Palpitations, cardiac awareness, and panic disorder.

This article reviews and appraises a variety of studies on panic disorder, visceral sensitivity, and cardiac disease. The literature reviewed includes descriptive surveys, small-scale experimental manipulations, and clinical interventions. Instruments have included structured diagnostic interviews, clinical observation, self-report inventories, direct measures of perceptual sensitivity, and cognitive tests. The subjects in these studies have ranged from community residents to carefully defined samples of designated patients with psychiatric or cardiac disease. We then outline a prospective investigation to examine the prominence of palpitations in panic anxiety and speculate on the importance of sensitivity to cardiac sensation in several other clinical conditions characterized by marked discrepancies between cardiac activity and cardiac symptoms.