حملات هراس غیربالینی در شیوع اواخر نوجوانی و آسیب شناسی روانی همراه است

This study investigated the prevalence of nonclinical panic attacks and associated psychopathology in 576 older adolescents. Nonclinical panic attacks are defined as panic occurring in individuals not seeking treatment. In this study, recent panickers (those reporting at least one nonclinical panic attack in the past month) comprised 12.2% of the sample. Nonpanickers and past panickers comprised 71.4 and 16.5% of the sample, respectively. Recent panickers evidenced significantly higher levels of trait anxiety, state anxiety, and depression, with a trend toward higher levels of anxiety sensitivity and internal negative attributions. This group also reported lower life experiences ratings suggesting higher levels of negative life stress. Finally, 46 recent panickers were administered a structured diagnostic interview, and 31 received a clinical diagnosis. The most common diagnoses were generalized anxiety disorder, social phobia, and specific phobia. Comorbidity rates were high in this sample: 24 of the 31 who received a diagnosis were comorbid with at least one other disorder. Implications of these findings for assessment and treatment are discussed.

A panic attack is defined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association, 1994) as a discrete period characterized by the sudden onset of intense fear, apprehension, or discomfort which is accompanied by at least 4 of 13 somatic or cognitive symptoms (e.g., palipitations, fear of dying). Norton, Cox, and Malan (1992) defined nonclinical panic attacks as “panic reported by individuals not seeking treatment” (Norton et al., 1992, p. 122), and indicated that the occurrence of nonclinical panic is a fairly common phenomenon, with an average of 30.4% of individuals assessed via questionnaires, such as the Panic Attack Questionnaire (PAQ; Cox, Norton, & Swinson, 1992), reporting at least one panic attack. Norton and coworkers also reported that nonclinical panickers tend to fall in an intermediate range between clinical panickers and nonpanickers on measures of associated depression and anxiety. While the DSM-IV does not offer information regarding age at onset for panic attacks per se, it does suggest that late adolescence may be the initial peak for onset of panic disorder (a disorder characterized by recurrent unexpected panic attacks). Similarly, the National Institute of Mental Health Epidemiologic Catchment Area Program Study found peak age of onset for panic symptomatology to be between 15 and 19 years of age among adults experiencing panic attacks and panic disorder (Von Korff, Eaton, & Keyl, 1985). In a recent review of the literature, Ollendick, Mattis, and King (1994) concluded that panic attacks are a common occurrence in adolescence, with 35.9–63.3% of adolescent community samples reporting panic attacks. Warren and Zgourides (1988) conducted an initial normative study of the prevalence and nature of panic attacks in adolescents by administering a panic attack survey to 338 students, aged 12–19. The survey defined panic attacks as “very intense feelings of fear or anxiety that come on very suddenly and unexpectedly and usually reach a peak very quickly.” Symptoms that may occur during a panic attack were listed. Based on survey responses, Warren and Zgourides reported a total panic attack prevalence of 60%, with 29% indicating current problems with panic attacks. Similarly, Macaulay and Kleinknecht (1989) administered a modified version of the PAQ (Norton et al., 1986 and Norton et al., 1985) to 660 adolescents, aged 13–18. Macaulay and Kleinknecht’s modification of the PAQ described a panic attack as “the sudden occurrence of intense feelings of apprehension, fear, or terror … often accompanied by feelings and thoughts that something terrible is about to happen, even though no real danger is present.” Of the respondents, 63.3% reported one or more panic attacks in the past year. The sample was divided into four groups based on self-reported frequency, severity, and distress: no panic (35.7%), mild panic (47.5%), moderate panic (10.4%), and severe panic (5.4%). The mild group evidenced significantly fewer recent attacks (i.e., in the previous 4 weeks) relative to the moderate and severe groups. Finally, Lau, Calamari, and Waraczynski (1996) examined the prevalence of panic attacks among 77 high school students, aged 14–18. These researchers administered the revised PAQ (Norton et al., 1986), and found that 39% of their sample reported at least one panic attack in the past year. This prevalence is somewhat lower than the findings reported above, possibly due to Lau and coworkers’ additional requirement that panickers report at least four panic-related symptoms during their attacks. While the studies described above have investigated panic attacks in American adolescent samples, King and coworkers have studied the prevalence of panic attacks among Australian adolescents (King et al., 1993 and King et al., 1996). In their first study, King and coworkers administered a PAQ similar to that used by other investigators (e.g., Macaulay & Kleinknecht, 1989; Norton et al., 1985; Warren & Zgourides, 1988) to 534 Australian adolescents, aged 13–18. Of this sample, 42.9% reported having experienced a panic attack at some point in their lives. Similarly, King and coworkers found a lifetime panic attack prevalence of 35.9% after administering the modified PAQ utilized by Macaulay and Kleinknecht to 649 Australian youth, aged 12–17. Research investigating the prevalence of nonclinical panic attacks in college students has also identified panic as a common phenomenon among older adolescents and young adults, with 27.6–51.3% of college students reporting panic attacks (Cox et al., 1991, Norton et al., 1988 and Whittal et al., 1994; Wilson et al., 1992). Norton and coworkers administered a revised version of the PAQ (Norton et al., 1986) to 358 college students between the ages of 17 and 50. This version of the PAQ provided information about the frequency and symptom profile of panic attacks as defined by the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III; American Psychiatric Association, 1980). However, unlike the DSM-III definition, the revised PAQ did not require that attacks be unexpected. Of this sample, 50% reported experiencing at least one panic attack within the past year. Furthermore, 25% were identified as recent panickers who had experienced at least one panic attack in the previous 3-week period (Norton et al., 1986). Cox et al. (1991) also administered the PAQ (Norton et al., 1986) to 275 college students. Of this sample, 76 participants (27.6%) reported at least one four-symptom panic attack, and 38 of these (13.8% of the sample) reported one or more attacks in the previous 3 weeks. While the age range of the entire sample was not provided, the mean age of the 38 recent panickers was 21.1 years (S.D.=2.3 years). Similarly, Wilson et al. (1992) administered the PAQ (Norton et al., 1986) to 1610 undergraduates between the ages of 17 and 22. Half of the participants completed the original version of the PAQ, while the other half also read a brief clinical vignette describing the experience of a full-blown panic attack. The authors reported a higher prevalence of panic attack self-reports on the original PAQ (51.3%) compared with a 33.4% prevalence among participants, who also read the vignette. Wilson and coworkers suggested that the clinical vignette may have reduced the rate of false positive responses to the PAQ. Finally, Whittal et al. (1994) administered the PAQ (Norton et al., 1986) to 311 female undergraduate students (age range was not provided). Of this sample, 3.22% reported panic attacks consistent with criteria for panic disorder, 40.19% were identified as infrequent panickers, four participants reported limited symptom attacks, and 50.8% were nonpanickers. Studies of panic attacks in adolescents and young adults have investigated the presence of related psychopathology (e.g., anxiety, depression) in this population. For instance, Macaulay and Kleinknecht (1989) reported comorbidity between panic and depression in their sample of adolescents, with panickers receiving significantly higher scores on the Center for Epidemiologic Studies — Depression Scale (Weissman, Sholomskas, Pottenger, Prusoff, & Locke, 1977) relative to nonpanickers. Furthermore, severity of panic was significantly predicted by self-reported depression scores as well as stress and female gender. Similarly, Hayward, Killen, and Taylor (1989) found significantly higher levels of depression on the SCL-90-R (Derogatis, 1983) among ninth grade panickers relative to nonpanickers. In their research with Australian adolescents, King et al., 1993 and King et al., 1996 found significantly higher levels of anxiety, depression, and fear reported by panickers than by nonpanickers. Furthermore, path analysis revealed that anxiety, depression, and fear, as well as gender and family support, had meaningful influences on panic symptomatology (King et al., 1996). Finally, Norton et al. (1988) observed a “spectrum of severity” of psychopathology among college students who reported panic attacks, with recent panickers (i.e., those who experienced at least one attack in the previous 3 weeks) reporting higher levels of anxiety and depression. While research has focused on the prevalence and nature of panic attacks in samples of adolescents and college students, no previous study has specifically assessed the occurrence of nonclinical panic attacks during the more circumscribed period of late adolescence. As described above, studies of adolescents have incorporated a fairly broad age range (typically age 12 or 13 through 17 or 18), while studies of college students have incorporated both older adolescents and adults within the same samples. The period of late adolescence merits further investigation given the DSM-IV suggestion that late adolescence may be the initial peak for onset of panic disorder. Furthermore, previous research has investigated the association between nonclinical panic attacks and other forms of psychopathology (e.g., anxiety, depression), yet little is known regarding the presence of specific DSM-IV diagnoses in this population. Since panic attacks can occur in the context of various anxiety disorders (American Psychiatric Association, 1994), further diagnostic assessment of nonclinical panickers seems warranted. The purpose of the present study was thus to examine the prevalence of nonclinical panic attacks in older adolescents while gaining a deeper understanding of psychopathology associated with this phenomenon.