Panik bozukluğun, “kontrol kaybından duyulan endişe”, “mükemmelliyetçilik” ve “kaçınmacı başetme stratejileri” gibi faktörlerle ilişki içerisinde olduğu literatürde sıklıkla vurgulanmaktadır. Bu özelliklerin panik bozukluğun ortaya çıkmasında nasıl etkili olduklarının ve nasıl bir mekanizma içerisinde bir araya geldiklerinin anlaşılması, rahatsızlığın yeniden ortaya çıkmasını önlemeye yönelik terapötik müdahalelerin etkililiğini arttıracaktır. Kimi çalışmalar, panik bozukluk etiyolojisinde kaçınmacı ya da obsesif-kompülsif kişilik özelliklerinin yer alabileceğinden söz etse de bu özelliklerle panik bozukluk arasında nedensel bir bağlantı kurmaya yönelik açıklamalara nadiren rastlanılmaktadır. Genellikle psikodinamik kuram çerçevesinde yapılan bu açıklamalar ise, kişinin, karşılanamayan bağımlı olma ihtiyaçları ve etkili bir biçimde baş edemediği öfke duygusu sebebiyle yaşantıları üzerinde aşırı bir kontrol sağlama çabası içerisine girmiş olabileceklerini vurgulamaktadır. Bu makalede, bir panik bozukluk vakasının formüle edilmesi üzerinden, kontrol kaybı kaygısının ve diğer ilişkili faktörlerin, ebeveyne yönelik öfkenin bastırılması ve tepki oluşumu stratejisi çerçevesinde nasıl örgütlendikleri ele alınacak ve bu faktörlerin danışanın hayatında ve panik bozuk semptomlarının ortaya çıkmasında nasıl bir role sahip oldukları tartışılacaktır.

Panic disorder patients’ reports of their anxiety of losing control has been frequently noticed. In fact, the disorder itself is characterized by an inability to tolerate a series of physiological symptoms which are uncontrollable. Several authors reported that patients with panic disorder strive to control a variety of events in their daily lives; such as excessive control over emotional reactions, perfectionism, and obsessive-compulsive patterns. Psychoanalytical explanations define “striving for control” as a secondary reaction formation strategy for panic disorder patients, who try to deal with their dependency needs that were unmet during childhood. In line with these suggestions, a case example is presented in order to draw a link between the dependency needs, anger towards the parents, the development of reaction formation strategies, and the panic disorder. Ms.B. was a 23 years old female client. Since the first sessions, it was obivous in B’s life how the tasks, responsibilities, and rules were given importance and priority. Being quite restricted in affect, B. frequently reported that she rarely engaged in social interactions and avoided from romantic attempts. In the following sessions, B.’s perfectionism over tasks and her avoidance from social interactions were examined in terms of “strival for control”. Accordingly, the tasks and responsibilities were observed to be the space where B felt having relatively more control; thus she developed an unflexible life pattern in which she dedicated most of her time for her studies and daily organizations. On the other hand, the uncontrollable nature of personal interactions boosted her anxiety. When her anxious state was questioned in more detail, it was observed that what she was most anxious about was being unable to control her emotions, particularly anger. A general anxiety of being unable to control anger was evident in the relationship with her parents and her brother. Accordingly, it was revealed that she repressed her feelings of anger towards her parents for their inability of meeting her dependency needs. It was further observed that she directed her anger towards her brother, with whom she compared herself in terms of coping with the unmet needs. Through these observations, the sessions with B. were conducted aiming at increasing her awareness and developing more adaptive strategies to deal with the dependency needs rather than relying on excessive control mechanisms. It has been reached a consensus that symptomatic improvement per se is not enough for psychotherapeutic interventions and that strategies aiming at relapse prevention are needed. In order to enhance these strategies, it is crucial to understand the mechanisms underlying the disorders. However, regarding the panic disorder, very few is known about the underlying mechanisms. Although the personal histories vary, the case examples are believed to provide important data for the common problems. Hence, it is recommended in further studies to merge these data into a systematic model of underlying mechanisms of panic disorder.