Objective
To evaluate the family environment in patients with infrequent panic attacks.
Design
Survey.
Setting
Waiting room of a family health center at a university-based family practice residency program. The center primarily serves low-income or underinsured patients, 80% of whom are Hispanic.
Patients or Other Participants
Randomly selected patients completed the panic disorder section of the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Thirty patients with infrequent panic attacks were compared with 30 control patients without panic attacks matched for age, gender, and ethnicity. Both groups completed in-depth interviews.
Interventions
None.
Main Outcome Measures
The in-depth structured interview included family environment instruments^ Family Adaptability and Cohesion Evaluation Scales and Duke Social Support and Stress Scale^as well as a genogram. Family violence and sexual abuse were assessed by means of the Conflict Tactic Scales and the Sexual Stress Questionnaire.
Results
Although patients with infrequent panic attacks were of lower birth order than patients without panic attacks (Wilcoxon 
2=2.13, P
.02), no differences in childhood or current family functioning were found. However, patients with infrequent panic attacks reported higher levels of childhood (paired t=3.97, P.001) and current (paired t=3.05, P.005) family stress. Although the prevalence of family violence was similar between groups, the group with infrequent panic attacks reported more violent events in the past year (paired t=2.60, P.02) than did the group with no panic attacks. Similarly, 60% of patients with infrequent panic attacks reported childhood sexual abuse, as opposed to 13% of patients without panic attacks (McNemar's 2=10.5, P.005).
Conclusions
Although no association between infrequent panic attacks and family functioning or support were found, the group with infrequent panic attacks reported more frequent violent events currently and higher levels of family stress. The high rate of childhood sexual abuse may have important causative implications for infrequent panic attacks.
