Panic Disorder (DSM-IV-R)
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DIAGNOSTIC CRITERIA FOR PANIC ATTACK

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

 

  1. palpitations, pounding heart, or accelerated heart rate
  2. sweating
  3. trembling or shaking
  4. sensations of shortness of breath or smothering
  5. feeling of choking
  6. chest pain or discomfort
  7. nausea or abdominal distress
  8. feeling dizzy, unsteady, lightheaded, or faint
  9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
  10. fear of losing control or going crazy
  11. fear of dying
  12. paresthesias (numbness or tingling sensations)
  13. chills or hot flashes

 

A Panic Attack has a sudden onset and builds to a peak rapidly (usually 10 minutes or less) and is often accompanied by a sense of imminent danger or impending doom and an urge to escape. Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks.

 

There are three characteristic types of Panic Attacks: unexpected (uncued), situationally bound (cued), and situationally predisposed.  

  •  Unexpected (uncued) Panic Attacks are defined as those for which the individual does not associate onset with an internal or external situational trigger (i.e., the attack is perceived as occurring spontaneously "out of the blue").  
  • Situational (cued) Panic Attacks are defined as thoswe that almost invariably occur immediately on exposure to, or in anticipation of, the situational cue or trigger (e.g., a person with Social Phobia having a Panic Attack upon entering into, or thinking about, a public speaking engagement).
  • Situationally Predisposed Panic Attacks are similar to situationally bound Panic Attacks but are not invariably associated with the cue and do not necessarily occur immediately after the exposure (e.g., the attacks are more likely to occur while driving, but there are times when the individual drives and does not have a Panic Attack or times when the Panic Attack occurs after driving for a half hour).

 

* The occurrence of unexpected Panic Attacks is required for a diagnosis of Panic Disorder.