*Panic Disorder

DSM-5 Criteria for Panic Disorder

• Panic Disorder

  • A. Recurrent unexpected panic attacks.

  • Definition of Panic Attack:

    • An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.

    • During this period, 4 (or more) of the following symptoms must appear:

    1. Palpitations, pounding heart, or accelerated heart rate.

    2. Sweating.

    3. Trembling or shaking.

    4. Shortness of breath.

    5. Feeling of choking.

    6. Chest pain or discomfort.

    7. Nausea or abdominal distress.

    8. Feeling dizzy, faint, or light-headed.

    9. Chills or heat sensations.

    10. Paresthesias (numbness or tingling sensations).

    11. De-realization or depersonalization.

    12. Fear of losing control.

    13. Fear of dying.

  • B. At least one of the attacks has been followed by 1 month (or more) of one of the following:

  1. Persistent worry or concern about additional panic attacks.

  2. A significant maladaptive change in behavior related to attacks.

  • C. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

  • D. The disturbance is not better explained by another disorder.

Additional Characteristics of Panic Disorder

• Symptoms:

  • Unexpected panic attacks must include at least 4 physiological or emotional symptoms.

  • Fear of having another attack must persist for at least 1 month.

• Association with Agoraphobia:

  • Approximately 40% of individuals with Panic Disorder may develop agoraphobia, which is characterized by fear or anxiety regarding at least 2 out of the following 5 situations:

  1. Using public transportation.

  2. Being in open spaces.

  3. Being in enclosed spaces.

  4. Standing in line or being in a crowd.

  5. Being outside of home alone.

  • This fear is linked to the thought that escape may be difficult in the event of a panic attack.

  • The fear must be persistent for at least 6 months.

Psychological Contributions

• Coping Mechanisms:

  • Some individuals may use drugs or alcohol as a means of coping with panic attacks.

• Nocturnal Panic:

  • About 60% of individuals with Panic Disorder experience nocturnal panic attacks, which can start when individuals sink into a deep sleep (delta wave stage).

  • The frequency of these events may vary, with occurrences described as occurring once per week for months to every day with months in between.

• Anxiety About Future Attacks:

  • Individuals may become vulnerable to developing anxiety over the possibility of having another panic attack.

  • Physical sensations associated with panic attacks can be misinterpreted as life-threatening.

• Interoceptive Avoidance:

  • To avoid feeling anxious, individuals with Panic Disorder may display interoceptive avoidance, which is the avoidance of internal physical sensations.

  • This can manifest as removing oneself from situations or activities that may produce physiological arousal resembling the onset of a panic attack.