Internal threats to our bodies trigger different fear system from external threats.

A large volume of work has documented the amygdala's role in fear, and now Feinstein et al. present a surprising finding that carbon dioxide inhalation evokes fear and panic in three patients with bilateral amygdala damage (who feel no fear from external threats). These results indicate that the amygdala is not required for fear triggered internally rather than by external threats.  Here is the abstract:

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.

Why do these 'fearless' patients feel fear when CO₂ levels in their blood are increased? The authors suggest:

...that all of these other stimuli were exteroceptive in nature, mainly processed through visual and auditory pathways that project to the amygdala. In contrast, CO₂ acts internally at acid-activated chemoreceptors and causes an array of physiological changes. Thus, CO₂ might engage interoceptive afferent sensory pathways that project to the brainstem, diencephalon and insular cortex. In addition, many brain areas outside the amygdala possess CO2 and pH-sensitive chemoreceptors, including acid-sensing ion channels. Thus, CO₂ may directly activate extra-amygdalar brain structures that underlie fear and panic, which may help to explain the apparent discrepancy between these findings and previous work in mice. In either case, our results indicate that, in humans, the internal threat signaled by CO₂ is detected and interpreted as fear and panic despite the absence of an intact amygdala.