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SAN FRANCISCO (WOMENSENEWS)–A racing heart, shortness of breath, dizziness, trembling and a terrible feeling that death is near. Any woman who has experienced a panic attack dreads these symptoms and tries to keep out of situations that could bring them on.

And any mother certainly wouldn’t wish her daughter to suffer from panic attacks. But, research suggests, daughters of women with panic disorder are more likely to inherit it.

Panic disorder–marked by repeated and unexpected attacks that typically last about 10 minutes–strikes up to 5 percent of Americans or at least 2.4 million people. Women are two times as likely to be affected as men.

The disorder often runs in families and, while researchers don’t know its physiological or psychological sources, they do know daughters are more likely to inherit the disorder. A 1983 study of 43 people–male and female–found that among female relatives the risk of developing the disorder was twice that of male relatives.

That study, led by Raymond Crowe of University of Iowa Health Care, left many unanswered questions about how panic disorder is inherited. “Its method of transmission remains uncertain,” Crowe noted at the time.

New Look at Transmission

Now, a researcher at Stanford University School of Medicine aims to help stop mother-daughter transmission of the disorder.

The study–a six-month pilot project led by Dr. Kimberly Wilson, a fellow at Stanford’s Department of Psychiatry and Behavioral Sciences–looks at both the physical symptoms as well as the thoughts of young women whose mothers have panic disorder.

“We’re trying to figure out what some of the vulnerabilities are and what some of the buffers are,” Wilson said.

Wilson’s study, which started this summer, is still seeking additional volunteers. It involves 30 mothers–half of whom have panic disorder–and their teen-age daughters, age 12 to 17. None of the daughters has yet developed panic disorder as onset is typically age 18 to 25. Through questionnaires, Wilson will evaluate the teens’ sensitivity to panic symptoms and their response to situations they perceive as threatening.

For instance, daughters are asked to rate how afraid they are of bodily sensations associated with anxiety, such as how nervous they get when their heart races or feel lightheaded. People who are less bothered by these experiences, or have less “anxiety sensitivity,” are also less likely to have panic disorder, Wilson said. Responses of daughters of women with panic disorder will be compared to the girls with no family history of the disorder.

“We’re looking at what the teen girls pay attention to and how they react, for instance, to threatening words versus non-threatening words,” Wilson said.

How the female teens respond to their environment can offer clues to whether they are on the path towards developing panic disorder.

Cultural Links Suspected

Although researchers don’t yet know why women more likely to develop panic disorder than men, many speculate that it is linked to cultural factors. In American culture, Wilson said, women are often taught to avoid confrontation. They are more likely to be anxious than men, have less self-esteem and suffer depression more often. All these factors, she said, can contribute to panic disorder.

Some researchers have suggested that premenstrual hormonal fluctuations may partially explain the increased incidence of panic disorder in women, according to Gregory Leskin, a clinical psychologist at the Veterans Affairs Palo Alto Healthcare System, who evaluated recent research into physiology and panic disorders.

Writing in the January issue of Psychiatric Times, a monthly trade journal based in Irvine, Calif., Leskin also noted that women’s symptoms of panic disorder commonly differ from those of men. While women are more likely to experience shortness of breath, nausea and the feeling of being smothered, men are more likely to sweat and feel stomach pain.

Normal hormonal fluctuations could explain why the smothered sensation is more common in women, according to Leskin.

“Women with premenstrual syndrome show similar respiratory difficulties as patients with panic disorder,” he writes.

Low Public Awareness

Ironically, those most likely to experience panic attacks–women younger than 34 and over 55–are least likely to be aware of panic disorder. This is according to a 2003 survey by the Anxiety Disorders Association of America, which launched a campaign last year to raise awareness about women and anxiety. Almost half of women surveyed in these groups were not familiar with it, the survey found.

Among the goals of the research is just what Wilson’s patients asked for–help stopping the cycle.

“We want to understand how women with panic disorder can help minimize the risk of anxiety developing in their daughters,” Wilson said. The hope is that identifying situations that can produce a panic response and identifying how daughters respond to those situations could offer families concrete ways to curb the onset of panic disorder.

Wilson said that while physiological factors may play a role, her research is more focused on learned behavior within families.

Measuring Family Dynamics

A major part of her investigation, for instance, is how family dynamics can influence daughters’ behavior.

“We’re most concerned with what’s happening in these girls’ learning environment that makes them more vulnerable to developing panic disorder,” Wilson said.

In the study, for instance, investigators will ask female teens how they would respond in certain situations that could induce a panic response and how it makes them feel, such as do they feel “funny in their stomach,” Wilson said.

Then, as researchers look on, mothers are asked to discuss the same scenario with their daughters and problem-solve about how the daughter might respond effectively. The change in the daughters’ response can help investigators measure the mother’s influence over the daughter.

Previous studies of children with anxiety disorder have shown that kids are more likely to suggest solutions that are actually behaviors associated with panic disorders–such as avoiding confrontation–when talking it over with their parents rather than developing their own approaches, Wilson said.

Wilson designed the study based on her clinical experience with panic disorder patients, many of whom are women who want to prevent the disorder from developing in their children.

“It made me start thinking about how women can minimize the risk for transference to their children.”

Rebecca Vesely is a health writer at the Oakland Tribune.

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