The first panic attack: a neurobiological theory.

We extend a neurodevelopmental model of specific phobias to the etiology of an initial panic attack and its elaboration into panic disorder. An important difference between the initial panic attack and specific phobia is the developmental timing of critical emotional experience: Those occurring early in development lead to panic; those occurring later in development lead to specific phobia. By this account, sensory and emotional experiences that occur early in development are stored in a set of modules, each with a unique developmental trajectory. Reinstatement, which occurs during hormonal stress, produces an aggregate of sensory and emotional memories and the first experience of an unexplained panic attack. Panic disorder, which evolves from unexplained panic attacks, involves retrieval of a disaggregate set of sensory and emotional memory fragments supplemented by an inferential fitting of an explanatory context to this incomplete aggregate.