teria for a panic attack) may be a risk factor for later panic attacks and panic disorder.
Although separation anxiety in childhood, espe cially when severe, may precede the later
development of panic disorder, it is not a consistent risk factor. 
Environmental. Reports of childhood experiences of  sexual and physical abuse are more
common in panic disorder than in certain othe r anxiety disorders. Smoking is a risk factor
for panic attacks and panic disorder. Most individuals report identifiable stressors in the
months before their first panic attack (e.g., interpersonal stressors and stressors related to
physical well-being, such as negative experiences with illicit or prescription drugs, dis-
ease, or death in the family). 
Genetic and physiological. It is believed that multiple genes confer vulnerability to panic
disorder. However, the exact genes, gene prod ucts, or functions related to the genetic re-
gions implicated remain unknown. Current ne ural systems models for panic disorder em-
phasize the amygdala and related structures, mu ch as in other anxiety disorders. There is
an increased risk for panic d isorder among offspring of pare nts with anxiety, depressive,
and bipolar disorders. Respiratory disturbance, such as asthma, is associated with panic
disorder, in terms of past history, comorbidity, and family history. 
Culture-Related Diagnostic Issues 
The rate of fears about mental and somatic symptoms of anxiety ap pears to vary across
cultures and may influence the rate of panic attacks and panic disorder. Also, cultural ex-
pectations may influence the classification of panic attacks as expected or unexpected. For
example, a Vietnamese individual who has a panic attack after walking out into a windy
environment ( trúng gió;  “hit by the wind”) may attribut e the panic attack to exposure to