The catastrophic misinterpretation of physiological distress1

Cognitive theories of panic disorder suggest that the catastrophic misinterpretation of bodily sensations is the trigger for a panic attack. A challenge to cognitive theories is the suggestion that dyspnea (shortness of breath) is central to the development of panic and that negative cognitions are byproducts of panic. To examine these seemingly contradictory theoretical perspectives, the present study investigated panic symptomatology in a sample of patients with chronic shortness of breath (i.e. pulmonary patients). Past studies have shown an increased prevalence of panic in pulmonary patients, a ®nding that may be useful in elucidating panic etiology. The current sample of pulmonary patients (N=28) con®rmed previous reports of high prevalence rates of panic in this population. Based on selfreport of panic symptomatology, a total of nine patients (32%) met DSM-IV criteria that were consistent with panic disorder. Multivariate comparison of participants with and without panic symptomatology revealed that panickers had signi®cantly higher levels of anxiety, depression and agoraphobic cognitions. However, these groups showed no signi®cant di€erences on physiological measures of pulmonary functioning. The authors conclude that dyspnea alone is inadequate in predicting panic development. High levels of panic symptomatology in pulmonary samples may re ̄ect increased opportunities for these patients to misinterpret bodily sensations and, in particular, their pulmonary symptoms. # 1999 Elsevier Science Ltd. All rights reserved.