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Carbon dioxide hypersensitivity, hyperventilation, and panic disorder
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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“This theoretical framework was derived from cross-sectional research that identified hypocapnia as a critical biomarker in PD (e.g., Hegel & Ferguson, 1997; Papp, Klein, & Gorman, 1993).”
From Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. (2010) · cites this paper as Papp, Klein, & Gorman, 1993
In the citing paper
“While such sigh breathing may produce short-term relief from symptoms, it is also dysfunctional in that it lowers PCO2 levels and may thereby contribute to symptoms and fear levels in susceptible individuals (Papp et al., 1993; Abelson et al., 2001; Wilhelm, Trabert, et al., 2001).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Papp et al., 1993
In the citing paper
“There is also a solid literature on panic induction by CO2 challenge tests (e.g., Fyer et al., 1987; Papp et al., 1993; Perna et al., 1994), which may be part of the reason the augmented respiratory relief intervention has received little further scrutiny.”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Papp et al., 1993
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Metadata
- 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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