Physiological recordings of naturally occurring panic attacks in individuals with panic disorder indicate abrupt surges of arousal, usually of heart rate, that reach a peak within minutes and subside within minutes, and for a proportion of these individuals the panic attack may be preceded by cardiorespiratory instabilities.
Functional Consequences of Panic Attacks
In the context of\co-occurring mental disorders, including anxiety disorders, depressive disorders, bipolar disorder, substance use disorders, psychotic disorders, and personality disorders, panic attacks are associated with increased symptom severity, higher rates of comorbidity and suicidality, and poorer treatment response. Also, full-symptom panic at- tacks typically are associated with greater morbidity (e.g., greater health care utilization, more disability, poorer quality of life) than limited—symptom attacks.
Other paroxysmal episodes (e.g., “anger attacks”). Panic attacks should not be diag- nosed if the episodes do not involve the essential feature of an abrupt surge of intense fear or intense discomfort, but rather other emotional states (e.g., anger, grief).
Anxiety disorder due to another medical condition. Medical conditions that can cause or be misdiagnosed as panic attacks include hyperthyroidism, hyperparathyroidism, pheo- chromocytoma, vestibular dysfunctions, seizure disorders, and cardiopulmonary con- ditions (e.g., arrhythmias, supraventricular tachycardia, asthma, chronic obstructive pulmonary disease). Appropriate laboratory tests (e.g., serum calcium levels for hyperpara- thyroidism; Holter monitor for arrhythmias) or physical examinations (e.g., for cardiac con- ditions) may be helpful in determining the etiological role of another medical condition.
Substance/medication-induced anxiety disorder. Intoxication with central nervous system stimulants (e.g., cocaine, amphetamines, caffeine) or cannabis and withdrawal from central nervous system depressants (e.g., alcohol, barbiturates) can precipitate a panic attack. A detailed history should be taken to determine if the individual had panic attacks prior to excessive substance use. Features such as onset after age 45 years or the presence of atypical symptoms during a panic attack (e.g., vertigo, loss of consciousness, loss of bladder or bowel control, slurred speech, or amnesia) suggest the possibility that a medical condition or a substance may be causing the panic attack symptoms.
Panic disorder. Repeated unexpected panic attacks are required but are not sufficient for the diagnosis of panic disorder (i.e., full diagnostic criteria for panic disorder must be met).
Panic attacks are associated with increased likelihood of various comorbid mental dis- orders, including anxiety disorders, depressive disorders, bipolar disorders, impulse- control disorders, and substance use disorders. Panic attacks are associated with increased likelihood of later developing anxiety disorders, depressive disorders, bipolar disorders, and possibly other disorders.
Diagnostic Criteria 300.22 (F40.00)
A. Marked tear or anxiety about two (or more) of the following five situations:
Using public transportation (e.g., automobiles, buses, trains, ships, planes).
Being in open spaces (e.g., parking lots, marketplaces, bridges).
Being in enclosed places (e.g., shops, theaters, cinemas).
Standing in line or being in a crowd.
5. Being outside of the home alone.
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B. The individual tears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symp- toms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the el- derly; fear of incontinence).
C. The agoraphobic situations almost always provoke fear or anxiety.