Panic Disorder Panic disorder is characterized by panic attacks: acute periods, generally lasting about 15 minutes, with intense fear and at least four of the following symptoms (146–152):  Diaphoresis  Trembling
Shortness of breath
A sense of unreality
Fear of going crazy or dying
Chills or hot ﬂashes The attacks can recur with or without specific precipitating events (148). The patient is preoccupied with them and makes behavioral changes she hopes will avert future attacks: avoiding specific situations, assuring herself there is an escape route from certain situations, or refusing to be alone.
The symptoms of panic attacks are often confused with the symptoms of cardiac or pulmonary disease. They lead to many fruitless trips to the emergency department and to costly, even invasive, medical investigations. A careful history can establish the correct diagnosis in most cases (153–155).
Agoraphobia Agoraphobia is the avoidance of situations in which the patient fears she may be trapped, such as the center of a row in the theater or driving over a bridge. She fears that such a situation will trigger anxiety or a panic attack and therefore tends more and more to stay at home or limit her sphere of activity to an increasingly short list of venues. Agoraphobia and panic disorder can occur separately or together (150–154).
Specific Phobias Specific phobias are irrational fears of certain objects or situations, although the patient recognizes that the object or situation poses no real danger. Of particular concern in gynecology are fear of needles and fear of vomiting (150).
Social phobia causes the patient to fear and avoid situations in which the patient anticipates, without rational cause, that she will be perceived in a humiliating light. Such situations include giving a business-related presentation, making an announcement at a meeting, and having a casual dinner with friends. Patients may alter their lives to avoid these anxieties, interfering with their interpersonal relationships and their ability to carry out their responsibilities, or they may manage to carry on despite considerable psychological pain (150).
Obsessive-compulsive disorder (OCD) is characterized by obsessions: recurrent impulses, images, or thoughts that the patient recognizes as her own, but dislikes and cannot control; or compulsions: intrusive, repetitive behaviors that the patient feels she must perform to prevent some dire consequence (155–157). The disorder can be mild or totally crippling; in half of the cases, it becomes chronic. This disorder is classified as an anxiety disorder because the obsessions are anxiety provoking, and the compulsions are performed to avoid overwhelming anxiety. The term OCD has made its way into popular parlance to describe people who focus on petty details and have trouble making up their minds. This is an incorrect use of the term.
Posttraumatic stress disorder (PTSD) is the result of exposure to an event that threatens the life or bodily integrity of the patient or others. At the time of the trauma, the patient experiences horror, terror, or a sense of helplessness. Afterward, the patient may lose conscious memory of all or part of the event, avoid situations reminiscent of it, and become acutely distressed when she cannot avoid them. She feels numb and detached, without a sense of the future. She is hyperarousable and irritable and has difficulty sleeping and concentrating. She re-experiences the event in nightmares, ﬂashbacks, and intrusive thoughts (149).