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So this is where my understanding of panic disorder stood until I Googled “how do you treat a patient who thinks she’s suffocating? So when people discovered a condition that limits the ability to breathe automatically, some very imaginative doctor named the condition Ondine’s Curse (some much less imaginative doctors provided its alternate name, central hypoventilation syndrome).

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I recently presented this case at a conference and I figured you guys might want to hear it too.

Various details have been obfuscated or changed around to protect confidentiality of the people involved.

In the feedback model of panic disorder, this response begins too early and recurses too heavily. Your body notices this unusual sensation and falsely interprets it as the sort of abnormality that might indicate major dysfunction.

It increases heart rate, starts sweating, et cetera.

You might want to read the full paper, as it’s got far too many fascinating things to list here, including a theory of sighing. Klein is a professor of psychiatry who studies the delightful field of “experimental panicogens”, ie chemicals that cause panic attacks if you inject them in someone. But if for some reason they stop breathing, they don’t notice.

These include lactate, bicarbonate, and carbon dioxide, all of which naturally occur in the body under conditions of decreased respiration. All of these chemicals naturally occur in the body under conditions of decreased respiration. During exercise, for example, your body has much higher oxygen demand but (no matter how much you pant while running) only a little bit higher oxygen supply, so at the muscle level you don’t have enough oxygen and start forming lactate. Even deliberately holding your breath doesn’t make you panic, although it’s about the fastest way possible to increase levels of those chemicals. Needless to say, this condition is very, very fatal.A 20-something year old woman comes into the emergency room complaining that she can’t breathe.The emergency doctors note that she’s breathing perfectly normally.So it looks like your body is actively predicting how much lactate/bicarbonate/CO2 you should have, and only getting concerned if there’s more than it expects. The usual method of death is that somebody stops breathing at night (ie sleep apnea, very common among the ordinary population, but not immediately dangerous since your body notices the problem and makes you start breathing again) and just never starts again.So Klein theorized that the brain has a “suffocation alarm”, which does some pretty complicated calculations to determine whether you’re suffocating or not. Klein says that this proves the existence of the suffocation alarm: Ondine’s Curse is an underactive suffocation alarm – and thus the opposite of panic disorder, which is an overactive suffocation alarm.It’s marked by “panic attacks”, short (minutes to hours) episodes where patients experience extreme terror, increased heart rate, gasping for breath, feeling of impending doom, choking, chest pain, faintness, et cetera.

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