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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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Items 101–135 of 135
Thakur, M. K., Kashyap, R., Marwaha, R., et al. (2017) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20170430
“6%) patients of palpitation.(8) In a study done by Chignon et al, the prevalence of panic disorder in patients with palpitations was 15 to 31 percent.”
BackgroundElectrocardiography (Holter) study of patients with panic attacks
Hmood, A. R., Al-Badri, S. A., & Aldabbagh, L. (2014)
Il cardiopalmo: epidemiologia, classificazione e prognosi
Pedrinazzi, C., Durin, O., Bonara, D., Inama, L., & Inama, G. (2010) · Giornale italiano di cardiologia · doi:10.1714/660.7679
Electrocardiography (Holter) study of patients with panic attacks
Hmood, A. R., & Al-Badri, S. A. (2014) · Karbala Journal of Medicine
Pines, J. M., Carpenter, C. R., Raja, A. S., & Schuur, J. D. (2012) · Wiley eBooks · doi:10.1002/9781118482117.ch24
Gray, J. A., & McNaughton, N. (2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.003.0001
Probst, M. A., & Carpenter, C. R. (2023) · Wiley eBooks · doi:10.1002/9781119616870.ch22
(2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.002.0003
Preface to the paperback edition
(2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.002.0006
(2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.002.0005
(2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.002.0007
(2003) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198522713.002.0008
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McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0007
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0001
The neurology of anxiety—planning circuits
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0011
A theory of the septo-hippocampal system (SHS)
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0010
Symptoms and syndromes of anxiety
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0013
The neurology of anxiety—survival circuits
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0006
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0002
The treatment of anxiety and fear disorders
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0014
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0011
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0015
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0009
The anxiolytic drugs—our key tool
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McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0003
List of online appendices and reviews
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0010
A conceptual theory of the goal inhibition system
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0005
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0006
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0004
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.002.0005
Zhang, W., Chen, M., Feng, Y., Zhang, Q.-E., Sha, S., Su, Z., Cheung, T. C. C., Ungvari, G. S., Ng, C. H., Wang, G., et al. (2025) · Current Psychology · doi:10.1007/s12144-025-08422-6
“Further, individuals with panic symptoms could experience more intense fear and palpitations (Barsky et al., 1994).”
Incidence and Predictors of Symptom-Arrhythmia Association During Outpatient Holter Monitoring
Saraiya, A., Corsi, D. R., Farhan, S., Hazlewood, C., Qiu, G., & Pavri, B. B. (2025) · Cureus · doi:10.7759/cureus.96201
“…certain patient groups (e.g., female patients or patients with frequent activations) have poorer symptom-arrhythmia associations, whereas patients with certain comorbidities (such as mitral valve prolapse) may be more “internally aware,” but these associations have not been rigorously studied [4].”
From accuracy to expectation: A reframed view of heartbeat counting and panic disorder
Prentice, F., Brewer, R., & Murphy, J. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106887
Characteristics of patients presenting to a cardiac clinic with palpitation
Mayou, R. (2003) · QJM · doi:10.1093/qjmed/hcg017 · Cited by 52
“Of 184 patients seen at the clinic and included in the study, 40 patients with benign palpitation received a nurse-delivered psychological intervention in addition to usual care in the RCT described elsewhere.(13) Of the remaining 144 patients, 112 (78%) were followed-up at three months.”
MethodJeejeebhoy, F. M., Dorian, P., & Newman, D. M. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00103-8 · Cited by 46
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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