Near-Drowning Experiences and Panic Disorder

To the Editor: I read with great interest the article by Colin Bouwer, M.B., and Dan J. Stein, M.B. (1), on past traumatic suffocation experiences as a risk factor for panic disorder. I have made similar observations, confirming their hypothesis.

After two panic disorder patients’ spontaneous declarations of near-drowning experiences, I began to ask my panic patients about their past traumatic suffocation experiences—namely, near-drowning experiences in water. Twenty (33%) of 62 patients with DSM-III-R panic disorder that were seen in a 6-month period reported that they had experienced a life-threatening and frightening suffocation experience preceding the onset of their panic disorder. Their mean age at the time of the suffocation experience was 13.88 years (range=5–55, SD=10.75), and their mean age at the onset of panic disorder was 29.69 years (range=15–57, SD=10.04). Sixteen (47.1%) of 34 patients with prominent respiratory symptoms and four (14.3%) of 28 patients with nonprominent respiratory symptoms reported a near-drowning experience. The difference between subtypes (2) was significant (χ²=7.54, df=1, p=0.006). Three patients noted that they had experienced multiple instances of near drowning, and another patient had a near-drowning experience with a foreign object stuck in the throat. Among the patients with near-drowning histories (N=20), three patients were moderately phobic and four patients were severely phobic to bodies of water (N=7, 35%), although they knew how to swim.

Furthermore, five (14.7%) other patients with prominent respiratory symptoms described histories of an object stuck in the throat, which caused fear of choking to death. Although the data were statistically nonsignificant, Verburg et al. (3) first reported that a history of objects stuck in the throat is higher in panic patients (13.4%) than in other anxiety-disorder patients (5.9%). Likewise, some patients in our group described other possible forms of trauma. One patient described falling from a 10-meter height onto his chest, causing a dyspnea severe enough to create an intense fear of death at the age of 9 years. Two additional patients reported witnessing scenes in which drownings occurred. One had witnessed her daughter’s rescue from a near drowning and a close friend’s drowning in a pool.

In conclusion, traumatic suffocation histories may, indeed, play an etiological role, at least in some panic patients. However, traumas other than those mentioned in the Bouwer and Stein article (1) must also be considered. A broad spectrum of trauma (e.g., foreign objects in the throat or chest trauma) and witnessing the real and serious danger of the suffocation of others may also predispose individuals to panic disorder.