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Hyperventilation or over-breathing is often a key component in anxiety and panic disorders, and also in the condition known as dysfunctional breathing/hyperventilation syndrome. This paper examines the role of breathing retraining in these conditions and provides a case study on the subject.
Generalised anxiety disorder is a common condition characterised by excessive anxiety and worry which is out of proportion to the event or the circumstance that is the focus of the woMrry.
Panic disorder is a condition that causes repeated unexpected attacks of intense fear or panic attacks. Generalised anxiety disorder, panic disorder and a condition known as dysfunctional breathing/hyperventilation syndrome (DB/HVS) share many similarities, but are generally viewed as separate conditions.
According to one estimate, approximately 50% of patients with panic disorder manifest hyperventilation as a symptom, and an estimated 25% of patients with DB/HVS also manifest panic disorder (Kern, 2014).
However, the incidence of hyperventilation preceding or during panic attacks is arguable, because of the difficulty of monitoring real-life panic attacks (Meuret & Ritz, 2010). For the purposes of this article, DB/HVS will be referred to as hyperventilation syndrome (HVS).
Hyperventilation syndrome
HVS is a respiratory disorder, which may be psychologically or physiologically based. In HVS, erratic breathing patterns such as breath-holding, sighing and yawning may be seen and the patient may complain of "air hunger," difficulty in breathing or shortness of breath.
HVS can result in significant patient morbidity and may contribute to several symptoms including dyspnoea, breathlessness, chest tightness, dizziness, tremor, faintness, apprehension and paraesthesia (Jones et al. 2013).
Paradoxically, HVS may also present with numerous symptoms including respiratory, cardiac, neurologic, or gastrointestinal but without any obvious or apparent hyperventilation. Dysfunctional or disordered breathing patterns in adults may be subtle and are not always evident (see table) and patients with chronic hyperventilation may undergo extensive testing in an attempt to discover organic causes of their complaints. Hypocapnoea or decreased carbon dioxide (CO2) levels due to excessive exhalation of CO2 seen in hyperventilation may be present without any obvious change in breathing volume if the patient exhibits frequent sighs interspersed with normal respirations (Kern, 2014). Respiratory physician and pioneer on hyperventilation research, the late Dr Claude Lum, maintained that chronic hyperventilation was not always evident and in fact, he referred...