Friday, 2 March 2012

Phenomenology of Panic Attacks Reflects Human Evolutionary History of Separation Anxiety


Matthews S, Charlton BG. (2000). Phenomenology of panic attacks reflects human evolutionary history of separation anxiety. Irish Medical Journal. 93: 184-5.

A relationship between panic and separation anxiety was suggested by Klein1 who argued that, while most forms of anxiety involve the fight or flight response which is a preparation of the body for action, panic is almost literally a cry for help. More precisely, panic is a disabling form of anxiety in which the animal does not attempt to escape or repel danger, but instead signals for assistance from its family group.

The suggestion that panic is an adult form of separation anxiety is consistent with several sources of evidence. Panic has a distinctive response to tricyclic antidepressants (rather than anxiolytics), and displays several biochemical features such as lactate-inducibility and absence of hypothalamo-pituitary-adrenal axis activation (Klein)2. Silvoe et al 3 have shown that childhood separation anxiety is correlated with adult panic disorder, and have used a phenomenological study to demonstrate symptoms of childhood separation anxiety in adults.

Signalling for help is an appropriate response to danger for dependent infants, but may also have been adaptive for adults under the tribal hunter-gatherer conditions that prevailed during most of the time over which human psychology evolved. The present phenomenological study was based on the prediction that not only the form, but important features of the subjective content of adult panic may be identical with the symptomatic content of childhood separation anxiety. We anticipated that the content of a panic attack would explicitly reflect themes of separation anxiety, being expressive of the fear of separation and the desire to be reunited with the family group. This prediction was tested by interviewing pure cases of Panic Disorder about their subjective experiences during attacks.
Pure cases of Panic Disorder were selected on the basis that they suffered from spontaneous panic attacks and fulfilled DSM IV criteria for panic disorder without agoraphobia (300.01), and without other coincident diagnoses such as general anxiety or major depressive disorder. The study involved tape-recorded semi-structured interviews which centred on the subjects personal experience of panic attacks, and concentrated on exploring the precipitation of the attack in relation to social circumstances, and the mental contents at the time of attack including wants and objectives present during a panic episode.

Three pure cases were found; all were women (transcriptions of two case interviews are available on request one patient having refused permission to make her details available). The responses of all subjects were consistent with the predictions that panic is a form of separation anxiety. Panic attacks occurred only when the subject was separated from her family, and the theme of thoughts during their episodes of panic was related to a desire to be reunited with the family. Subjects made spontaneous and vivid references to their fear of separation from their family group, and their desire to be reunited with the family as a theme occurring before, during and after panic attacks.

The results of this study are consistent with the theory that panic disorder is an adult equivalent of childhood separation anxiety, and that human evolutionary history may shape not only the form of panic attacks, but its specific content. Walston et al 4 have described a similar coincidence of form and content in pure cases of persecutory delusions. Consistent with the nature of hostile threats in an ancestral environment, men were found predominantly to fear strangers, while women feared family and neighbours. It is possible that the phenomenology of other psychiatric illnesses may likewise be found to be understand able in terms of human evolutionary history.

1.     Klein D.F, Anxiety Re-conceptualised. Early experience with imipramine and anxiety. Comprehensive Psychiatry, 1980; 12:411-427
2.     Klein D.F. False suffocation alarms, spontaneous panics and related conditions; an integrative hypothesis. Archives of General Psychiatry, 1993; 50; 306-317
3.     Silove D, Manicavasagar V, Curtis J, & Blaszcynsia A. Is early separation anxiety a risk factor for adult panic disorder? Archives of general Psychiatry, 1996; 37: 475-482
4.     Walston, AS David, BG Charlton. Sex differences in the content of persecutory delusions: a reflection of hostile threats in the ancestral environment? Evolution and Human Behaviour, 1998; 19: 257-260