H. Michael Zal, D.O., F.A.C.N., is a Board-Certified Psychiatrist who has maintained a private practice in Bala Cynwyd, Pennsylvania, for over twenty years. A graduate of the University of Pennysylvania and the Philadelphia College of Osteopathic Medicine, Dr. Zal completed a three-year National Institute of Mental Health Fellowship in Psychiatry through the Philadelphia Mental Health Clinic.

Introduction	p. 19
Anxiety: Past, Present, and Future--A Question of Definition	p. 23
Clinical Vignette: Mary Ann	p. 25
History	p. 27
Theories of Anxiety	p. 28
A Physiologic Viewpoint	p. 30
Normal Versus Abnormal Anxiety	p. 32
The Positive Aspects of Anxiety	p. 34
Pathological Anxiety	p. 35
The Signs and Symptoms of Anxiety	p. 36
A Modern View	p. 38
From Anxiety to Panic Disorder: An Historical Perspective	p. 41
The Classification of Mental Disorders	p. 43
1952--Diagnostic and Statistical Manual (DSM-1)	p. 44
1968--DSM-II	p. 46
1980--DSM-II	p. 49
Classification Controversies	p. 51
1987--DSM-III-R	p. 54
Limited Symptom Attacks	p. 55
Clinical Vignette: Wanda	p. 56
The Benefits of Awareness	p. 57
Panic Disorder: A Special Anxiety State	p. 59
Clinical Vignette: Ray	p. 61
What Is Panic Disorder?	p. 61
Definition: DSM-III-R Criteria	p. 62
Who Gets Panic Disorder?	p. 64
The Panic-Prone Person	p. 65
Typical Course or Presentation	p. 66
Other Clinical Presentations	p. 68
An Irritable Bowel Syndrome Presentation	p. 70
Clinical Vignette: Andrew	p. 71
Relationship to Substance Abuse	p. 72
Possible Resolutions of Panic Disorder	p. 73
Clinical Vignette: Rose	p. 75
Relationship to Pregnancy	p. 75
The Emotional Problem of the 1980s	p. 76
The Great Pretender: Differential Diagnosis of Panic Disorder	p. 79
Differentiation from Other Psychiatric Disorders	p. 84
Differentiation from Medical Conditions	p. 89
The Panic Disorder Medical Workup	p. 93
Panic Disorder: Is It Emotional or Physical?	p. 97
Biological (Physical) Theories	p. 99
Psychological (Emotional) Theories	p. 110
Hereditary Predisposition	p. 113
Etiologic Conclusions	p. 114
Panic Disorder through the Life Cycle: A Longitudinal--Life History Approach	p. 115
Early Development/Childhood	p. 117
Separation Anxiety	p. 118
Adolescence/Young Adulthood	p. 120
Clinical Vignette: Jody	p. 121
Middle Age	p. 122
Clinical Vignette: Marie	p. 124
Clinical Vignette: Russ	p. 127
The Geriatric Years	p. 130
Clinical Vignette: Mrs. Elliot	p. 131
Treatment: The Initial Phase--Reassurance and Education	p. 133
Clinical Vignette Continued	p. 135
The Therapeutic Aspects of Diagnosis	p. 136
Establishing Rapport	p. 137
Offering Reassurance	p. 138
Education	p. 140
Self-Help Techniques	p. 142
How Can Family Members and Friends Help?	p. 143
Clinical Vignette: Jim and Julie	p. 145
Making Human but Expert Contact	p. 147
Treatment: Individual Psychotherapy	p. 149
Clinical Vignette: Joyce	p. 151
The Psychiatric History: The Initial Phase of Psychotherapy	p. 152
The Mental Status Examination	p. 153
Areas to Explore and Understand in Therapy	p. 155
Recent Stress	p. 155
Dealing with Feelings	p. 156
Independence/Dependence	p. 157
Emotional Needs	p. 158
Dealing with Internal Conflict	p. 159
Toward a More Independent Life-Style	p. 160
Other Mental Health Treatments	p. 163
Stress Reduction	p. 165
Relaxation Training	p. 167
Group Psychotherapy	p. 168
Hypnosis	p. 170
Cognitive Therapy	p. 172
Exposure Therapy	p. 175
Treatment: Psychopharmacology	p. 179
Beta Blocking Agents	p. 182
Alpha-Adrenergic Agonists	p. 183
Antidepressants	p. 184
Tranquilizers	p. 188
Relapse after Withdrawal of Medication	p. 191
Clinical Choices and Guidelines	p. 192
Panic Disorder: The Future	p. 195
Classification	p. 197
Etiology	p. 198
Differential Diagnosis: Relationship to Other Disorders	p. 201
An Individualized Treatment Plan	p. 204
A Holistic Point of View: A Psychological, Behavioral, Biological Synthesis	p. 206
References	p. 209
Index	p. 225
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