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Selective Information Processing, Interoception, and Panic Attacks

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Panic and Phobias 2

Abstract

Panic attacks have recently been given a central role in the classification of anxiety disorders (DSM-IIIR, Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, third edition-revised, APA 1987). The etiology of these anxiety attacks is controversial. One of their most puzzling and fascinating features for clinicians and researchers is that panic attacks often occur in the absence of any perceived situational triggers. This apparent spontaneity has led researchers to search for possible causes of panic attacks “within” the patient.

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Ehlers, A., Margraf, J., Roth, W.T. (1988). Selective Information Processing, Interoception, and Panic Attacks. In: Hand, I., Wittchen, HU. (eds) Panic and Phobias 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73543-1_12

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