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Expert Q&A

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Why is panic disorder a psychiatric condition?

Asked by Chad, Richmond, Virginia

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Why is panic disorder classified as just a psychiatric condition when there are so many physical symptoms (some painful) that arise during the attack? They would occur whether in good/bad mood, or even asleep.

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert Answer

This is a great question that cuts right to the heart of mind-body medicine. Panic attacks are a great example of how our false dichotomies between emotional and physical issues really don't stand up to the way the world really is. Panic attacks are so physical, in fact, that they are often first diagnosed when a person goes to the emergency room absolutely convinced that he or she is having a heart attack.

Let me ask you some questions in return. Why do people with major depression tend to have increased heart rate and blood pressure, and why do they have increased inflammation, just like people who are sick? Why does stress early in life greatly increase a person's risk for developing heart disease, diabetes and dementia later in life? Why do the bodies of people with schizophrenia seem to have a metabolism that puts them at risk for diabetes? Why -- back in the old days before modern medications -- did nearly 5 percent of all people admitted to psychiatric hospitals drop dead from their psychiatric diseases, usually after developing fevers as high as 110° F and becoming stiff as boards?

You get my point. Because the mind and body cannot be separated (except perhaps by the guillotine!), mental processes affect the functioning of the body. And bodily processes affect the functioning of the brain. These days, this is one of the hottest areas of scientific research in medicine.

So that is one answer to your question. The other answer is that historically, illnesses are psychiatric until a clear cause for them is found, and then they tend to migrate over to other medical disciplines. The classic example of this is the insanity that often accompanies syphilis in its advanced stages. A century ago, syphilitic patients filled psychiatric wards. Then, antibiotics were discovered and the responsibility for preventing syphilis-related insanity became the province of infectious disease doctors.

As a psychiatrist, it is kind of discouraging that if we researchers do our job right, there may be no "psychiatric" illnesses left in 100 years. They may all be understood, and as a result will have been farmed out to every other medical discipline, as appropriate.

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