Childhood Abuse Experiences in Adult Panic Disorder

H. George Nurnberg, MD, Marjorie Raskin, MD

Disclosures

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Abstract & Introduction

This study reports on early developmental events and family background of patients with panic anxiety disorder (PAD) admitted to an anxiety disorders treatment clinic serving a disadvantaged urban population. A standardized set of interviews was administered to 42 subjects, 31 with PAD and 11 without PAD (NPAD), to determine histories of childhood physical or sexual abuse, childhood psychiatric disorders, and current personality disorders. PAD patients reported higher levels of disturbed childhood environments, particularly separation, and physical and emotional abuse; childhood anxiety disorders; and adult personality disorder. Multiple patterns of abuse were the rule. An abusive background appears to be an important antecedent to the formation of PAD. These findings support our thesis that the traumatic background of patients is an important factor that allows anxiety disorder to be passed down generations.

The shift in psychiatric interest to fantasy at the turn of the century, and subsequently to biology in the early 1960s, resulted in a relative neglect of the role of actual events in shaping the individual. More recently, the pendulum seems to be shifting, and the origins of adult psychiatric illness are now being traced to child abuse, which has become better recognized as a major social issue. The nonspecific pernicious behaviors encompassed by the term "child abuse" extend over a spectrum of experiences, including incest, physical and psychological assault, abandonment, humiliation, exploitation, witnessing of intrafamilial violence, and neglect. Its most severe form results in death.

Child abuse occurs more frequently in multiproblem families and is often associated with other types of parental dysfunction, such as multiple changes in caretakers, maternal deprivation, illness, extended maternal separation, impoverishment, and substandard physical care. The environment of these children is usually highly stressful and lacking in support systems. As a consequence, victims of childhood abuse may continue to experience long-standing negative sequelae into adulthood, and they are over-represented in populations with psychiatric illness. The current state of knowledge suggests that abuse of the child is associated with childhood emotional disorders, personality disorders, panic anxiety disorders, and many other psychiatric disorders, which increase in severity during the patient's adulthood. This work focuses on the early development of anxious adults, with particular attention to physical and sexual abuse, emotional mistreatment, and parental violence and neglect. We report here data on the early childhood experiences and developmental history of 42 patients seeking treatment at an anxiety disorders clinic.

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