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Time course of panic disorder and posttraumatic stress disorder onsets

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Abstract

Purpose

Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults.

Methods

Participants were community-dwelling adults (62.6% women; Mage = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder.

Results

PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207–1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597–1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = − 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women.

Conclusions

Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.

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Acknowledgements

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was sponsored and conducted by the National Institute on Alcohol Abuse and Alcoholism, with supplemental support from the National Institute on Drug Abuse. Dr. Berenz is supported by the National Institute on Alcohol Abuse and Alcoholism (R00AA022385). Dr. Mezuk is supported by a Grant from the National Institute of Mental Health (K01-MH093642-01A). Dr. Amstadter is supported by a NARSAD Independent Investigator Award from the Brain and Behavior Research Foundation, and from National Institutes of Health Grants: R01AA020179, P60MD002256, and MH081056-01S1. Dr. Roberson-Nay is supported by a Grant from the National Institute of Mental Health (NIMH) (R01-MH101518 and administrative supplement), NIMH R21-106924, and a NARSAD Independent Investigator Award. Dr. York is supported by National Institute of Health Grants P60MD002256 and R01 AG037986.

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Authors and Affiliations

  1. Department of Psychology, University of Illinois at Chicago, 1007 West Harrison Street (M/C 285), Chicago, IL, 60607-7137, USA

    Erin C. Berenz & Hanaan Bing-Canar

  2. Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA

    Timothy P. York

  3. Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA

    Ananda B. Amstadter, Charles O. Gardner & Roxann Roberson-Nay

  4. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

    Briana Mezuk

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  1. Erin C. Berenz
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  2. Timothy P. York
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Correspondence to Erin C. Berenz.

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Berenz, E.C., York, T.P., Bing-Canar, H. et al. Time course of panic disorder and posttraumatic stress disorder onsets. Soc Psychiatry Psychiatr Epidemiol 54, 639–647 (2019). https://doi.org/10.1007/s00127-018-1559-1

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  • DOI: https://doi.org/10.1007/s00127-018-1559-1

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