Responses to balance challenges in persons with panic disorder: A pilot study of computerized static and dynamic balance measurements

Introduction: Several studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales. This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD. Methods: Twelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM-A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS). Balance was clinically assessed using the Activities-Specific Balance Confidence (ABC) scale and physically by the Mini-Balance Evaluation Systems Test (Mini-BESTest). Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations. Results: PwPD had higher scores on the HAM-A (17.6 ± 10.3 vs. 3.0 ± 2.9; p <.001), PDSS (11.3 ± 5.1 vs. 0; p <.001), and PAS (20.3 ± 8.7 vs. 0; p <.001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p =.016; Mini-BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p =.014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p <.001). In the static balance tests, PwPD showed a not-significantly smaller ellipse area of center of pressure trajectory (p =.36) and higher body sway velocity (p =.46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p =.018). Conclusion: The computerized balance tests results point to an adoption of a ‘‘postural rigidity’’ strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.