Abstract
Patients who suffer from panic attacks are often deeply distressed by the symptoms of panic and their aftermath. Alarming physiological symptoms (i.e., dizziness, shakiness, and abdominal distress) are typically accompanied by a sense of imminent doom. This article presents a formulation of panic disorder that assumes that panic results from selfobject failures, leading to fragmentation and disorganizing experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. A single clinical case, along with examples from research, illustrates the benefit of focusing on developmental processes and unconscious and preconscious fantasies.
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REFERENCES
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Edition). Washington, DC: Author.
Baker, R. (Ed). (1989). Panic Disorder: Theory, Research and Therapy. New Jersey: Wiley & Sons.
Beck, A.T. (1976). Cognitive Therapy and Emotional Disorders. New York: International Universities Press.
Beck, A.T. and Clark, D.M. (1988). Cognitive approaches. In C.G. Last & Hersen (Eds.), Handbook of Anxiety Disorders (pp. 362-385). New York: Pergammon Press.
Beck, A.T. and Emery, G. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.
Clark, D. (1988). A cognitive model of panic attacks. In McNally, D. (Ed.), Panic Disorder: A Critical Analysis. New York: Guilford Press.
Cohen, M. (1985). A theoretical discussion of and strategy of research to investigate agoraphobia as a disorder in early object relations. Unpublished Doctoral Dissertation. Forest Institute, Des Plaines, Illinois.
Cooper, A.M. (1985). Will neurobiology influence psychoanalysis? American Journal of Psychiatry, 142: 1395-1402.
Diamond, D. (1985). Panic attacks, hypochondriasis, and agoraphobia: A Self Psychological formulation. American Journal of Psychotherapy, 39 (1): pp. 114-125.
Freud, S. (1926). Inhibitions, symptoms, and anxiety. Standard Edition, 20. London: Hogarth Press.
Gabbard, G. (1994). Psychodynamic Psychiatry in Clinical Practice. Washington, DC: APA.
Gorman, J., Papp, L. and Coplan, J. (1995). Neuroanatomy and neurotransmitter function in panic disorder. In S. Roose & R. Glick. (Eds.), Anxiety as Symptom and Signal (pp. 39-56). Hillsdale, NJ: New Jersey Press.
Goldberg, A. (1995). The Problem of Perversion. New Haven: Yale University Press.
Kendler, H. (1987). Historical Foundations of Modern Psychology. Chicago: The Dorsey Press.
Klein, D. (1993). False suffocation alarms, spontaneous attacks, and related conditions: An integrated hypothesis. Archives of General Psychiatry, 50: 302-317.
Kohut, H. (1977). The Restoration of the Self. New York: International Universities Press.
Kohut, H. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.
LeDoux, J. (1996). The Emotional Brain: The Mysterious Underpinnings of Emotional Life. In Mellinger, D. Anxiety: Two Minds for One Mood. The Anxiety Disorders Association of America (ADAA) Reporter (Summer/Fall), pp. 5-7.
Lincoln, Y. and Guba, E. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage Publications.
Mahoney, D. (1999). Panic disorder and self states: An ethnomethodological approach. Unpublished Doctoral Dissertation. Institute for Clinical Social Work, Chicago, Illinois.
Margraf, J. and Ehlers, A. (1989). Etiologic models of panic-medical and biological aspects. In Baker, R. (Ed.). Panic Disorder: Theory, Research, and Therapy. ( pp. 16-26) NJ: Wiley and Sons.
McNally, R. (1994). Panic Disorder: A Critical Analysis. New York: The Guilford Press.
Nemiah, J. (1988). Handbook of Anxiety Vol. I: Psychodynamic Perspective of Anxiety. New York: Elsevier.
Palombo, J. (1992). Narratives, self-cohesion, and the patient's search for meaning. Clinical Social Work Journal, 20(3): 249-270.
Roose, S. and Glick, R. (Eds.). Anxiety as a Symptom and Signal. Hillsdale, NJ: The Analytic Press.
Rowe, C. and MacIsaac, D. (1991). Empathic Attunement: The Technique of Analytic Self Psychology. New Jersey: Aronson Press.
Safran, J. and Segel, Z. (1990). Interpersonal Process in Cognitive Therapy. Northvale, NJ: Jason Aronson, Inc.
Shear, M, Cooper, A.M., and Klerman, G.L. (1993). A psychodynamic model of panic disorder. The American Journal of Psychiatry, 150(6): 859-866.
Stern, D. (1985). The Interpersonal World of the Infant. New York: Basic Books.
Tolpin, M. and Kohut, H. (1980). The disorders of the self: The psychodevelopment of the first years of life. In J. Greenspan and E. Pollack (Eds.), The Course of Life, Vol. I. (pp.7-30). New York: Free Press.
Wakefield, J. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47: 373-388.
Wolf, E. (1998). Treating the Self. New Jersey: The Guilford Press.
Wolfe, B. (1995). The meaning of panic symptoms. The Anxiety Disorders of America (ADAA) Reporter (Summer/Fall), pp. 2 & 20.
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Mahoney, D.M. Panic Disorder and Self States: Clinical and Research Illustrations. Clinical Social Work Journal 28, 197–212 (2000). https://doi.org/10.1023/A:1005158418551
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DOI: https://doi.org/10.1023/A:1005158418551