Psychological Disorders: Panic Disorder

American Description
A. Recurrent unexpected Panic Attacks
Criteria for Panic Attack:
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
palpitations, pounding heart, or accelerated heart rate
sweating
trembling or shaking
sensations of shortness of breath or smothering
feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
derealization (feelings of unreality) or depersonalization (being detached from oneself)
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling sensations)
chills or hot flushes

B. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
persistent concern about having additional attacks
worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
a significant change in behavior related to the attacks

C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

European Description
The essential features are recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set of circumstances, and which are therefore unpredictable. As in other anxiety disorders, the dominant symptoms vary from person to person, but sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization) are common. There is also, almost invariably, a secondary fear of dying, losing control, or going mad. Individual attacks usually last for minutes only, though sometimes longer; their frequency and the course of the disorder are both rather variable. An individual in a panic attack often experiences a crescendo of fear and autonomic symptoms which results in an exit, usually hurried, from wherever he or she may be. If this occurs in a specific situation, such as on a bus or in a crowd, the patient may subsequently avoid that situation. Similarly, frequent and unpredictable panic attacks produce fear of being alone or going into public places. A panic attack is often followed by a persistent fear of having another attack.

Diagnostic Guidelines
In this classification, a panic attack that occurs in an established phobic situation is regarded as an expression of the severity of the phobia, which should be given diagnostic precedence. Panic disorder should be the main diagnosis only in the absence of any of the phobias in F40.

For a definite diagnosis, several severe attacks of autonomic anxiety should have occurred within a period of about 1 month:

(a) in circumstances where there is no objective danger;
(b) without being confined to known or predictable situations; and
(c) with comparative freedom from anxiety symptoms between attacks (although anticipatory anxiety is common).

Includes:
* panic attack
* panic state

Differential Diagnosis
Panic disorder must be distinguished from panic attacks occurring as part of established phobic disorders as already noted. Panic attacks may be secondary to depressive disorders, particularly in men, and if the criteria for a depressive disorder are fulfilled at the same time, the panic disorder should not be given as the main diagnosis.