Abstract
The mystery surrounding recurrent chest pain has attracted researchers from several disciplines. No single solution will arise from these efforts because patients with chest pain not caused by coronary artery disease are a heterogeneous group. One of its subgroups is panic disorder, a psychiatric condition affecting at least 1% to 2% of the population and characterized by acute episodes of intense fear or discomfort accompanied by from 4 to 13 of the symptoms listed in Table 1. Panic disorder is associated with significant reductions in quality of life [1, 2], increased likelihood of suicide attempts [3], increased frequency of strokes [4], possible increased likelihood of death by cardiovascular disease [5, 6], and excessive medical care costs [7]. Since panic disorder appears highly responsive to both certain medications [8] and certain forms of psychotherapy [9] diagnostic suspicion should remain high. One of the diagnostic difficulties with panic disorder is the contraintuitive patient subtype who presents with the cluster of somatic symptoms but without the direct expression of fear. Researchers have found nonfear panic disorder patients in cardiology [10] and neurology populations [11] as well as in primary care outpatient clinics [12].