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Fear and panic in humans with bilateral amygdala damage


Decades of research have highlighted the amygdala's influential role in fear. We found that inhalation of 35% CO2 evoked not only fear, but also panic attacks, in three rare patients with bilateral amygdala damage. These results indicate that the amygdala is not required for fear and panic, and make an important distinction between fear triggered by external threats from the environment versus fear triggered internally by CO2.

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Figure 1: Panic attack rate and self-reported levels of fear and panic during the first CO2 inhalation.
Figure 2: CO2-evoked physiological changes.
Figure 3: Anticipatory physiological responses before inhalation.


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We thank A. Wunsch for technical support and M. Coryell and J. Potash for critically reading this manuscript. C.B. was supported by a Doris Duke Clinical Research Fellowship. D.T. was supported by the National Institute of Neurological Disorders and Stroke (P50 NS19632). J.A.W. was supported by the Department of Veterans Affairs (Merit Award), the National Institutes of Mental Health (5RO1MH085724) and a McKnight Neuroscience of Brain Disorders Award. R.H. was supported by a Starting Independent Researcher Grant (NEMO—Neuromodulation of Emotion) jointly provided by the Ministry of Innovation, Science, Research and Technology of the German State of North Rhine-Westphalia (MIWFT) and the University of Bonn. M.J.W. receives funding from the Howard Hughes Medical Institute.

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J.A.W., M.J.W., J.S.F., R.L.F., D.T., W.H.C. and N.S.D. conceived and planned the experiments. J.A.W., D.T., R.H. and W.H.C. provided financial support, equipment and supplies. J.A.W., C.B., J.S.F., R.L.F., R.H. and N.S.D. recruited participants and performed the experiments. J.A.W., C.B., M.J.W., J.S.F., R.H., D.T., R.L.F., W.H.C. and N.S.D. wrote and edited the manuscript and figures.

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Correspondence to Daniel Tranel or John A Wemmie.

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The authors declare no competing financial interests.

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Supplementary Figures 1–3, Supplementary Table 1, Supplementary Panic Descriptions (PDF 2975 kb)

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Feinstein, J., Buzza, C., Hurlemann, R. et al. Fear and panic in humans with bilateral amygdala damage. Nat Neurosci 16, 270–272 (2013).

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