A Reconceptualization of Panic Disorder in Women Over 45: Taking Into Consideration the Integral Complementarity of Men and Women

Abstract

Panic disorder is one of the most sex discriminate psychopathologies. Current treatment models and conceptualizations do not take the sex and age of the patient into consideration. Panic disorder is thought to be a stress–diathesis disorder. Psychologists have conceptualized the diathesis as a “fear of fear.” As a consequence, psychological treatment has focused on cognitive restructuring with the assumption that the fears are misconstruals of benign stimuli. There is sufficient evidence, however, to show that panic disorder is more accurately conceptualized as a stress overload and it is the accumulation of stressors, whether physical, psychological or existential, that lead to panic attacks and subsequent anticipatory anxiety. Stress is idiosyncratic, but there are specific patterns of stress reactivity that are sex and age specific. This sex specific reactivity is tied to the integral complementarity of men and women. In particular, older women are more stressed by interpersonal stressors than men. In older women with late onset panic disorder, the initial panic attacks appear to be tied to failures in interpersonal relationships. In contrast, in women who have experienced early onset panic disorder, the initial panic attacks appear to be related to conditioned learning and personality traits. The failure to recognize these sex and age differences has led to the failure to adequately treat panic disorder in women in peri–menopause and menopause. A more effective treatment model would incorporate a more holistic view of women and take into consideration their physiology, psychology and ontology.