Cited by 272Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their TreatmentsNeuroscience of respiration and sleep

Carbon dioxide hypersensitivity, hyperventilation, and panic disorder

Laszlo A. Papp, Donald F. Klein, Jack M. Gorman·1993·American Journal of Psychiatry

Abstract

OBJECTIVE: The purpose of this article is to offer a comprehensive, data-based explanation of the relationship between hyperventilation and panic disorder linking CO2 hypersensitivity, cognitive/behavioral factors, and the respiratory effects of antipanic pharmacologic and psychological treatments. METHOD: The authors conducted a computerized search of MEDLINE for relevant articles. RESULTS: Some panic patients have a chronic, subtle respiratory disturbance. Acute hyperventilation is neither necessary nor sufficient for panic to occur. Respiratory abnormalities in panic patients may adaptively aim at coping with a hypersensitive CO2 chemoreceptor system. Pharmacologic panicogens also stimulate the respiratory system, causing hyperventilation. Triggering this hypersensitive respiratory control mechanism may incite panic. Antipanic medications may reset the receptor threshold. Misattribution and catastrophic interpretation of somatic symptoms or the sense of loss of control may contribute to panic symptoms. Behavioral interventions such as desensitization or breathing retraining may block the full-blown attack. Cognitive strategies through cognitive control of respiration may supplement and accentuate these interventions. CONCLUSIONS: Panic disorder may be due to an inherently unstable autonomic nervous system, coupled with cognitive distress.

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Crossref · 10.1176/ajp.150.8.1149

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Authors
Papp, L. A., Klein, D. F., & Gorman, J. M.
Affiliations
Columbia University (US)
Venue
American Journal of Psychiatry
Published
1993-08-01
Volume
150
Issue
8
Pages
1149-1157
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2397525421
Cited by
272
References
81
Citations by year
2026: 3 · 2025: 2 · 2024: 23 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 8 · 2017: 5 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 6 · 2012: 12
FWCI
15.00
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01mh041778-08, 5k20mh000858-02)
  • National Institute of Mental Health (NIMH MH-41778, NIMH MH30906, MH 00858)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
panic disorder, hyperventilation, respiratory control, misattribution, loss of control, breathing retraining, desensitization, somatic symptoms
MeSH terms
Alkalosis, Respiratory, Carbon Dioxide, Humans, Hyperventilation, Lactates, Receptors, Cell Surface, Respiratory Center, Cognitive Behavioral Therapy, Panic Disorder, Lactic Acid

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