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Panic Disorder: Symptoms, DSM-5 Criteria and Treatment

Picture of Dr. Alexander Sidawi

Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

Panic Disorder

Panic disorder is marked by sudden and unforeseen panic attacks and a significant fear of panic attack recurrence. While panic attacks can be different for each person, they are often characterized as brief yet intense episodes of anxiety associated with a sense of doom and physical symptoms such as shortness of breath, shakes and rapid heartbeat. These episodes can be profoundly distressing, often disrupting day-to-day life. This article delves into the characteristics of panic disorder, referencing DSM-5 criteria for diagnosis, and highlights key information about its prevalence, gender-related trends, onset age, related conditions, and therapeutic strategies.

Characteristics of Panic Disorder

  1. Panic Attacks: Central to panic disorder are panic attacks, characterized by abrupt, intense surges of fear or discomfort peaking within minutes. Symptoms can range from heart palpitations and sweating to chest pain and fears of losing control.

  2. Anticipation Anxiety: A persistent dread of future panic attacks frequently emerges, prompting individuals to avoid places or scenarios linked to past episodes.

  3. Behavioral Adjustments: Panic disorder can lead to significant changes in behavior. Individuals might avoid certain social situations or require constant companionship, especially in settings they perceive as challenging to escape from during a panic attack.

DSM-5 Diagnostic Criteria for Panic Disorder

The DSM-5 defines panic disorder by the following criteria:

  1. Recurrent and unexpected panic attacks: The individual experiences recurrent panic attacks, with the onset of an attack being unpredictable and not tied to specific situations.

  2. At least one of the panic attacks is followed by at least one month (or more) of the following:
    1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack).
    2. Significant maladaptive behavior changes related to the attacks (e.g., avoiding places or activities that may trigger panic attacks).

  3. The panic attacks are not attributable to the direct physiological effects of a substance (e.g., drugs or medications) or another medical condition (e.g., hyperthyroidism).

  4. The panic attacks are not better explained by another mental disorder, such as social anxiety disorder, specific phobia, or post-traumatic stress disorder.

Key Insights into Panic Disorder

  • Prevalence: Panic disorder affects about 2-3% of the U.S. population over a lifetime.
  • Gender Differences: It is twice as prevalent in females.
  • Age of Onset: Commonly begins in late adolescence or early adulthood but can occur at any age.
  • Comorbidities: Often coexists with conditions like agoraphobia, generalized anxiety disorder, and major depressive disorder.
  • Symptom Variability: The frequency and intensity of panic attacks vary widely among individuals, with some experiencing attacks even during sleep.
  • Genetic Factors and Panic Disorder: Research suggests a genetic component in the risk of developing panic disorder, although environmental factors and life experiences are also influential.

How To Treat Panic Disorder

Treatment of Panic Disorder is generally with medications and therapy, though there are various treatment approaches.

One common treatment option is the use of antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). You may know some of these, such as Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), Cymbalta (duloxetine), and Effexor (venlafaxine). These medications may help reduce the frequency and intensity of panic attacks enough to get you back on track and living your life. In some cases, benzodiazepines may be prescribed for short-term use during acute episodes of panic or severe anxiety. However, these medications are generally avoided for long-term use due to the risk of dependence and withdrawal.

Therapy, particularly Cognitive-behavioral therapy (CBT) is an essential component of panic disorder treatment. CBT helps individuals identify and modify negative thought patterns and behaviors associated with panic attacks, thereby reducing the fear and avoidance that can perpetuate the disorder. Other possible psychotherapy interventions may include exposure therapy, acceptance and commitment therapy (ACT), psychodynamic psychotherapy, interpersonal therapy and mindfulness therapy. Panic disorder is a complex mental health condition that can significantly impact an individual’s well-being.

Effective treatment options offer hope and support to those living with panic disorder. If you or someone you know is experiencing symptoms of panic disorder, remember that help is available, and reaching out to a mental health professional is the first step towards healing and managing the condition successfully.