Panic disorder (PD) is a clinical entity which complexity can be organized in a “march of panic” whose organizing psychopathological principle is represented by the unexpected panic attacks. Panic phenomenology is defined not only by full blown and limited symptoms panic attacks but also by aborted panic attacks and shadows of panic. All together these phenomena are the expression of the psychobiological mechanisms abnormally activated in PD. The target of psychopharmacological treatment should be focused on panic phenomenology while the only effective psychotherapeutic intervention, cognitive behavioral therapy, should correct the cognitive distortions and the avoidant and protective behaviors that limit panic patient’s freedom. A complete therapeutic approach should include also regular aerobic exercise and evidence based breathing therapy. Often the chronicization of PD is the results of mistakes in the diagnostic and therapeutic processes rather than a true treatment resistance.
