Background: Although some evidence suggests a bimodal age at onset of panic
attacks, the literature comparing subjects with early versus late onset is
limited. Previous work suggests that people with late-onset panic attacks
may have fewer panic symptoms and exhibit less avoidance. This study sought
to compare late-onset panic attacks and early-onset panic attacks with reg
ard to (1) comorbidity, (2) health care utilization, and (3) illness behavi
ors and coping.
Method: This community-based study involved interviewing randomly selected
adults for the presence of DSM-III-R panic attacks. If panic attacks were c
onfirmed, subjects were asked questions concerning panic characteristics, p
sychiatric comorbidity, symptom perceptions, illness attitudes, coping, and
family characteristics. Subjects reporting early-onset panic (panic onset
< 50 years of age) were compared with those reporting late onset (onset 2 5
0 years of age). Significant univariate analyses were controlled for differ
ences in age, panic duration, and socioeconomic status by using analysis of
covariance and logistic regression.
Results: Subjects with late-onset panic attacks (N = 9) utilized the mental
health sector less, but were mon likely to present to family physicians fo
r their worst panic. Patients with late-onset panic felt that choking and n
umbness more strongly disrupted function, but felt less strongly that eithe
r depersonalization or sweating disrupted function. Subjects with late-onse
t had fewer comorbid conditions and lower Symptom Checklist-90 scores. Late
-onset subjects also had less hypochondriasis and thanatophobia while copin
g less through avoidance or wishful thinking.
Conclusion: Late-onset panic attacks are associated with less mental health
utilization, lower levels of comorbidity, less hypochondriasis, and a grea
ter number of positive coping behaviors.