctionnelles
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“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 · Cited by 1
Metadata
- 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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