Testing the suffocation false alarm theory of panic disorder.

The need for hypotheses concerning the nature of those functions that have been impaired in stereotyped psychiatric syndromes is emphasized. With regard to panic disorder, the key role of the spontaneous panic attack became apparent from several viewpoints. However, panics seem to be a type of misreleased fear, which guided the thinking concerning the nature of possible psychological or physiological malfunctions. We indicate that spontaneous panic cannot be fear, but must represent some other malfunction and suggest that the spontaneous panic is a suffocation false alarm. The development of this idea is outlined, and attempts to develop tests of this hypothesis are indicated. In particular, studies of children with congenital central hypoventilation syndrome, patients with Chronic Obstructive Pulmonary Disease, dyspnea, field measures of panic, pregnancy, childbirth and the postpartum period, as well as the premenstrual syndrome afford pointed opportunities, new information and potential tests of the theory. A recent challenge to the theory from acetazolamide infusion is discussed. Developing a possible antecedent for the pathologically depressed threshold for the suffocation alarm, in the form of a phasic endorphinergic deficiency, is presented.