Respiration and the Emotion of Dyspnea/Suffocation Fear

Abstract

The thesis of this paper is that the experience of acute severe dyspnea accompanied by dyspnea/suffocation fear are prerequisites for the classic primary panic attack (1, 2). The probability that the occurrence of a single panic attack leads to panic disorder depends on the intensity and duration of the initial attack and whether or not the accompanying environmental cues (endogenous and/or exogenous) facilitate generalization of dyspnea/suffocation fear to a relatively broad range of stimuli. Thus, an initial classic panic attack is less likely to lead to subsequent secondary panic attacks (attacks of dyspnea/suffocation fear in the absence of severe dyspna) or to tertiary attacks (relatively mild anxiety/apprehension elicited by anticipatory thoughts, and their antecedents, of prior primary or secondary attacks) if the initial primary attack occurs in a relatively unique environment. This dyspnea/suffocation fear theory of panic is based on information derived from clinical self reports, surveys, controlled studies, analyses of adventitious panic attacks (2, 3, 4, 5, 6, 7, 8), principles of respiratory physiology, and essays on the biological nature of fear as an adaptive response. The purpose of this paper is to review research on relevant issues of respiratory psychophysiology as they pertain to the thesis that stress-induced dyspnea with concomitant dyspnea/suffocation fear, especially hyperventilation stress-induced dyspnea, underlie (a) primary panic attacks, (b) the Pavlovian/classical conditioning of dyspnea/suffocation fear in secondary panic attacks, and (c) the anxious apprehension that characterizes the discomfort of the tertiary panic attack. (2).