The rate of fears about mental and somatic symptoms of anxiety appears to vary across cultures and may inﬂuence the rate of panic attacks and panic disorder. Also, cultural ex- pectations may inﬂuence the classification of panic attacks as expected or unexpected. For example, a Vietnamese individual who has a panic attack after walking out into a windy environment (tru’ng gié; ”hit by the wind") may attribute the panic attack to exposure to wind as a result of the cultural syndrome that links these two experiences, resulting in clas- sification of the panic attack as expected. Various other cultural syndromes are associated with panic disorder, including ataque de nervios (”attack of nerves”) among Latin Ameri- cans and khyfil attacks and ”soul loss” among Cambodians. Atuque de nervios may involve trembling, uncontrollable screaming or crying, aggressive or suicidal behavior, and deper- sonalization or derealization, which may be experienced longer than the few minutes typical of panic attacks. Some clinical presentations of utaque de nervios fulfill criteria for condi- tions other than panic attack (e.g., other specified dissociative disorder). These syndromes impact the symptoms and frequency of panic disorder, including the individual’s attribu- tion of unexpectedness, as cultural syndromes may create fear of certain situations, rang- ing from interpersonal arguments (associated with ataque de nervias), to types of exertion (associated with khyril attacks), to atmospheric wind (associated with trting gié attacks).
Clarification of the details of cultural attributions may aid in distinguishing expected and unexpected panic attacks. For more information regarding cultural syndromes, refer to the ”Glossary of Cultural Concepts of Distress" in the Appendix.
The specific worries about panic attacks or their consequences are likely to vary from one culture to another (and across different age groups and gender). For panic disorder,
U.S. community samples of non—Latino whites have significantly less functional impair- ment than African Americans. There are also higher rates of objectively defined severity in non—Latino Caribbean blacks with panic disorder, and lower rates of panic disorder over- all in both African American and Afro—Caribbean groups, suggesting that among individ- uals of African descent, the criteria for panic disorder may be met only when there is substantial severity and impairment.
The clinical features of panic disorder do not appear to differ between males and females.
There is some evidence for sexual dimorphism, with an association between panic disor- der and the catechol-O-methyltransferase (COMT) gene in females only.
Agents with disparate mechanisms of action, such as sodium lactate, caffeine, isoprotere- nol, yohimbine, carbon dioxide, and cholecystokinin, provoke panic attacks in individuals with panic disorder to a much greater extent than in healthy control subjects (and in some cases, than in individuals with other anxiety, depressive, or bipolar disorders without panic attacks). Also, for a proportion of individuals with panic disorder, panic attacks are related to hypersensitive medullary carbon dioxide detectors, resulting in hypocapnia and other respiratory irregularities. However, none of these laboratory findings are consid— ered diagnostic of panic disorder.
Panic attacks and a diagnosis of panic disorder in the past 12 months are related to a higher rate of suicide attempts and. suicidal ideation in the past 12 months even when comorbid— ity and a history of childhood abuse and other suicide risk factors are taken into account.
Functional Consequences of Panic Disorder
Panic disorder is associated with high levels of social, occupational, and physical disabil- ity; considerable economic costs; and the highest number of medical visits among the anx- iety disorders, although the effects are strongest with the presence of agoraphobia.
Individuals with panic disorder may be frequently absent from work or school for doctor and emergency room visits, which can lead to unemployment or dropping out of school.