Panic Disorder

Panic Disorder is characterized by having had recurrent panic attacks and then developing intense fear of having another panic attack or unhelpful (maladaptive) behaviors to avoid experiencing the distress of a panic attack. 

While many people will have a panic attack at some point in their lives, it’s the ongoing fear and behavioral changes that define panic disorder. 

Panic disorder used to be linked with agoraphobia, where a person fears and avoids going out into public spaces where panic symptoms may occur, but these 2 conditions are now diagnosed separately. 

Panic Disorder tends to emerge in late adolescence or early adulthood.  It often presents as somatic symptoms of distress such shortness of breath, tachycardia, dizziness, or parasthesias.

Symptoms

Panic attack: an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and during which 4+ of the following occur:

  • Palpitations, pounding heart
  • Sweating
  • Trembling/shaking
  • SOB/smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Dizziness/light-headed
  • Chills or heat
  • Paresthesias
  • Derealization/depersonalization
  • Fear of losing control or “going crazy”
  • Fear of dying

DSM-5 Criteria

The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

  • Palpitations or quickened heartbeat
  • Abnormal sweating
  • Trembling or shaking
  • Instances of shortness of breath or feeling smothered
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal pain
  • Dizziness or faintness
  • Chills or hot flashes
  • Numbness or tingling sensations
  • Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of death

One or more of the attacks were followed by a month (or longer) of one or both of the following:

  • Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
  • A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC

Disorder-specific treatment strategies

Panic Disorder is best treated with Cognitive Behavioral Therapy (CBT) with or without a selective serotonin reuptake inhibitor (SSRI).  The CBT focus in treatment of Panic Disorder often involves exposure to, and learning tolerance of, interoceptive stimuli like an increased heart rate or dizziness.