Causal modeling of panic disorder theories.

We compare a variety of theories of panic disorder using a neutral framework: causal modeling. The framework requires identification of key constructs and specification of their interaction. Biological, cognitive, and behavioral elements of the theory have to be clearly distinguished, as do critical past events and current trigger conditions. The theories compared were drawn from the psycho-dynamic, cognitive, and neurobiological literature. We conclude that there are substantive differences among the cognitive theories and between the biological theories reviewed. However, cognitive and biological theories appear to be compatible in principle. It is not clear whether substantive differences among theories are due to the existence of subtypes of PD or due to the predominance of multifactorial cause. It is argued that current treatment methods imply particular theories, and that particular patterns of success and failure can be understood in relation to theory through the methods we have employed.