FIGURE 1.

The cycle of panic disorder: Vulnerability factors such as genetic predisposition, early life adversity, chronic illness, physiological state (i.e., dehydration), or other psychiatric disorder diagnosis associate with innate sensitivity to homeostatic triggers. These homeostatic triggers are threats to internal homeostasis that lead to a heightened state of alarm, the activation of threat responses systems and a panic attack. The emotional, behavioral and physiological responses occurring during panic attacks such as fear, anxiety, hyperventilation and cardiovascular responses are evoked in an effort restore physiological homeostasis. The engagement of these systems and the conditioned responses to contexts where panic attacks occurred can lead to hypersensitivity to future homeostatic triggers, novel stressors or trauma, and exposure to previous panic contexts. This can lead to a cycle of recurrent panic attacks, and anticipatory anxiety and avoidance of panic-associated contexts, that ultimately facilitates the development of panic disorder.