Criteria

Diagnostic and statistical manual of mental disorders: 5th edition, text revision (DSM-5-TR)[1]

A diagnosis of panic disorder is based on the experience of recurring, unexpected panic attacks. At least one of these attacks has been followed by a 1-month period in which the individual worries about having additional attacks or their implications (e.g., having a heart attack), and/or the individual has changed his or her behavior in a maladaptive way (e.g., avoiding situations that may provoke panic sensations). The person may go on to experience varying frequencies and intensities of expected and unexpected panic attacks.

Panic attacks are characterized by an abrupt surge of intense fear or physical discomfort, reaching a peak within a few minutes, in which at least 4 of the following 13 symptoms are present:

  • Palpitations, pounding heart, or accelerated heart rate

  • Sweating

  • Trembling or shaking

  • Sensations of shortness of breath or smothering

  • Feelings of choking

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Feeling dizzy, unsteady, light-headed or faint

  • Chills or heat sensations

  • Paresthesias (numbness or tingling sensations)

  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)

  • Fears of losing control or "going crazy"

  • Fear of dying.

In order to meet diagnostic criteria for panic disorder, the symptoms must not be attributable to substance-related effects (e.g., drug of misuse or medication), other medical conditions (e.g., hyperthyroidism, cardiopulmonary disorders), or other psychiatric disorders (e.g., social anxiety disorder, specific phobias, obsessive compulsive disorder, posttraumatic stress disorder, separation anxiety disorder, or illness anxiety disorder).

Panic attacks are not an independently coded condition, but may be listed as a specifier to any other DSM-5-TR disorder and are particularly common for patients with anxiety, mood, and substance-related disorders.

In DSM-5-TR, agoraphobia is considered its own disorder, frequently comorbid but independent of panic disorder. Agoraphobia is characterized by marked fear or anxiety in 2 or more situations and associated fear or avoidance of these situations because of thoughts that escape might be difficult, or that help might not be available in the event of developing panic-like symptoms, or other incapacitating or embarrassing symptoms.

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