Panic disorder and self states: Clinical and research illustrations

Patients who suffer from panic attacks are often deeply distressed by the symptoms of panic and their aftermath. Alarming physiological symptoms (i.e., dizziness, shakiness, and abdominal distress) are typically accompanied by a sense of imminent doom. This article presents a formulation of panic disorder that assumes that panic results from selfobject failures, leading to fragmentation and disorganizing experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. A single clinical case, along with examples from research, illustrates the benefit of focusing on developmental processes and unconscious and preconscious fantasies.