History of Panic Attacks

Introduction. History of panic attacks. Freud’s concept

The first description of anxiety disorders derives from Freud’s work. He created the first historical description of disorders that today we call “panic attacks” or “generalized anxiety disorder”. Freud described these disorders using the term: “anxiety neurosis” (German: “Angstneurose”). As he wasn’t able to identify in both disorders any visible triggering stimuli, he initially called them “neurosis without conflict”. Freud emphasized the relevance of unconscious conflicts in his clinical observations at a later point and using the psychotherapeutic, analytical process to uncover the source of such conflict.

Freud (December 1984) authored the paper, “On the grounds for detaching a particular syndrome from neurasthenia”. Looking retrospectively at the history of panic attacks Freud research created the theoretical foundation and described exactly the symptoms of the disorder. He discussed the causes of panic disorder and stated that “In some cases of anxiety neurosis no aetiology (root cause) at all is to be discovered. It is worth noting that in such cases there is seldom any difficulty in establishing evidence of a grave hereditary taint. But where there are grounds for regarding the neurosis as an acquired one, careful enquiry directed to that end reveals that a set of noxae and influences from sexual life are the operative etiological factors”.

Panic attacks, hereditary predisposition

Freud paid attention to the fact that there is a higher occurrence of anxiety symptoms running in the members of the same family. For the cases without a family history, he related the origin of anxiety to sexual suppression. From today’s perspective (and author’s own clinical experience) we can conclude that the Freudian link to suppressed sexuality is valid only in a very low percentage of the anxiety disorders.

From neurosis to disorder

Looking back on the history of panic attacks and generalized anxiety, we will find old fashioned psychoanalytical terms such as “neurosis”, “neurasthenia” or “hysteria”. Over time these words “infiltrated” common language gradually acquiring a negative overtone. In the current psychiatric nomenclature psychiatrists have replaced the terms “neurosis” or “hysteria” with the more “politically correct” word “disorder”.

Freud’s historical description of panic attacks

On the symptomatic level Freud’s description of the anxiety neurosis correlates astonishingly well with the current description of panic attacks. In his paper on “anxiety neurosis” he wrote:

“I append here a list which includes only those forms of anxiety attack which are known to me:

(a) Anxiety attacks accompanied by disturbances of the heart action, such as palpitation.

(b) Anxiety attacks accompanied by disturbances of respiration, several forms of nervous dyspnoea, attacks resembling asthma, and the like.

(c) Attacks of sweating, often at night.

(d) Attacks of tremor and shivering which are easily confused with hysterical attacks.

(e) Attacks of ravenous hunger, often accompanied by vertigo.

(f) Diarrhoea coming on in attacks.

(g) Attacks of locomotor vertigo.

(h) Attacks of what are known as congestions, including everything that has been termed vasomotor neurasthenia.

(i) Attacks of paraesthesia (numbness). (But these seldom occur without anxiety or a similar feeling of discomfort.)”