DSM-III—the Diagnostic and Statistical Manual of the American Psychiatric Association—contains some 150 disorders. The newly revised edition contains even more. Neither volume includes the hyperventilation syndrome, the subject of this monograph.
The author, Robert Fried, is unhappy about this. He points out that anxious people hyperventilate. Hyperventilation causes anxiety. This is so well known, he believes, that omitting the hyperventilation syndrome is incomprehensible.
DSM-III did not overlook breathing. It frequently uses words like "dyspnea," "smothering sensations," or "sighing." Dyspnea, in fact, is the first symptom listed in connection with panic disorder. What bothers the author is that hyperventilation was not only ignored as a syndrome but not even mentioned in the index.
Should it have been? There is no question that breathing is almost always affected by anxiety. If this takes the form of hyperventilation, the result is reduced blood CO2 level and alkalosis. These in turn produce