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An Analysis of Uncued Panic Attacks
in Panic Disorder - Part4

RESULTS
Dissociation

Table 7. summarises the results investigating Derealisation and depersonalisation phenomenon experienced prior and during an uncued panic attack and a limited symptom (anxiety) attack.
PD - Panic Disorder vs AD - Other Anxiety Disorders

Table 7. Dissociation experienced by Panic Disorder and Other Anxiety Disorder participants. Note. Total also includes figures from meditation experiences.

Dissociation experiences	Experience then panic PD(AD)	Panic PD(AD)	Experience without fear PD(AD)	Anxiety PD(AD)	Total PD(AD)
Expanded so that you feel huge/ larger than normal	17%(0%)	3%(0%)	8%(3%)	3%(3%)	36%(8%)
Body has shrunk to minute proportions/ smaller than usual	11%(0%)	0%(3%)	8%(3%)	6%(0%)	25%(6%)
'Witness of what is happening to your body	14%(11%)	8%(0%)	14%(0%)	11%(0%)	50%(11%)
Feel as if you are falling into a void	8%(6%)	11%(0%)	8%(3%)	6%(3%)	36%(11%)
"Outside of body" either situated alongside, above or behind it	3%(3%)	8%(0)	19.4%(3%)	3%(0%)	39%(6%)
Eyes are closed and unable to open them	11%(3%)	6%(0%)	0%(3%)	0%(3%)	19.4%(8.3%)
Feel as if you are floating	22%(6%)	8%(0%)	17%(3)	17%(0%)	67%(14%)
Feel as if body is being pressed to the ground	3%(0%)	8%(3%)	6%(0%)	6%(0%)	25%(3%)
Experience a feeling of "superhuman strength"	3%(0%)	3%(0%)	0%(6%)	0%(0%)	8%(6%)
You and your surroundings do not seem real	25%(8%)	31%(6%)	8%(3%)	25%(8%)	72%(19%)
Experience your surroundings through a diffused light, fog or mist	17%(6%)	25%(0%)	11%(6%)	8%(6%)	56%(17%)
Experience a visual sensation where stationary objects appear to move	17%(3%)	14%(3%)	8%(0%)	28%(3%)	56%(6%)
Experience whole body being enveloped in light	3%(0%)	3%(0%)	6%(0%)	3%(0%)	22%(0%)

Analysis of the other Anxiety Disorder results show that dissociation play an insignificant role in the limited symptom (anxiety) attack. The Panic Disorder results, however, show a highly significant relationship between dissociation and a uncued panic attack. Experiences with a very high correlation to Panic Disorder and panic attacks compared to Anxiety Disorder are: you and your surroundings do not seem real (72% vs 19%, P<0.002), feel as if you are floating (67% vs 14%, P<0.008), experience surroundings through a diffused light, fog or mist (56% vs17%, P<0.01) and experience a visual sensation where stationary objects appear to move (56% vs 6%, P<0.002). Only Panic Disorder participants experience their whole body being enveloped in light (22%).
Experiences categorised to a higher proportion by Panic Disorder participants as experienced then panic were: your body is expanded so that you feel huge/larger than normal, your body has shrunk to minute proportions/smaller than usual and feel as if you are floating. Also categorised significantly as experienced then panic were:'witness of what is happening to you, falling into a void, you and your surroundings do not seem real, experience surroundings through a diffused light, fog or mist and experience a visual sensation where stationary objects appear to move. These experiences may be experienced and then overwhelming energy movements may occur or energy movements may occur simultaneously to the dissociative experiences and then panic.

Experiences categorised to a higher proportion by Panic Disorder participants as panic or central to the panic attack experience were a feeling of falling into a void; feeling as if your body is pressed to the ground; you and your surroundings do not seem real; and experience surroundings through a diffused light, fog or mist. Also categorised significantly as experienced as panic were:'witness' of what is happening to you; 'outside of body' either situated alongside, above or behind it; closed and are unable to open them and feel as if floating. These experiences may be experienced simultaneously to the panic 'energies' described above.

Dissociation experiences categorised predominantly as anxiety by Panic Disorder participants were: you and your surrounding do not seem real; experience a visual sensation where stationary objects appear to move; and feeling as if you are floating. Comparing the results for Panic Disorder and other Anxiety Disorder clearly show that these experiences were insignificant in Anxiety Disorder. The Panic Disorder participants experienced these as anxiety but if these experiences were associated with anxiety the other Anxiety Disorder participants would have shown a more equal level of experience. The conclusion may be that the Panic Disorder participants may be experiencing these phenomenon on an ongoing basis outside of the panic attack and may be personally linking to anxiety symptoms occurring at the time.

Dissociative Experience Scale

Results coincide with the results achieved by E.Bernstien PhD and F.Putnam MD(10) for dissociative scores achieved by normal (mean=5.7) and Anxiety Disorders (mean=7.2). The Panic Disorder mean score however was higher (mean=28). This however corresponds to our knowledge of Panic Disorder being highly dissociative. Analysis of the specific dissociative experiences for normal, Anxiety Disorder and Panic Disorder shown in Table 14. show the high level of dissociative experiences for Panic Disorder participants. The scores specify percentage of time people experience these specific dissociative experiences.

Table 14. Frequency (% of time occurring) of specific Dissociative experiences
for Normal, Other Anxiety Disorder and Panic Disorder participants.

Dissociative Experiences	Normal	Other Anxiety Disorder	Panic Disorder
Driving a car and suddenly realise don't remember what has happened during all/part of trip	5	19	30
Listening to someone talk and realise did not hear part/all of what was just said	3	21	60
Find themselves in a place and have no idea how they got there	0.1	1.3	15
Experience feeling as though standing next to themselves and watching themselves do something	0.2	4	9
Have no memory for some important events in their lives eg. wedding, graduation	5	9	24
Experience feeling that their body does not seem to belong to them	0.2	3	23
Experience feeling that other people, objects and the world do not seem real	0.6	7.5	37
Experience of sometimes remembering a past event so vividly that they feel as if they are reliving it	6	7	27
Experience of not sure whether things that they remember happening really did happen or a dream	8	9	31
Experience of being in a familiar place but finding it strange and unfamiliar	2	4	19
When watching TV or movie they become so absorbed they are unaware of the events happening near them	10	10	28
Become so involved in a fantasy or daydream it feels as though it is really happening	3	6	20
Find that they are sometimes able to ignore pain	6	12	29
Sometimes sit staring off into space, thinking nothing and not aware of the passage of time	4	15	36
May act so differently from situation to situation they feel as if they were two different people	3	10	28
Sometimes can't remember whether have done something or just thought about doing that thing	3	10	32
Feel as if looking at the world through a fog so that people and objects appear far away or unclear	0.4	4	21

Relationship of inner sound and inner lights to Uncued panic attack

Table 8. summarises the results investigating "inner" sounds phenomenon experienced prior and during a panic attack and limited symptom (anxiety) attack.

Table 8. Comparison of experiences of "hearing" unusual inner sounds
prior, during or after experiencing 'energy' movement.

"Inner sounds"	Panic Disorder participants	Other Anxiety Disorder participants
Low rumbling	11%	0%
Roaring of water	11%	0%
Rushing of wind	14%	0%
Ringing	42%	19%
Electricity "Buzzing"	19%	0%
"White" noise	22%	6%
High pitched shrill	36%	0%
Sound vibrates through the body	14%	6%
Total	64%	25%

The hearing of 'inner' sounds is experienced to a higher proportion by Panic Disorder participants compared to other Anxiety Disorder participants (64% vs 25%, P<0.02). Also, the inner sounds seem to vibrate through the body more for Panic Disorder participants. 'Inner' sounds specifically associated with the panic attack are high pitched shrill (36%), the sound of electricity 'buzzing' (19%), rushing of wind (14%), low rumbling and roaring of water (11%). A sound similar to 'white noise' on TV was also heard.
Table 9. summarises the results investigating brilliant 'inner' lights phenomenon experienced prior and during a panic attack and a limited symptom (anxiety) attack.

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