[fear of fear] cycle in panic disorder

Panic Disorder is not defined solely by the presence of panic attacks, but crucially by the development of a "fear of fear."

This is a cognitive and emotional cycle in which the person begins to fear the possibility of experiencing future attacks, which paradoxically increases their vulnerability and maintains the disorder.

The Aversive Experience of the First Attack

Usually, the first panic attack occurs unexpectedly and is a terrifying experience.

Due to the intensity of the physical symptoms (palpitations, shortness of breath, dizziness), the person often believes that they are suffering a catastrophic medical event, such as a heart attack, or that they are losing control or going crazy.

The Catastrophic Interpretation of Sensations

Following this first experience, the person begins to develop a hypersensitivity to their own bodily sensations.

Any change A normal physiological reaction (such as a slight increase in heart rate when climbing stairs) can be misinterpreted as the onset of a new panic attack.

This catastrophic interpretation of harmless internal sensations is a central component of the cycle.

Anticipatory Anxiety and Avoidance Behaviors

Catastrophic interpretation generates anticipatory anxiety, that is, a constant fear that another attack will occur.

The person begins to fear the sensations themselves and situations where they think they might have an attack or where it would be difficult to escape or get help.

This leads to avoidance behaviors (not going to certain places, avoiding activities) and safety behaviors (always carrying medication, having someone else), which, although they relieve anxiety in the short term, prevent the person from disconfirming their fears and learning that they can manage the sensations.

The Vicious Cycle

The cycle perpetuates itself as follows:

• A physical sensation (internal or external) is perceived.

• This sensation is interpreted catastrophically ("This is dangerous!" "I'm going to have an attack!").