The Pain that I Cannot Feel. Clinical and Neurobiological Aspects of Panic Disorder

Journal title QUADERNI DI GESTALT
Author/s Rosanna Biasi, Michele Cannavò
Publishing Year 2025 Issue 2025/1
Language Italian Pages 19 P. 51-69 File size 0 KB
DOI 10.3280/qg2025-1oa19318
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Panic disorder is a psychiatric disorder from which an estimated 2 to 3 percent of the world’s population suffers (DSM-V), severely affecting quality of life. Integrating social, neurobiological aspects and the most recent clinical applications of attachment theories, the article proposes a reading of panic disorder as an expression of a society in which pain is dissociated due to widespread fear of suffering and pressures to perform and not express experiences of fragility. From a neurobiological point of view, relevance is given to the diversity of the panic attack from the acute anxiety attack, paying attention to those circuits that originate from the brainstem, in line with the important affective-body implication of this pathology. Finally, with a look at attachment theories, it is proposed that, the incomplete acquisition of body-mediated affect regulation processes makes people suffering from this disorder unable to modulate negative states of intense psychophysiological activation; this results in the inability to cope in an integrated way with the intense psychological pain that results from the loss of the attachment relationship. Regarding the psychotherapeutic pathway, the authors focus on the central role of clinical co-regulatory experiences between patient and therapist, which become implicit memories, facilitating an integration of proprioception and esteroception and promoving wellbeing. This articulated look at panic disorder may shed light on new studies in order to further define the clinical and neurophysiologic diversity between panic disorder and anxiety disorder and stimulate reflection on the various interconnected aspects in the etiopathogenesis and treatment of this psychopathological framework.

Keywords: ; Gestalt psychotherapy; panic; pain; dysregulation; integration

  1. Sanavio E., Sanavio F. (2019). Attacchi e disturbo di panico. Firenze: Hogrefe.
  2. Schore A.N. (2001). Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22, 1-2: 7-66. DOI: 10.1002/1097-0355(200101/04)22:1%3C7::AID-IMHJ2%3E3.0.CO;2-N.
  3. Schore A.N. (2009). Attachment Trauma and the Developing Right Brain: Origins of Pathological Dissociation. In: Dell P., O’Neil J., eds., Dissociation and the Dissociative Disorders. DSM-V and Beyond. New York, NY: Routledge.
  4. Siegel D.J. (2021). La mente relazionale. Neurobiologia dell’esperienza interpersonale. Milano: Raffaello Cortina (ed. or.: The Interpersonal Neurobiology of the Developing Mind. New York, NY: Guilford Press, 2012).
  5. Spagnuolo Lobb M., a cura di (2001). Psicoterapia della Gestalt. Ermeneutica e clinica. Milano: FrancoAngeli.
  6. Spagnuolo Lobb M. (2005). Perché la psicoterapia negli attacchi di panico. In: Francesetti G., a cura di, Attacchi di Panico e postmodernità. Milano: FrancoAngeli.
  7. Spagnuolo Lobb M. (2011). Il now-for-next in psicoterapia. La psicoterapia della Gestalt raccontata nella società post-moderna. Milano: FrancoAngeli.
  8. Spagnuolo Lobb M. (2017). La conoscenza relazione estetica del campo. Per uno sviluppo del concetto di consapevolezza in psicoterapia della Gestalt e nella clinica contemporanea. Quaderni di Gestalt, XXX, 1: 17-33. DOI: 10.3280/GEST2017-001003.
  9. Spagnuolo Lobb M. (2019). La psicoterapia nella società post-moderna: uno strumento sociale a sostegno delle risorse umane del tempo. In: Fava Vizziello G., a cura di, Psicoterapie nella vertigine del cambiamento. Tra concepimenti senza sesso, migrazioni permanenti e sconosciuto potere tecnologico. Padova: Cleup, pp.69-90.
  10. Spagnuolo Lobb M. (2020). Il paradigma della reciprocità: come rispettare la spontaneità nella pratica clinica. Quaderni di Gestalt, XXXIII, 2: 19-40. DOI: 10.3280/GEST2020-002003 (ed. or.: The Paradigm of Reciprocity: How to Radically Respect Spontaneity in Clinical Practice. Gestalt Review, 23, 3: 234-254. DOI: 10.5325/gestaltreview.23.3.0232, 2019).
  11. Spagnuolo Lobb M., Rubino V. (2015). Le esperienze dissociative in psicoterapia della Gestalt. Quaderni di Gestalt, XXVIII, 1: 27-47. DOI: 10.3280/GEST2015-001003.
  12. Taylor M. (2016). Psicoterapia del trauma e pratica clinica Corpo. Neuroscienze e Gestalt. Milano: FrancoAngeli. (ed. or.: Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and The Body. New York: McGraw Hill, 2014).
  13. Thayer J.F. (2007) What the Heart Says to the Brain (and vice versa) and Why we Should Listen. Psychological Topics 16, 2: 241-250.
  14. Warren S.L., Huston L., Egeland B., Sroufe L.A. (1997). Child and Adolescent Anxiety Dis-orders and Early Attachment. J Am Acad Child Adolesc Psychiatry, 36, 5: 637-644. DOI: 10.1097/00004583-199705000-00014.
  15. Wollants G. (2021). Psicoterapia della Gestalt: terapia della situazione. Milano: FrancoAngeli (ed. or.: Gestalt Therapy: Therapy of Situation. London, UK: Sage Publications Ltd, 2012).
  16. Zhou D., Wong C., Xu Y. (2018). Epidemiology of Panic Disorder in Women: A Systematic Review. The Journal of Nervous and Mental Disease, 206, 5: 371-380. DOI: 10.1097/EDE.0000000000000822.
  17. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Dis-orders (5th ed.). Arlington, VA: American Psychiatric Publishing (trad. it.: DSM-5, Manuale diagnostico e statistico dei disturbi mentali, quinta edizione. Milano: Raffaello Cortina, 2014).
  18. Bifulco A., Kwon J., Jacobs C., Moran P.M., Bunn A., Beer N. (2006). Adult Attachment Style as Mediator Between Childhood Neglect Abuse and Adult Depression and Anxiety. Soc Psychiatry Psychiatr Epidemiol. 41, 10: 796-805. DOI: 10.1007/s00127-006-0101-2.
  19. Bunn T. (2019). Panic Free: The Ten-day Program to End Panic, Anxiety, and Claustrophobia. Novato, CA: New World Library.
  20. Cascio A. (2011). La funzione dell’emergenza in Teoria e pratica della terapia della Gestalt: vitalità e accrescimento nella personalità umana. Quaderni di Gestalt, XXIV, 1: 25-34. DOI: 10.3280/GEST2011-001003.
  21. Cassidy J., Shaver P.R. (2018). Handbook of Attachment. Theory, Research and Clinical Ap-plications (3rd edition). New York, NY: The Guilford Press.
  22. Chul Han B. (2021). La società senza dolore. Perché abbiamo bandito la sofferenza dalle nostre vite. Torino: Einaudi (ed. or.: Die Müdigkeitsgesellschaft. Berlino, DE: Suhrkamp Verlag, 2010).
  23. Corrigan F.M. (2021). Minaccia e sicurezza: la neurobiologia delle risposte di difesa attive e passive. In: Lanius U.F., Paulsen S.L., a cura di, Neurobiologia e trattamento della dissociazione traumatica. Verso un Sé incarnato. Milano: FrancoAngeli (ed.or.: Neurobiology and Treatment of Traumatic Dissociation. New York, NY: Springer Publishing, 2014).
  24. Damasio A. (2012). Il Sé viene alla mente. La costruzione del cervello cosciente. Milano: Adelphi Edizioni (ed. or.: Self Comes to Mind: Constructing the Conscious Brain. New York, NY: Pantheon Books, 2010).
  25. Dana D. (2019). La Teoria Polivagale nella terapia. Roma: Giovanni Fioriti (ed. or.: The Polyvagal Theory in Therapy. New York, NY: W.W. Norton & Company, 2018).
  26. Faretta E. (2018). EMDR e disturbo di panico. Dalle teorie integrate al modello di intervento nella pratica. Milano: Edra.
  27. Francesetti G. (2014). La psicoterapia della Gestalt con il disturbo di panico. In: Francesetti G., Gecele M., Roubal J., a cura di, La psicoterapia della Gestalt nella pratica clinica. Dalla psicopatologia all’estetica del contatto. Milano: FrancoAngeli.
  28. Francesetti G. (2014). Dalla sintomatologia individuale ai campi psicopatologici. Verso una prosepttiva di campo sulla sofferenza clinica. Quaderni di Gestalt, XXVII, 2: 31-56. DOI: 10.3280/GEST2014-002003.
  29. Goddard A.W. (2017). The Neurobiology of Panic: A Chronic Stress Disorder. Chronic Stress. 1: 1-14. DOI: 10.1177/2470547017736038.
  30. Gorman J.M., Liebowitz M.R., Fyer A.J., Stein J. (1989). Neuroanatomical hypothesis for panic disorder. Am J. Psychiatry, 146, 2: 148-161. DOI: 10.1176/ajp.146.2.148.
  31. Guan X., Cao P. (2024). Brain Mechanisms Underlying Panic Attack and Panic Disorder. Neurosci. Bull., 40, 6: 795-814. DOI: 10.1007/12264-023-01088-9.
  32. Hill D. (2017). Teoria della regolazione affettiva. Un modello clinico. Milano: Raffaello Cortina (ed. or.: Affect Regulation Theory. A Clinical Model. New York, NY: W.W. Norton & Company, 2015).
  33. Izci F., Gultekin B.K., Saglam S., Koc M.I., Zincir S.B., Atmaca M. (2014). Temperament, Character Traits and Alexithymia in Patients with Panic Disorder. Neuropsychiatric Disease and Treatment, 10: 879-885. DOI: 10.2147/NDT.S62647.
  34. Jacobs L., Hycner R., ed. (2009). Relational Approaches in Gestalt Therapy. New York, NY: A Gestalt Press Book.
  35. Janiri L. (2021). La Psicoterapia e le sfide della post-modernità. Intervento all’Expert Meeting SIPG “La Psicopatologia del nostro tempo”, online 8 aprile (incisione su nastro).
  36. Kessler R.C., Berglund P., Demler O., Jin R., Merikangas K.R., Walters E.E. (2005). Lifetime Prevalence and Age-of-onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry., 62, 6: 593-602. DOI: 10.1001/archpsyc.62.6.59.
  37. Khalsa S.S., Adolphs R., Cameron O.G., Critchley H.D., Davenport P.W., Feinstein J.S., Feusner J.D., Garfinkel S.N., Lane R.D., Mehling W.E., Meuret A.E., Nemeroff C.B., Oppenheimer S., Petzchner F.H., Pollatos O., Rhudy J.L., Schramm L.P., Simmons W.K., Stein M.B., Stephan K.E., Van den Bergh O., Van Diest I., von Leupoldt A., Paulus M.P. (2018). Interoception and Mental Health: a Roadmap. Biological Psychiatry Cognitive Neuroscience and Neuroimaging, 3, 6: 501-513. DOI: 10.1016/j.bpsc.2017.12.004.
  38. Klein, D.F. (1993). A diagnosis for the ’90s: Panic Disorder. The Journal of Nervous and Mental Disease, 181, 6: 345-349.
  39. Le Doux J. (2016). Ansia. Come il cervello ci aiuta a capirla. Milano: Raffaello Cortina (ed. or.: Anxiety: A Natural History. New York, NY: Viking Press, 2015).
  40. Lieb R., Pfister H., Hutten K., Wittchen H.U. (2005). The Role of Parental Anxiety Disorders in the Development of Panic Disorder in Adolescents. Psychological Medicine, 35, 3: 405-415.
  41. Limmer J., Kornhuber J., Martin A. (2015). Panic and Comorbid Depression and their Associations with Stress Re-activity, Interoceptive Awareness and Interoceptive Accuracy of Various Bioparameters. Journal of Affective Disorders, 2015,185: 170-179. DOI: 10.1016/j.jad.2015.07.010.
  42. Macaluso M.A. (2024). Fenomenologia del sé e relazione terapeutica. Individuo e campo nell’approccio gestaltico. Milano: FrancoAngeli.
  43. McNally R.J. (2002). Anxiety and Panic Disorders. Annals of Internal Medicine, 136, 7: 578-581. DOI: 10.1016/S0887-6185(02)00174-3.
  44. Nemiah J.C., Freyberger H., Sifneos P.E. (1976). Alexithymia: A view of the psychosomatic process. In: Hill O.W., ed., Modern Trends in Psychosomatic Medicine. London, UK: Butterworths, pp. 430-439.
  45. Noyes R., Holt C.S., Litz B. (2001). Panic Disorder: An Overview of Diagnosis and Treatment. The American Journal of Psychiatry. 158, 3: 325-334.
  46. Perls F.S., Hefferline R.F., Goodman P. (1971; 1997). Teoria e pratica della Terapia della Gestalt. Vitalità e accrescimento nella personalità umana. Roma: Astrolabio (ed. or.: Gestalt Therapy: Excitement and Growth in the Human Personality. New York, NY: The Gestalt Journal Press, 1951; 1994).
  47. Panksepp J. (1998). Affective Neuroscience: The Foundations of Human and Animal Emotions. Oxford, UK: Oxford University Press.
  48. Paulsen S.L., Golston J. (2021). Nozioni di base sulla stabilizzazione. In: Lanius U.F., Paulsen S.L., a cura di, Neurobiologia e trattamento della dissociazione traumatica. Verso un Sé incarnato. Milano: FrancoAngeli (ed. or.: Neurobiology and Treatment of Traumatic Dissociation. New York, NY: Springer Publishing, 2014).
  49. Pintus G., Grech M.L. (2021). L’addiction come trauma persistente dello sfondo: neurobiologia e psicoterapia della Gestalt. In: Spagnuolo Lobb M., Cavaleri P.A., a cura di, Psicopatologia della situazione. La psicoterapia della Gestalt nei campi clinici delle relazioni umane. Milano: FrancoAngeli, pp. 193-213.
  50. Polster M. (1987). Il linguaggio dell’esperienza. Quaderni di Gestalt, 2/3: 97-107.
  51. Porges S.W. (2001). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. Physiology and Behavior, 86, 5: 503-512.
  52. Porges S.W. (2009). The Polyvagal Theory: New Insights into Adaptive Reactions of the Autonomic Nervous System. Cleveland Clinic Journal of Medicine, 76, 2: 86-90. DOI: 10.3949/ccjm.76.s2.17.
  53. Porges S.W. (2014). La teoria polivagale. Roma: Giovanni Fioriti (ed. or.: The Polyvagal Theory. New York,NY: Norton & Company, 2011).
  54. Porges S.W., Dana D. (2020). Le applicazioni cliniche della teoria polivagale. La progressiva affermazione della teoria polivagale nelle terapie. Roma: Giovanni Fioriti (ed. or.: Clinical Applications of the Polyvagal Theory. New York, NY: W.W. Norton & Company, 2019).
  55. Robine J.-M. (2006). Il rivelarsi del sé nel contatto. Milano: FrancoAngeli (ed. or.: Plis et Déplis du Self. Bordeax: Institut Francais de Gestalt-therapie, 1977).
  56. Roy M., Shohamy D., Daw N., Jepma M., Wimmer E., Wager T.D. (2014). Rapresentation of Aversive Prediction Errors in the Human Periaqueductal Gray. Nat. Neurosci. 17, 11: 1607-1612. DOI: 10.1038/nn.3832.
  57. Rosenfeld E. (1978). An Oral History of Gestalt Therapy: A Conversation with Laura Perls. Gestalt Journal; 1, 1: 8-31.
  58. Rovetto F. (2003). Panico. Origini, dinamiche, terapie. Milano: Mc Graw-Hill Education.

Rosanna Biasi, Michele Cannavò, Il dolore che non posso sentire. Aspetti clinici e neurobiologici del disturbo di panico in "QUADERNI DI GESTALT" 1/2025, pp 51-69, DOI: 10.3280/qg2025-1oa19318