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Panic Attack


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Panic Disorder Diagnosis Page #1 

panic attackPanic Disorder diagnosis overview: 

A panic disorder diagnosis is characterized by recurrent and unexpected panic attacks. At least one of these attacks must be followed by (1) persisting concern for additional attacks for at least a month, (2) worry about the implications or consequences of the panic attack, or (3) changes in your typical behavior patterns as a result of the attack, such as avoidance of school or work activities.  In addition, the panic attacks cannot come from the direct effects of illicit substance use, medication, or some other type of general medical condition.  Also, the panic attacks cannot be better explained by another mental disorder such as a social phobia.  Additionally, when the criterion for panic disorder is also accompanied by agoraphobia you may also have what is defined as a panic disorder diagnosis with agoraphobia. 


Panic attacks are an important feature of panic disorder and in combination with agoraphobia (i.e. being in a position not easily escaped from or where help is not easily accessible if panic occurs) are important to a panic disorder diagnosis with agoraphobia, the criteria for panic attacks and for agoraphobia stand alone.  An accurate diagnosis is very difficult without an understanding of these features.  The criteria for panic attacks can be quite difficult to understand at times while the criteria for agoraphobia are generally straightforward. 

Researchers have found that people frequently report what they believe to be a panic attack during or in conjunction with a perceived actual physical threat.  It is important however to distinguish between an actual threat and between a fear reaction in the absence of a “real danger”. These attacks involve an occurrence of intense fear and discomfort accompanied by a minimum of 4 of the 13 symptoms identified in the diagnostic criteria for a panic attack.  Diagnostic manuals recognize three characteristic types of panic attacks, including those that are situationally bound, those that are unexpected and those that are situationally predisposed (those that occur when exposed to situational triggers or when anticipating it. A limited symptom attack is a term that is sometimes used to refer to panic-like episodes which involve fewer than four symptoms. 

While unexpected panic attacks are required for a diagnosis of panic disorder, not all panic attacks are unexpected.  Unexpected attacks can wax and wane over the course of the disorder and overtime they seem to become situationally bound or predisposed.  Also, situationally bound or predisposed panic attacks can co-occur with other disorders such as depression or all of the other anxiety disorders.  However, in order to get a clear understanding of the distinction between the different types of panic attacks in order to have a differential diagnosis, you must consider the characteristics of panic including frequency of attacks, duration of attacks, number and intensity of symptoms, mechanisms responsible for termination of the attack and the nature of catastrophic thinking. An understanding of these features is important in identifying, exacerbating and controlling the various factors related to the attacks.

Information adapted from DSM-IV-TR Mental Disorders Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman

Webpage and additional information By Paul Susic MA Licensed Psychologist Ph.D Candidate 

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