Panic Disorder Diagnostic Criteria

By Dr. Stephen Antony C, MD (Psychiatry)

Panic disorder can be a disabling condition and put a severe restriction to your activity making your fearful of facing certain situations.

Panic disorder is often difficult to assess when it presents acutely, as many symptoms may also be experienced with physical illness. It is common for patients with panic disorder to present repeatedly to their GP or local emergency department with episodes of repeated worries and multiple symptoms that may appear similar to a life-threatening illness.

Panic disorder is a form of anxiety disorder and it can often co-exist with other anxiety disorders such as agoraphobia. In agoraphobia the individual is extremely frightened of visiting crowded places like the market, sport stadiums, bus stations etc.

Agoraphobia is not a stand-alone diagnosis and it occurs very rarely without panic disorder. Panic disorder is often classified into panic disorder with, or without, agoraphobia and their treatments are indeed readily available which any one can follow it.

Panic disorder can also co-exist with social anxiety. When the patient suffers from social anxiety (s)he often withdraws from social occasions and situations, social activities such as public speaking may cause intense fear. Phobia with social anxiety is diagnosed where the situations avoided are predominantly social and interactive in nature.

The first panic attack may often be associated with some for of stress and the person can identify the source of stress but gradually the attacks become dissociated and occur ‘out of the blue’. Panic disorder is a chronic condition with relapses that lead to much distress and social dysfunction.

Recent research reveals the dysfunction of neuro chemical activity in the rain, a Gamma-aminobutyric acid (GABA) receptor dysfunction is thought to play an important role in panic disorder pathophysiology.

To meet the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) panic disorder diagnostic criteria, the panic attacks must be associated with >1 month’s duration of subsequent, persisting anxiety about recurrence of the attacks, the consequences of the attacks, or significant behavioural changes associated with them.

1. A panic attack is defined as a transient episode of intense subjective fear, where at least 4 out of 13 characteristic symptomatic manifestations, listed below, arise rapidly and peak within 10 minutes of the onset of the attack:
2. Attacks usually last at least 10 minutes but their duration is variable.
3. The symptoms must not arise as a result of alcohol or substance misuse, medical conditions or other psychiatric disorders, in order to satisfy the diagnostic criteria.

Characteristic symptoms experienced during panic attacks:

Panic disorder manifests as the sudden, spontaneous and unanticipated occurrence of panic attacks, with variable frequency, from several in a day to just a few per year:

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