Definition and Diagnosis
Panic Disorder involves recurrent, unexpected panic attacks — sudden surges of intense fear or discomfort that peak within minutes — followed by at least a month of persistent worry about having more attacks, or a significant change in behavior aimed at avoiding them.
Epidemiology
Panic Disorder affects approximately 2-3% of adults over a 12-month period, with onset typically in late adolescence or early adulthood. It is more common in women and frequently co-occurs with agoraphobia.
Risk Factors
Genetic predisposition, a history of childhood separation anxiety, heightened sensitivity to bodily sensations, and major life stressors all contribute to risk. Smoking and certain respiratory conditions have also been associated with increased likelihood of panic attacks.
Symptoms and Subtypes
Attacks typically involve palpitations, sweating, trembling, shortness of breath, chest discomfort, dizziness, and a fear of losing control or dying. Between attacks, anticipatory anxiety and avoidance of situations associated with prior attacks are common.
Diagnosis
Diagnosis requires ruling out medical causes such as cardiac or thyroid conditions before confirming Panic Disorder through clinical interview against DSM-5-TR criteria. Careful history-taking distinguishes panic attacks that occur in the context of other anxiety disorders from the standalone diagnosis.
Treatment
CBT focused on interoceptive exposure and cognitive restructuring is highly effective, often combined with SSRIs or SNRIs for moderate to severe presentations. Benzodiazepines may be used short-term for acute symptom relief but are generally avoided for long-term management due to dependence risk.
Prognosis
With treatment, most individuals experience a significant reduction in attack frequency and severity. Untreated Panic Disorder can become chronic and lead to substantial avoidance behavior, underscoring the value of early treatment.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).