Panic Disorder Diagnosis

Aka: Panic Disorder Diagnosis, Panic Symptoms

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II. Diagnosis (DSM 5, 300.01, F41.0)

  1. See Patient Health Questionnaire for Panic Disorder (PHQ-PD)
  2. Recurrent unexpected Panic Attacks
    1. Discrete episode of intense fear or discomfort with a strong sympathetic response
    2. Symptoms peak within minutes (e.g. 10 minutes)
    3. Four or more symptoms (see below)
      1. Does NOT include culture specific symptoms (e.g. Tinnitus, Neck Pain, Headache, uncontrolled crying)
  3. Consequences of attacks (either or both for at least 1 month)
    1. Persistent worry about future attacks or consequences
    2. Maladaptive behavior changes (e.g. avoiding unfamiliar situations)
  4. No identified alternative medical causes (e.g. Hyperthyroidism) or substance adverse effects
    1. See Anxiety Secondary Causes
  5. No other dominant or more specific psychiatric condition to explain the symptoms
    1. Social Anxiety Disorder
    2. Specific Phobias
    3. Obsessive Compulsive Disorder
    4. Posttraumatic Stress Disorder
    5. Separation Anxiety Disorder
  6. Identify whether avoidance behaviors are present
    1. Panic Disorder with Agoraphobia
    2. Panic Disorder without Agoraphobia

III. Symptoms: Criteria for Panic Disorder (4 or more required for diagnosis)

  1. Generalized
    1. Diaphoresis
    2. Chills or Hot Flushes
  2. Respiratory
    1. Shortness of Breath or smothering
    2. Sensation of Choking
  3. Cardiovascular
    1. Chest Pain or discomfort
    2. Palpitations, heart pounding or Tachycardia
  4. Gastrointestinal
    1. Nausea or Abdominal distress
  5. Neurologic
    1. Dizzy, light-headed, unsteady or faint feeling
    2. Paresthesias
    3. Trembling or shaking
  6. Psychologic
    1. Sensation of foreboding: dying or heart attack
    2. Fear or losing control or going crazy
    3. Feelings of unreality (derealization) or being detached from oneself (depersonalization)

IV. References

  1. APA (2014) DSM 5, APA, p. 208-9
  2. Starr (November, 1998) Patient Care
  3. DeGeorge (2022) Am Fam Physician 106(2): 157-64 [PubMed]
  4. Katerndahl (1997) Postgrad Med, 101(1): 147-66 [PubMed]
  5. Katerndahl (1996) J Fam Pract, 43(3): 275-82 [PubMed]
  6. Rubin (1996) Phys Sportsmed, 24(12):54-65 [PubMed]
  7. Saeed (1998) Am Fam Physician, 57(10):2405-12 [PubMed]
  8. Weinstein (1995) Am Fam Physician, 52(7):2055-63 [PubMed]

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